NEW YORK (Reuters Health) - New prospective study findings suggest that douching does not increase the risk of pelvic inflammatory disease (PID) or gonococcal/chlamydial genital infection.

Studies that have examined the relationship between douching and cervicitis and PID have yielded inconsistent results (see Reuters Health reports, June 12, 2003, October 8, 2001, and August 27, 1999). There are very few prospective data addressing these issues, Dr. Roberta B. Ness, at the University of Pittsburgh, and her colleagues note in their paper, published in the American Journal of Epidemiology for January 15th.

Dr. Ness's group enrolled 1199 women in the GYN Infections Follow-through Study, ages 13 to 36 years, considered to be at high risk of acquiring a sexually transmitted infection. The majority were between 19 and 24 years old and African American. Overall, 39% reported douching at least monthly.

Every 6 to 12 months, subjects answered questions regarding lifestyle, medical information, and douching and provided vaginal specimens collected using cotton swab applicators. Those with pelvic pain or who tested positive for Neisseria gonorrhoeae or C. trachomatis underwent pelvic examinations and an endometrial biopsy.

The 4-year incidence of PID was 10.9%. However, rates were similar among women who did not douche, those who douched once a month, and women who douched two or more times per month. The results were similar when the women were stratified by age, presence of bacterial vaginosis, and sexual activity in the past year.

At least one infection with N. gonorrhoeae or C. trachomatis was diagnosed in 21.9% of women. Again, there was no association with douching.

The only subgroup that had a small increased risk associated with douching was white women. However, the authors note that only about 20% of the cohort was white, and they were less likely to report douching, making for "unstable estimates."

"These data do not support an association between douching and development of PID or gonococcal/chlamydial genital infection among predominantly young, African-American women," Dr. Ness and her colleagues conclude.

Am J Epidemiol 2005;161:186-195.

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