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DOUCHING DESCRIPTION
Douching is rinsing or cleaning out the vagina (also called the birth canal) by squirting water or other solutions (such as vinegar, herbal solutions, baking soda, or douching solutions you can buy at drug and grocery stores) into the vagina. The water or solutions are held in a bottle and squirted into the vagina through tubing and a nozzle.
WHY DO WOMEN DOUCHE?
Douching is a practice that is thought to have been around since ancient times. Reasons women have given for using douches include to: rinse away blood after a menstrual period; clean the vagina after sex to avoid sexually transmitted diseases (STDs) and wash away semen to prevent pregnancy; treat medical conditions and reduce odors.
Douching can be used as a medical therapy to treat various vaginal infections, such as candida (yeast), bacterial vaginosus (garnerella or hemophilus), or trichomonas. In some cases, a midwife or health care provider may instruct a woman to douche with a special solution to fight these types of chronic yeast and bacterial infections.
It is common for Women who douche say they "feel clean when they douche and dirty if they don't". A Pittsburgh study found that the habit of douching is typically passed down from mother to daughter or from another family relative.
HOW COMMON IS DOUCHING?
Douching is a common practice among women in the United States - 37% of American women between the ages of 15 to 44 douche regularly. Of these women, about half douche on a weekly basis. Currently, almost 15% of adolescent girls and young women in the United States douche. Certain ethnic groups have much higher rates of douching than others. It is estimated that 1/3 of white women and 2/3 of black women douche. There is also an association between frequent douching and lower socio-economic status, especially in white women.
Other research data suggests that douching is predominantly done with commercial preparations (50%), while another 30% use a home preparation of vinegar and water, 10% use water alone, and 10% use other preparations. Douching is redominantly done for hygiene or to self-treat vaginal infections.
IS DOUCHING SAFE?
Health care providers and midwives do not recommend douching as the healthiest and safest way to routinely clean the vagina. Douching changes the delicate chemical balance in the vagina (and the vaginal flora), which can make a woman more prone to bacterial infections and may introduce new bacteria into the vagina and cervix. It also can spread existing vaginal or cervical infections up into the pelvic organs (uterus, fallopian tubes, and ovaries).
Research shows that women who douch on a regular (routine) basis actually tend to develop an increased amount of vaginal irritations and infections, called bacterial vaginosis (BV), and sexually transmitted diseases (STDs) than women who do not douche or who rarely douche. These women also develop more cases of pelvic inflammatory disease (PID) at an increased risk of 73% as compared to an estimated cumulative PID incidence of 10% in women up to 45 years of age. Women who douche at least once a week have a risk increased by about four times those who do not douche. PID is a chronic infectious disease affecting the woman's pelvic organs which include the cervix, uterus, fallopian tubes, and ovaries. Sexually transmitted bacteria traveling from the woman's vagina and cervix into the uterus and other pelvic organs usually cause PID. If left untreated, PID can lead to infertility (not being able to get pregnant) and ectopic pregnancy (pregnancy in the fallopian tubes instead of the uterus). Both BV and PID may lead to serious problems during pregnancy, such as infection in the baby, problems with labor, and preterm (early) delivery.
Many health care professionals agree that there is a need for further research to find out if douching directly causes BV and PID and why adolescent girls and young women douche.
Vaginitis: Vaginal Itching, Dryness, or Irritation
Vaginitis is an inflammation of the vagina. Most women will experience at least one episode of vaginitis in their lifetime, and many are plagued with episodes of itching, irritation, or discharge. The term "vaginitis" indicates symptoms and signs of inflammation - like redness or discharge - but doesn't tell us the origin of the problem. Causes of vaginitis (or the related condition, vulvitis, which involves inflammation of the vaginal lips) include bacteria, protozoa, fungi, hormonal changes, contact with irritants, and true allergic reactions.
pH Levels & Bacteria Connections
While you have probably never stopped to think about it, the vagina is an amazing structure. In the reproductive years, it must protect itself from infection if germs arrive, provide lubrication and sensation for intercourse, and be able to stretch open large enough to accommodate the birth of a full-term baby.
The function of the vagina changes through a woman's lifetime, from childhood through menopause and beyond, as the surface of the vagina responds to the hormonal changes that occur. In youth, when estrogen levels are low, the pH of the vagina is around 7 and the bacteria that live in the vagina are similar to those of the intestine. A child's vagina is not yet physiologically ready for intercourse and so is not as well protected as it will be later in life.
In adolescence and on into adulthood, under the influence of the hormone estrogen, the vaginal pH drops to around 4. This is a very acidic environment. This acidic pH protects the vagina from infection and promotes the growth of lactobacilli, the "good" bacteria that normally live there. The lactobacilli also help to prevent other sorts of bacteria from establishing themselves in the vagina.
In fact, strange as it may sound, the vagina can be scientifically described as a delicately balanced ecosystem, with the habitat being the vaginal walls under the influence of hormones and the inhabitants being the lactobacilli. If antibiotics, a change in hormones, or douching disturb that system, the environment may favor the growth of other organisms that lead to inflammation and irritation.
The problem can be compounded when the lower genital tract is exposed to any number of potential irritants, including bubble bath, soaps, laundry detergent or fabric softener residue, feminine hygiene products, and latex condoms.
Preventive Measures
Good vulvar care will prevent many cases of vaginitis. Many women who suffer from what they think are recurrent vaginal infections really have symptoms related to exposure to an irritant. To complicate matters, breaks in the skin or areas of inflammation can encourage the yeast organism that causes yeast vaginitis to set up shop. Preventing skin irritation can allay symptoms of vaginitis and prevent real yeast infections from developing.
