Vaginal douching and the risk of tubal pregnancy

To explore the possible association between vaginal douching and tubal pregnancy, we interviewed 273 women who were diagnosed with tubal pregnancy at Group Health Cooperative between September 31, 1981 and October 1, 1986. Their responses were compared with responses of a random sample of 722 female members of Group Health Cooperative who were assumed to be at risk of becoming pregnant at the time the cases conceived. After adjusting for differences between cases and controls with regard to other measured risk factors, we found a modest increase in risk associated with having douched more than two times per year in the past (RR = 1.3, 95% CI: 0.9-1.8). Among women who had more than one sexual partner during their lifetime, however, the risk for those who had douched more than twice per year was somewhat higher (RR = 1.6, 95% CI: 1.1-2.3). There was an indication that women who had been exposed to Chlamydia trachomatis, as indicated by elevated antibody titers, may further increase their risk for tubal pregnancy by douching (RR = 2.4, 95% CI: 0.8-7.3). The associations found in other studies between douching and pelvic inflammatory disease, and between pelvic inflammatory disease and subsequent tubal pregnancy, argue that a relation between douching and tubal pregnancy might be anticipated. Our results offer further support for this hypothesis.