The great douching debate: to douche, or not to douche

It has been implied douching causes chlamydial infection, acute salpingitis, ectopic pregnancy, and reduced fertility. However, the incriminating articles do not represent a vast accumulation of data from diverging sources; rather, most reflect repetitive analysis of data from a limited population base by an institutionally interrelated group of investigators. The conclusions reached were reintroduced periodically into the literature in different journals. An equally plausible alternate hypothesis is that douching is a marker for increased probability of one or more sexually transmitted diseases and their sequelae. Review of microbiologic rather than epidemiologic data published on douching revealed that douching with a preparation containing acetic acid caused a small reduction in total bacterial counts. Most of that change was attributable to washing. When povidone-iodine was present, significant reductions occurred, but these were short-lived. The first bacteria to recover are usually the lactobacilli, which might explain partial efficacy of prolonged douching with commercial preparations of povidone-iodine.