title: Vaginal douching and development of bacterial vaginosis among women with normal and abnormal vaginal microflora.
abstract: OBJECTIVE
  To evaluate the relationship between douching and bacterial vaginosis (BV) among women with and without prior abnormal vaginal flora.
  
  
  METHODS
  1193 women had vaginal swabs obtained for Gram stain for BV, culture for vaginal microflora, and DNA amplification for Neisseria gonorrhoeae and Chlamydia trachomatis at baseline and 6, 12, 24, and 36 months. Self-reported douching was queried every 6 months.
  
  
  RESULTS
  In cross-sectional analyses, douching at least once per month was associated with BV among women who had BV at the immediately preceding visit but not among women with normal or intermediate flora. In prospective analyses, douching increased the risk of acquisition for BV among women with intermediate flora (adj. HR 1.5, 95% CI 1.1-2.4) but not among women with normal flora.
  
  
  CONCLUSIONS
  Douching appeared to be associated with BV among women with already imbalanced flora but not among women with normal flora.
authors.affiliation: University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Katherine B
authors.initials: KB
authors.lastname: Hutchinson
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Kip
authors.forename: Roberta B
authors.initials: RB
authors.lastname: Ness
mesh_terms: D000328:Adult; D002692:Chlamydia trachomatis / Q000235:genetics / Q000302:isolation & purification; D003430:Cross-Sectional Studies; D004269:DNA, Bacterial / Q000032:analysis; D005260:Female; D006801:Humans; D009344:Neisseria gonorrhoeae / Q000235:genetics / Q000302:isolation & purification; D021141:Nucleic Acid Amplification Techniques; D010414:Pennsylvania / Q000453:epidemiology; D011446:Prospective Studies; D014621:Vagina / Q000382:microbiology*; D044364:Vaginal Douching / Q000009:adverse effects* / Q000706:statistics & numerical data; D014626:Vaginal Smears; D016585:Vaginosis, Bacterial / Q000453:epidemiology* / Q000382:microbiology* / Q000517:prevention & control
chemical_list: D004269:DNA, Bacterial