title: Vaginal douching as a risk factor for acute pelvic inflammatory disease.
abstract: OBJECTIVE
  To conduct a population-based evaluation of vaginal douching as a risk factor for acute pelvic inflammatory disease (PID), emphasizing timing, frequency, and reasons for douching.
  
  
  METHODS
  A population-based case-control study was conducted at Group Health Cooperative of Puget Sound, a staff-model health maintenance organization located in western Washington state. The cases (N = 131) were women 18-40 years of age who experienced a first episode of clinically diagnosed acute PID. Both hospitalized and ambulatory-care patients were identified. Medical records were reviewed for clinical inclusion criteria and for additional evidence of inflammation/infection. Controls (N = 294) were chosen from a population-based series of randomly selected women from a concurrent Group Health study of ectopic pregnancy. Of the women identified, 72.4% of cases and 73.4% of controls agreed to participate.
  
  
  RESULTS
  Relative to women who reported never having douched, women who douched during the previous 3 months had a risk of PID of 2.1 after controlling for other measured risk factors (95% confidence interval [CI] 1.2-3.9). Women who douched at least once a week had a higher estimated risk (odds ratio 3.9, 95% CI 1.4-10.9) than those who douched less often (odds ratio 1.8, 95% CI 1.0-3.4). The risk was highest in the small group of women who gave infection as the reason for douching (odds ratio 7.9, 95% CI 2.6-24.2). However, exclusion of this group did not eliminate the association among the remaining women (odds ratio 3.0, 95% CI 1.0-9.1 for douching at least once a week).
  
  
  CONCLUSIONS
  These population-based data lend added support to the hypothesis that vaginal douching can predispose a woman to PID.
authors.affiliation: Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington.
authors.forename: D
authors.initials: D
authors.lastname: Scholes
authors.forename: J R
authors.initials: JR
authors.lastname: Daling
authors.forename: A
authors.initials: A
authors.lastname: Stergachis
authors.forename: N S
authors.initials: NS
authors.lastname: Weiss
authors.forename: S P
authors.initials: SP
authors.lastname: Wang
authors.forename: J T
authors.initials: JT
authors.lastname: Grayston
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D000292:Pelvic Inflammatory Disease / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D007507:Therapeutic Irrigation / Q000009:adverse effects*; D014621:Vagina