Associations between Vaginal Douching Practice and Lower Genital Tract Symptoms and Menstrual Disorders among Young Women: A Search for Risk Modulating Factors

Abstract

This study assessed the associations between vaginal douching practice and the adverse reproductive tract outcomes, and the risk modulating factors among young women. The data source was a cross-sectional population based sample of 1488 women aged 18-35 years in a university community. Self-administered socio-demographic and female genital hygiene practices questionnaire were used to survey the participants. The overall prevalence of vaginal douching was 79.8%. Pelvic pain, vaginal itching, and vaginal discharge were significantly associated with higher odds for douching. Moreover, participants with menstrual disorders such as menorrhagia, oligomenorrhea, and inter-menstrual bleeding douche more often than those without these disorders. Early-onset, higher-frequency, and prolonged douching, as well as douching with commercial vaginal deodorant and inserting the nozzle of the douching tube inside the vagina were associated with higher rate of pelvic and menstrual disorders. The present study revealed a paradoxical relation between vaginal douching and adverse reproductive tract disorders, which supports the hypothesis of confounding by indication. The direction of the association is dependent on several modifiable and unmodifiable risk factors.

Share and Cite:

C. E. Ekpenyong and K. G. Davies, "Associations between Vaginal Douching Practice and Lower Genital Tract Symptoms and Menstrual Disorders among Young Women: A Search for Risk Modulating Factors," Advances in Sexual Medicine, Vol. 3 No. 4, 2013, pp. 76-84. doi: 10.4236/asm.2013.34012.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] D. M. Rein, W. J. Kassler, K. L. Irwin and L. Rabiee, “Direct Medical Cost of Pelvic Inflammatory Disease and Its Sequelae Decreasing, but Still Substantial,” Obstetrics and Gynecology, Vol. 95, No. 3, 2000, pp. 397-402. doi:10.1016/S0029-7844(99)00551-7
[2] M. X. Dawood, “Non-Steroidal Anti-Inflammatory Drugs and Changing Attitudes towards Dysmenorrhea,” American Journal of Medicine, Vol. 84, No. 5, 1988, pp. 23-29. doi:10.1016/0002-9343(88)90473-1
[3] A. K. Chappel, M. Hassell, M. Nicolson and J. Cantrill, “You Don’t Really Feel You Can Function Normally: Women’s Perception and Personal Management of Vaginal Thrush,” Journal of Reproduction and Infant Psychology, Vol. 18, No. 4, 2000, pp. 309-319. doi:10.1080/713683045
[4] R. L. Sweet, “Gynecologic Conditions and Bacterial Vaginosis: Implications for the Non-Pregnant Patient,” Infectious Diseases in Gynecology, Vol. 8, No. 3-4, 2000, pp. 184-190.
[5] M. R. Chacko, C. A. Kozaine, M. Regard and P. B. Smith, “The Relationship between Vaginal Douching and Vaginal Infection in Young Women,” Journal of Pediatric and Adolescent Gynecology, Vol. 5, No. 3, 1992, pp. 171-176.
[6] B. O. Wang, X. Li, B. Stanton, H. Yang, X. Fang, R. Zhao, et al., “Vaginal Douching, Condom Use and Sexual Transmitted Infections among Chinese Sex Workers,” Sexually Transmitted Diseases, Vol. 32, No. 11, 2005, pp. 696-702. doi:10.1097/01.olq.0000175403.68410.ec
[7] D. Scholes, J. R. Daling, A. Stergachis, N. S. Weiss, S. P. Wang and J. T. Grayston, “Vaginal Douching as a Risk Factor for Acute Pelvic Inflammatory Disease,” Obstetrics and Gynecology, Vol. 81, No. 4, 1993, pp. 601-606.
