To 'douche' or not to 'douche': hygiene habits may have detrimental effects on vaginal microbiota.

The importance of a healthy vaginal micro-flora is indisputable. Therefore, intravaginal practices, such as vaginal douching (VD), may inhibit or lower the colonisation of beneficial Lactobacilli strains. Although the results of disrupted vaginal microbiota have been widely reported in the literature, direct microbicidal effects of products used for VD have been rarely studied. Moreover, there are certain studies advocating the beneficial effects of VD. This in vitro study was designed to provide more evidence to help health care givers in disseminating the knowledge that VD might have detrimental effects on vaginal microbiota. Three commercially available VD products (A, B and C) were examined for their minimal inhibiting concentrations (MICs) against Lactobacilli strains. Although the MICs of product A (ranging from 0.19% to 0.09%, p < .05) were proven to be lower than the other two, all the products were potentially able to inhibit the growth of Lactobacilli strains effectively, and hence should be used with caution. Impact statement What is already known on this subject? The importance of vaginal microbiota has long been reported for the maintenance of health. The lack of a healthy vaginal ecosystem may lead to various diseases including pelvic inflammatory disease, bacterial vaginosis, sexually transmitted diseases, etc. Moreover, studies also stress that lack of beneficial bacteria may lead to miscarriages, premature delivery, ectopic pregnancy and cervical cancer. Despite a huge amount of data regarding the importance of vaginal microbiota, studies confirm that women still utilise VD for various reasons. Whilst the detrimental effect of VD have been widely reported in the literature; there are a few publications advocating the potential benefits of VD. Educational efforts are reported to lessen this practice. What do the results of this study add? In this in vitro study we aimed to substantiate the bactericidal potential of three commercially available products. There are studies about the clinical outcomes of VD, but a limited number of in vitro studies exist. Our results represent a direct measure of how potentially destructive VD is. What are the implications of these findings for clinical practice and/or further research? This information can be used for educational purposes, enhancing the efforts provided by health care givers used to lessen VD practice.