Interrelationships among douching practices, risky sexual practices, and history of self-reported sexually transmitted diseases in an urban population
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Updated: Oct 30, 2026

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Published on: May 30, 2025
B Foxman1, S O Aral, K K Holmes
1Department of Epidemiology, University of Michigan, School of Public Health, Ann Arbor 48109-2029, USA.
Goals:
To describe the interrelationships of douching, sex during menses, dry sex, and anal intercourse and their associations with self-reported history of sexually transmitted diseases (STD).
Study Design:
The authors interviewed by telephone 422 white Americans (WA) and 44 African Americans (AA) selected using random-digit dialing, and 135 AA selected from a listed sample of census tracks having a population of at least 40% AA.
Results:
After adjusting for lifetime numbers of vaginal sex partners, sex during menses was associated with self-reported history of chlamydial infection among women (WA: odds ratio [OR] = 3.9; confidence interval [CI]: 1.1, 14.0; AA: OR = 1.6; CI: 0.6, 4.2). Anal sex was associated with self-reported history of genital warts, genital herpes, hepatitis, and gonorrhea; douching with a twofold increase in self-reported pelvic inflammatory disease. Anal sex was most common in women with a history of same- and opposite-sex partners.
Conclusions:
These data confirm the association of douching and anal sex with various STD and suggest that sex during menses is associated with chlamydial infection.
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