title: Douching in relation to bacterial vaginosis, lactobacilli, and facultative bacteria in the vagina.
abstract: OBJECTIVE
  To study how frequency, recentness, and reason for douching impact bacterial vaginosis-related vaginal microflora and the occurrence of cervical pathogens. Douching has been linked to bacterial vaginosis as well as to chlamydial cervicitis in some, but not all, studies.
  
  
  METHODS
  A total of 1200 women at high risk for sexually transmitted infections were enrolled from five clinical sites around the United States. Cross-sectional, structured interviews were conducted and vaginal swabs were self-obtained for Gram stain, culture, and DNA amplification tests for Neisseria gonorrhoeae and Chlamydia trachomatis.
  
  
  RESULTS
  Douching at least once per month was associated with an increased frequency of bacterial vaginosis. Those who douched recently (within 7 days) were at highest risk [odds ratio (OR) 2.1, 95% confidence interval (CI) 1.3, 3.1]. Douching for symptoms (OR 1.7, 95% CI 1.1, 2.6) and for hygiene (OR 1.3, 95% CI 1.0, 1.9) both related to bacterial vaginosis risk. The associations between douching and Gardnerella vaginalis, Mycoplasma hominis, and lack of hydrogen peroxide-producing lactobacilli were similar to those between douching and bacterial vaginosis. Gonococcal or chlamydial cervicitis was not associated with douching.
  
  
  CONCLUSIONS
  Douching for symptoms or hygiene, particularly frequent or recent douching, was associated with bacterial vaginosis and bacterial vaginosis-associated vaginal microflora, but not with gonococcal or chlamydial cervicitis.
authors.affiliation: Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA. repro@pitt.edu
authors.forename: Roberta B
authors.initials: RB
authors.lastname: Ness
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Hillier
authors.forename: Holly E
authors.initials: HE
authors.lastname: Richter
authors.forename: David E
authors.initials: DE
authors.lastname: Soper
authors.forename: Carol
authors.initials: C
authors.lastname: Stamm
authors.forename: James
authors.initials: J
authors.lastname: McGregor
authors.forename: Debra C
authors.initials: DC
authors.lastname: Bass
authors.forename: Richard L
authors.initials: RL
authors.lastname: Sweet
authors.forename: Peter
authors.initials: P
authors.lastname: Rice
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007778:Lactobacillus / Q000302:isolation & purification; D016015:Logistic Models; D012307:Risk Factors; D007507:Therapeutic Irrigation / Q000009:adverse effects; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D002575:Uterine Cervicitis / Q000453:epidemiology / Q000382:microbiology; D014621:Vagina / Q000382:microbiology*; D016585:Vaginosis, Bacterial / Q000453:epidemiology* / Q000382:microbiology