Vaginal Douching - Is It Really Beneficial?

What is Vaginal Douching?

‘Douche’ means to soak or rinse. Vaginal douching is the process of irrigating the vagina with a liquid apparently to clean it for hygienic reasons, after menstruation or intercourse, and to prevent or treat infection or bad odor.

Most douches dispensed in health stores are pre-packaged mixtures of water and vinegar, iodine or baking soda. The mixtures usually come in a bottle or douche bag and are squirted up the vaginal passage through a nozzle or tube. The water mixture then flows back out through the vagina.

Douching differs from washing the outside of your vagina during a bath or shower. Rinsing the outside of your vagina with warm water will not harm the vagina. However, douching can lead to several complications.

What is the Prevalence of Douching?

The exact statistics for vaginal douching are not available and some studies have suggested the worldwide prevalence of this practice could vary between 32-76%.

Overall the incidence in the West seems to be on the decline, though studies in the US suggest that the practice is fairly common among American Black and Hispanic women, and to a lesser degree in American White women. There have been reports that the practice in adolescents could vary between 52-69% in the United States.

Vaginal douching is also a fairly common practice in African countries and in Turkey, with some African countries reporting a prevalence of over 90 percent.

Sporadic douching appears to be more common than regular douching and the frequency of douching has a bearing on the adverse effects related to douching.

Vaginal douching has been found to be associated with poverty, low level of education and multiple sexual partners though a causal relationship has not been established.

How does Vaginal Douching Cause Disease?

I. Douching disrupts the Normal Vaginal Flora

The predominant organism found in the normal healthy vagina is lactobacillus which produces lactic acid and contributes to the normal acidic pH of the vagina of about 4.5.

• This acidic pH ensures that the potential pathogens that reside in the vagina do not proliferate.
• The lactobacilli produce hydrogen peroxide which again prevent overgrowth of pathogens.
• The lactobacilli also bind to the epithelial cells in the vagina thereby preventing pathogens from binding to the epithelial cells, gaining entry into the cells and causing disease.

Douching can alter the normal vaginal bacterial flora and cause overgrowth of pathogens leading to infection and disease. The overall recommendation therefore is that douching is not a safe practice and often does more harm than good. Pregnant women, especially, should be educated about the dangers of vaginal douching.

Diseases and Conditions that may be Associated With Regular Vaginal Douching

• Bacterial vaginosis – A condition associated with foul smelling discharge from the vagina
• Sexually transmitted diseases (STD) such as chlamydia, gonorrhea that can cause pelvic infection leading to tubal scarring and infertility
• Pelvic inflammatory disease caused by anaerobic and/or facultative bacteria associated with vaginosis in addition to STD mentioned above
• Increased incidence of ectopic pregnancy
• Human immunodeficiency virus (HIV) infection – The normal acidic vaginal pH can at least partially inactivate the virus and douching may therefore increase the susceptibility of the woman to HIV infection
• Unclear association with cervical cancer with varying reports
• Vaginal dryness and irritation

II. Douching provides a high pressure liquid stream which may actually promote infection in the vaginal passage to ascend into the uterus and pelvis causing pelvic inflammatory disease and related complications such as infertility.

III. Adolescents are more susceptible to bacterial and viral sexually transmitted infections and cancer due to the cellular structure of their vaginal and cervical lining. They should therefore be educated and cautioned about the potential adverse effects of vaginal douching in causing genital infections and cancer.

Factors that Influence the Adverse Effects of Douching

Many factors affect the outcome of douching including frequency of douching, pregnancy, adolescence, and the phase of the menstrual cycle.

For example, the risk of ascending infection is highest during ovulation when the cervical os is open and the cervical mucus is thin.

Which are the Rare Instances Where Vaginal Douching May Be Considered Beneficial?

There are occasional instances when douching is recommended since it may have some beneficial effects in these situations. These include the following:

• Intrapartum vaginal antiseptic lavage with 0.2-0.4% chlorhexidine might reduce or prevent transmission of vaginal organisms from the mother to the child during delivery including HIV. This is a however, a onetime phenomenon and a completely different irrigation event than repetitive vaginal douching.
• There are conflicting reports that suggest that douching in symptomatic women with vaginitis or bacterial vaginosis may have some utility.

Overall however, there is universal agreement that repeated douching is harmful, more so during pregnancy and adolescence.

Need for Better Education about the Ill-Effects of Douching

Although several studies agree that vaginal douching is a harmful practice, douching solutions continue to be widely available over the counter as ‘feminine hygiene products’. These products often do not carry information about the potential ill effects of vaginal douching.

The need of the hour is spreading the message about the avoidance of regular and unsupervised vaginal douching unless specifically recommended by the doctor. It should be made mandatory for companies making douching agents to mention the possible side effects of douching within the pack.

More research is required to develop probiotic vaginal treatments that restore and maintain the normal vaginal flora. Women who continue to douche may be advised to use these probiotic agents to balance or counter the ill-effects of douching.