[8] D. D. Baird, C. R. Weinberg, L. F. Volgt and J. R. Daling, “Vaginal Douching and Reduced Fertility,” American Journal of Public Health, Vol. 86, No. 6, 1996, pp. 844-850. doi:10.2105/AJPH.86.6.844
[9] J. Zhang, A. G. Thomas and E. Leybovich, “Vaginal Douching and Adverse Health Effect: A Meta-Analysis,” American Journal of Public Health, Vol. 87, No. 7, 1997, pp. 1207-1211. doi:10.2105/AJPH.87.7.1207
[10] J. L. Martino and S. H. Vermund, “Vaginal Douching: Evidence for Risk or Benefits to Women’s Health,” Epidemiology Review, Vol. 24, No. 2, 2002, pp. 109-124. doi:10.1093/epirev/mxf004
[11] J. C. Abma, A. Chandra, W. D. Mosher, L. Peterson and L. Piccino, “Fertility, Family Planning and Women’s Health: New Data from 1995 National Survey of Family Growth,” Vital Health Statistics, Series 23, National Center for Health Statistics, Washington DC, 1997, 114p.
[12] D. Sunay, E. Kaya and Y. Ergun, “Vaginal Douching Behavior of Women and Relationship among Vaginal Douching and Vaginal Discharge and Demographic Factors,” Journal of Turkish Society of Obstetrics and Gynecology, Vol. 8, No. 4, 2011, pp. 264-271. doi:10.5505/tjod.2011.57805
[13] R. B. Ness, S. L. Hiller, K. E. Kip, H. E. Richter, D. E. Soper, C. A. Stamm, et al., “Douching, Pelvic Inflammatory Diseases, and Incident Gonococcal and Chlamydial Genital Infection in a Cohort of High Risk Women,” American Journal of Epidemiology, Vol. 161, No. 2, 2005, pp. 186-195. doi:10.1093/aje/kwi025
[14] G. Gresenguet, J. K. Kreiss, M. K. Chapko, S. L. Hillier and N. S. Weiss, “HIV Infection and Vaginal Douching in Central Africa,” AIDS, Vol. 11, No. 1, 1997, pp. 101-106. doi:10.1097/00002030-199701000-00015
[15] C. Tevi-Benissan, L. Belec, M. Levy, V. Schnieder-Fauveau, A. S. Mohamed, M. C. Hallouin, et al., “In Vivo Semen-Associated pH Neutralization of Cervicovaginal Secretions,” Clinical and Diagnostic Laboratory Immunology, Vol. 4, No. 3, 1997, pp. 367-374.
[16] S. I. Pavlova and L. Tao, “In Vitro Inhibition of Commercial Douche Products against Vaginal Microflora,” Infectious Diseases in Obstetrics and Gynecology, Vol. 8, No. 2, 2000, pp. 99-104.
[17] M. K. Oh, J. S. Merchant and P. Brown, “Douching Behavior in High-Risk Adolescents. What Do They Use, When and Why Do They Douche?” Journal of Pediatric and Adolescent Gynecology, Vol. 15, No. 2, 2002, pp. 83-85. doi:10.1016/S1083-3188(01)00148-6
[18] M. K. Oh, E. Funkhouser, T. Simpson, P. Brown and J. Merchant, “Early Onset of Vaginal Douching Is Associated with False Beliefs and High-Risk Behavior,” Sexually Transmitted Diseases, Vol. 30, No. 9, 2003, pp. 689-693. doi:10.1097/01.OLQ.0000079526.04451.DE
[19] B. Lichtenstein and T. R. Nansel, “Women’s Douching Practices and Related Attitudes: Findings from Four Focus Groups,” Women’s Health, Vol. 31, No. 2-3, 2000, pp. 117-131. doi:10.1300/J013v31n02_06
[20] L. Annang, D. M. Grimley and E.W. Hook 3rd, “Vaginal Douching Practices among Black Women at Risk: Exploring Douching Prevalence, Reasons for Douching and Sexually Transmitted Disease Infection,” Sexually Transmitted Diseases, Vol. 33, No. 4, 2006, pp. 215-219. doi:10.1097/01.olq.0000205046.11916.c5
[21] J. W. Krashin, E. H. Koumans, A. C. Bradshaw-Sydnor, J. R. Braxton, W. E. Secor, M. K. Sawyer, et al., “Trichomonas Vaginalis Prevalence, Incidence, Risk Factor and Antibiotic Resistance in an Adolescent Population,” Sexually Transmitted Diseases, Vol. 37, No. 7, 2012, pp. 440-410.
