Does douching promote ascending infection?

Despite the fact that vaginal douching is practiced regularly by approximately 20 million American women, little is known about who douches, why or its associated risks or benefits. Recent studies of douching collectively suggest a possible association with ectopic pregnancy and pelvic inflammatory disease. These findings, however, are difficult to interpret because of the small number of studies, conflicting findings and methodologic weaknesses, reflecting both the early stage of interest and difficulties inherent to studies of intimate behaviors. Further information is needed to differentiate between douching as a causal factor or as an indicator for behaviors that increase the risk of sexually transmitted diseases and their complications. The central issue is whether other risk factors and/or markers for sexually transmitted diseases, which are more common among women who douche, have been reasonably excluded as a source of bias. Few, if any, criteria for establishing a causal link between douching and adverse outcomes are satisfied, but this reflects a paucity of data rather than data that refute such a conclusion.