Avoid douching. Douching is believed to wash the good bacteria out of the vagina and can upset normal vaginal pH levels.
Prevent rectal bacteria from entering the vagina. Back-to-front wiping after bowel movement or anal-then-vaginal sexual practices may deliver so many bacteria into the vagina that it overruns the protective lactobacilli, leading to bacterial vaginosis.
Use a condom. Condoms can protect against infection caused by the protozoan vaginitis called trichomonas and prevent many cases of genital herpes and papillomavirus (HPV) vulvar infections.
WHAT EFFECTS DOUCHING WILL DOUCHING HAVE ON PREGNANCY?
Douching after sex does not prevent pregnancy. Sperm have the ability to reach the uterus and travel through the fallopian tubes before a woman can begin douching. But, research has shown that douching may affect a woman's ability to get pregnant (her fertility). In women trying to become pregnant (conceive), those who douched the most often (more than once per week) had the lowest pregnancy rate. Other research has shown a link between frequent douching and having low birth-weight babies. Studies also show that douching greatly increases the chance of ectopic pregnancy by 76% and those who use commercial douching preparations have a risk increased by about 4 times the usual incidence of etopic pregnancies. Ectopic pregnancy can be a life-threatening condition. Ectopic pregnancy is when the fertilized egg attaches inside of the fallopian tube instead of in the uterus. Overall, women who douche have no significantly increased risk of cervical cancer. But those who douche at least once a week may have a significantly increased risk of about 86%. Frequency and timing of douching may influence outcomes such as when it is performed at an appropriate time in the menstrual cycle (not around ovulation) and done infrequently.
Standard douching techniques are NOT recommended during pregnancy (see below for a pregnancy-adapted douching technique if douching becomes a medical need). Douching may lead to dislodging the mucous plug that is located in the cervix, acting as a barrier that seals the uterus away from the vagina and may also lead to membrane rupture. The antibiotics or douche solution may reach the intra-amniotic space and get transferred to the fetus. There is also a rare possibility of an air embolism occurring. It is also associated with an increased likelihood (about twice the chance of non-douching pregnant women) of preterm delivery (giving birth at 20 to 36 weeks) and increases the risk of infection for both the mother and the unborn baby. Douching itself doesn't trigger early delivery, but studies reveal that the douching disturbs the bacterial balance in the vagina, resulting in a mild infection called bacterial vaginosis (BV), that BV IS associated with an increased risk of pre-term delivery. In fact, women who douche at least once a month are 40% more likely to develop BV. In some cases, women who develop BV treat it by douching, which may transport bacteria up into the reproductive tract.
NEVER douche or put anything into your vagina if you suspect your amniotic membranes (bag of waters) have broken. This can lead to a possible serious infection of both mother and unborn baby.
If you are pregnant, do not use any douching solution (including vinegar, herbal teas, or medicinal solutions) without first consulting with your midwife or health care provider. Then, usually, the only form of douching advised in pregnancy may be with water acidifed with vinegar (there are exceptions to this for certain infections, but discuss it with your midwife first).
WHAT IS THE HEALTHIEST & SAFEST WAY TO CLEAN THE VAGINA?
Because the chemical balance of the vagina is very sensitive, it is best to let the vagina clean itself. The vagina takes care of cleaning itself naturally through secretions of mucous. Warm water and gentle, unscented soap during the bath or shower is the best way to clean the sensitive outside areas of the vagina. Products like feminine hygiene soaps, powders and sprays are not necessary, and may actually be harmful to use.
It is important to see your midwife or health care provider right away when you have any vaginal pain, itching, burning, or a foul odor; pain when urinating; a vaginal discharge that is not normal, such as thick and white (like cottage cheese) or yellowish-green. You may have a yeast infection, urinary tract infection, or bacterial infection, all of which can be treated with medications or other holistic therapies. Do not clean the vagina or douche before an exam with your midwife or a health care provider. This will wash away the vaginal discharge, which helps the health care provider or midwife to determine the type of infection. Do not douche before you have a pap smear. This will wash away cervical cells that are necessary for pap testing.
DOUCHING DURING PREGNANCY
Douching during pregnancy is highly discouraged by most midwives and health care providers unless there is no other treatment that can be used safely. When douching in pregnancy, extra care must be taken to avoid forcing water (or other recommended solution) up into the uterus, dislodging the protective cervical mucus plug and causing infection and other problems.
If your midwife or health care provider recommends a douche during pregnancy for some therapeutic purpose, there are special steps you can take to keep potential problems to a minimum:
SAFE DOUCHING DURING PREGNANCY
Fill douche bag with cooled tea, attach cleaned vaginal tip.
Hang bag 10 inches or less from the floor.
Lay in the bathtub and gently insert the nozzle into the vagina no more than half way in.
Very gently release the hose clamp and allow tea to run in and out of the vagina, do NOT attempt to retain water in the vagina in pregnancy.
When finished, clean the equipment thoroughly.
Douching should never be attempted if there is any question that cervical dilation, placenta previa or prematurely ruptured membranes are present.
DOUCHING LINKS
Yale New Haven Health News: Douching In Pregnancy Linked to Preterm Birth
HELPFUL PRODUCTS & FURTHER EDUCATION
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 4th Edition
Prescription for Herbal Healing: The A-To-Z Reference To Common Disorders
-- by Phyllis A. Balch
DOUCHING SUPPLIES
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