[22] L. M. Jenny and H. V. Sten, “Vaginal Douching: Evidence for Risks or Benefits to Women’s Health,” Epidemiology Review, Vol. 24, No. 2, 2002, pp. 109-124. doi:10.1093/epirev/mxf004
[23] L. S. Heng, H. Yatsuya, S. Morita and J. Sakamoto, “Vaginal Douching in Cambodian Women: Its Prevalence and Association with Vaginal Candidiasis,” Journal of Epidemiology, Vol. 20, No. 1, 2010, pp. 70-76. doi:10.2188/jea.JE20081046
[24] J. H. Beaton, F. Gibson and M. Roland, “Short Term Use of a Medicated Douche Preparation in the Symptomatic Treatment of Minor Irritation in Some Case Associated with Infertility,” International Journal of Fertility, Vol. 29, No. 2, 1984, pp. 109-112.
[25] W. H. Chow, J. R. Darling, N. S. Weiss, D. E. Moore and R. Soderstrom, “Vaginal Douching as a Potential Risk Factor for Tubal Ectopic Pregnancy,” American Journal of Obstetrics and Gynecology, Vol. 153, No. 7, 1985, pp. 727-729.
[26] S. E. Peters, C. M. Beck-Sague, C. E. Farshy, I. Gibson, K. A. Kubota, F. Solomon, et al., “Behavior Associated with Neisseria gonorrhea and Chlamydia trachomatis. Cervical Infection among Young Women Attending Adolescent Clinics,” Clinical Pediatrics, Vol. 39, No. 3, 2000, pp. 173-177. doi:10.1177/000992280003900307
[27] M. O. Jossens, B. Eskenazi, J. Schachter and R. L. Sweet, “Risk Factors for Pelvic Inflammatory Disease: A Case Control Study,” Sexually Transmitted Diseases, Vol. 23, No. 3, 1996, pp. 239-247. doi:10.1097/00007435-199605000-00014
[28] R. N. Shain, S. T. Perdue, J. M. Piper, A. E. Holden, J. D. Champion, E. R. Newton, et al., “Behaviors Changed by Intervention Are Associated with Reduced STD Recurrence: The Importance of Context in Measurement,” Sexually Transmitted Diseases, Vol. 29, No. 9, 2002, pp. 520-527. doi:10.1097/00007435-200209000-00005
[29] E. Odeblad, “The Biophysical Aspects of Cervical Mucus,” In J. A. Jordan and A. Singer, Eds., The Cervix, WB Saunders, London, 1976, pp. 155-163.
[30] M. J. Rosenberg and R. S. Phillips, “Does Douching Promote Ascending Infection?” Journal of Reproductive Medicine, Vol. 37, No. 11, 1992, pp. 930-938.
[31] A. J. Chatwani, S. Hassan, S. Rahimi, S. Jeronis and V. Dandolu, “Douching with Water Works Device for Perceived Vaginal Odor with or without Complaints of Discharge in Women with No Infections Cause of Vaginitis: A Pilot Study,” Infective Disorders in Obstetrics and Gynecology, Vol. 2006, 2006, Article ID: 95618.
[32] Health and Human Services, “Vaginal Douche Product for Over-the-Counter Human Use Establishment of a Monograph. Advanced Notice of Proposal Rulemaking,” Federal Registry, Vol. 48, No. 199, 1983, pp. 46693-46729.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.