title: An updated review of of evidence to discourage douching.
abstract: OBJECTIVE
  To review current studies on vaginal douching.
  
  
  METHODS
  MEDLINE PubMed, CINAHL, and Cochrane databases from 2002 to 2008 using MeSh terms "vaginal AND irrigation or vaginal and douching" from 2002 to 2003 and "vaginal douching" and "vaginal douching and adverse effects" from 2004 to 2008.
  
  
  METHODS
  MEDLINE PubMed included 156 records, CINAHL 15, and Cochrane 10. Articles in English were reviewed, and those pertaining to vaginal douching and reproductive and gynecologic outcomes were included. References from these articles were reviewed and included when appropriate. 2008 Web sites of the Centers for Disease Control and Prevention were also included.
  
  
  METHODS
  Articles were reviewed and summarized.
  
  
  RESULTS
  Vaginal douching is a common practice for almost one-third of women in the United States. Douching is associated with adverse pregnancy outcomes including ectopic pregnancy, low birth weight, preterm labor, preterm birth, and chorioamnionitis. Douching is more prevalent among non-Hispanic black women than among white women or Hispanic women. Douching alters the vaginal flora and predisposes women to develop bacterial vaginosis (BV), which is also more prevalent among women who douche and among black women. Douching is also associated with serious gynecologic outcomes, including increased risk of cervical cancer, pelvic imflammatory disease, endometritis, and increased risk for sexually transmitted infections, including HIV. Many factors influence women's douching behaviors, including social, cultural, and educational factors. Healthcare providers can influence women to stop douching.
  
  
  CONCLUSIONS
  Healthcare providers may not be aware of the mounting evidence of negative health outcomes associated with the practice of douching. At every opportunity, healthcare providers should ask women whether they douche and inquire about vaginal douching practices and beliefs associated with the practice. Douching should be discouraged because it places women at risk for multiple health problems.
authors.affiliation: Florida State University College of Nursing, Tallahassee, FL, USA. bcottrell@fsu.edu
authors.forename: Barbara Hansen
authors.initials: BH
authors.lastname: Cottrell
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D001294:Attitude to Health / Q000208:ethnology*; D005260:Female; D015438:Health Behavior / Q000208:ethnology*; D006266:Health Education / Q000458:organization & administration*; D007722:Health Knowledge, Attitudes, Practice; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007246:Infertility / Q000209:etiology; D008875:Middle Aged; D015404:Nursing Methodology Research; D007752:Obstetric Labor, Premature / Q000209:etiology; D000292:Pelvic Inflammatory Disease / Q000209:etiology; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000209:etiology; D012648:Self Care / Q000009:adverse effects* / Q000706:statistics & numerical data; D015231:Sexually Transmitted Diseases, Bacterial / Q000209:etiology; D014481:United States / Q000453:epidemiology; D014621:Vagina / Q000382:microbiology; D044364:Vaginal Douching / Q000009:adverse effects* / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data; D016387:Women's Health / Q000208:ethnology*; D055815:Young Adult