Is Douching Safe?

This vintage douche ad claims that its product is “safe to delicate tissues” and “non-poisonous.”

Douching is the practice of squirting a liquid, called a douche, into the vagina. Many people believe it helps keep the vagina clean and odor-free, and some are under the impression that it helps prevent pregnancy and sexually transmitted diseases. An estimated 25 percent of American women 15 to 44 years old douche regularly. But just because douching is widespread doesn’t mean it’s safe; indeed, there are two possible mechanisms by which douching might be harmful.

First, douching might alter the pH of the vagina, changing its ecosystem. You might not think of a vagina as an “ecosystem,” but the bacteria and other microscopic organisms that live there sure do — and altering their habitat can harm the beneficial microbes that live there, opening the door for disease-causing microbes to take over the territory. Frequent douching can result in the vagina’s normal microbial population having difficulty reestablishing its population.

Douching increases risk for infections and fertility problems, and has no proven medical benefits.

Second, a douche’s upward flow might give pathogens a “free ride” into the depths of the reproductive tract, granting them access to areas that might have been difficult for them to reach otherwise. In this manner, an infection might spread from the lower reproductive tract to the upper reproductive tract. Douching might be an even bigger risk for female adolescents, whose reproductive anatomy is not fully formed, leaving them more vulnerable to pathogens.

While douching is not guaranteed to harm you, there is no evidence that it is beneficial in any way. Establishing causation between douching and the problems that are associated with it is trickier — does douching cause these problems, or do people who douche also tend to engage in other behaviors that increase risk? So far, the best evidence indicates that douching is correlated with a number of diseases and other problems, including sexually transmitted diseases (STDs), bacterial vaginosis, pelvic inflammatory disease, fertility and pregnancy complications, and more.

This 1930 ad preys on women’s insecurities by claiming that its douche helps a woman guard against “an odor she may not detect herself but is so apparent to other people.”

By disrupting the normal vaginal flora, douching opens up territory for sexually transmitted pathogens. An altered vaginal pH can increase risk for HIV, and some douches can irritate the tissues inside the vagina, rendering them more susceptible to infection. Douching might increase risk for gonorrhea, chlamydia, and trichomoniasis.

Many people promote douching as a treatment for vaginal discharge or unpleasant odor, but, ironically, douching increases risk for bacterial vaginosis (BV), which itself is the leading cause of these symptoms! BV results from a decline in the population of lactobacilli, a type of vaginal bacteria that is very beneficial to vaginal health. Some types of douches contain antimicrobials that are harmful to lactobacilli, and when the lactobacilli species decline, disease-causing bacteria can take their place. Depending on how frequently one douches, BV risk can be increased by as much as five times compared to those who never douche. BV is associated with a variety of problems, including ectopic pregnancy, preterm labor, and low birth weight, and can increase risk for gonorrhea, chlamydia, trichomoniasis, HIV, and genital herpes. (Some researchers wonder if douching is a response to, rather than a cause of, BV.)

Evidence strongly supports the idea that douching increases risk for pelvic inflammatory disease (PID), a condition that causes scarring in the reproductive tract and can negatively affect fertility. According to the American Congress of Obstetricians and Gynecologists, douching might aid bacterial growth and push harmful bacteria farther into the reproductive tract. Infections such as chlamydia, gonorrhea, and BV can develop into PID. According to a 1997 meta-analysis published by the American Journal of Public Health, douching increases PID risk by 73 percent — and the more frequently one douches, the higher the risk for PID. While adolescents are the least likely to experience symptoms of PID, the disease is highest among this population, striking an estimated 1 in 8 sexually active 15-year-old girls.

Ectopic pregnancy is the implantation of a fertilized egg outside of the uterus, and, if left untreated, it can be life-threatening and might affect future fertility. Douching increases risk for ectopic pregnancy by 76 percent, which makes sense, as douching has been associated with increased risk for PID, which in turn is known to increase risk for ectopic pregnancy. Commercially available douches might increase ectopic pregnancy risk even more than homemade preparations using water or water and vinegar. A 2010 review also found that douching during pregnancy increases risk for preterm labor by two- to fourfold. Medical professionals strongly recommend against douching during pregnancy.

There are other possible negative effects of douching. For instance, douching can increase risk for a condition called endometritis (the inflammation of the inner uterine lining) or upper genital tract infections: A 2001 study found that douching more than once a month led to a 60 percent increased likelihood to develop endometritis, compared to non-douchers. Furthermore, douching before a gynecological appointment can interfere with a doctor’s ability to provide an accurate diagnosis. One group of researchers, investigating women’s reasons for douching, found that some women douche in preparation for a doctor’s appointment. It is important for sexually active people to be screened for STDs, and to increase the likelihood of an accurate diagnosis, it’s important not to insert anything into the vagina — no penetrative sex, no tampons, and no douching. Lastly, douching while recovering from an abortion can increase risk for infection.

The short answer to the question, “Is douching safe?” is that douching increases risk for many infections and fertility problems, has no proven medical benefits, and is not generally recommended by medical professionals. Furthermore, the practice does not prevent pregnancy and is not necessary for hygiene. As one group of researchers says, “the preponderance of the evidence suggests that douching is not necessary or beneficial and is very likely to be harmful.”