Vaginal douching: Evidence for risks or benefits to women's health

Epidemiologic Reviews

Volumn 24, Issue 2, 2002, Pages 109-124

  Martino, Jenny L ^b   Vermund, Sten H ^a  

^a UNIVERSITY OF ALABAMA AT BIRMINGHAM   (United States)

^b NONE

Author keywords

[No Author keywords available]

Indexed keywords

ALCOHOL; BENZOIC ACID; BENZOIC ACID DERIVATIVE; BICARBONATE; BLEACHING AGENT; CETYLPYRIDINIUM SALT; CITRIC ACID; EDETIC ACID; LACTIC ACID; LYSOL; OCTOXINOL; POVIDONE IODINE; SORBIC ACID; SURFACTANT; VINEGAR; YOGHURT;

CHLAMYDIASIS; CLEANING; CLINICAL TRIAL; DEMOGRAPHY; ECTOPIC PREGNANCY; EPIDEMIOLOGICAL DATA; ETHNOLOGY; FEMALE; FERTILITY; GONORRHEA; HUMAN; HUMAN IMMUNODEFICIENCY VIRUS INFECTION; INFERTILITY; LACTOBACILLUS; MEDICAL SOCIETY; META ANALYSIS; PELVIC INFLAMMATORY DISEASE; PREVALENCE; PRIORITY JOURNAL; PUBLIC HEALTH; RACE DIFFERENCE; REVIEW; RISK BENEFIT ANALYSIS; RISK FACTOR; SEXUALLY TRANSMITTED DISEASE; UTERINE CERVIX CANCER; VAGINA; VAGINA FLORA; VAGINITIS;

ADOLESCENT; ADULT; EVIDENCE-BASED MEDICINE; FEMALE; HEALTH BEHAVIOR; HIV INFECTIONS; HUMANS; IRRIGATION; PELVIC INFLAMMATORY DISEASE; PREVALENCE; RISK ASSESSMENT; RISK FACTORS; SEXUALLY TRANSMITTED DISEASES, BACTERIAL; UTERINE CERVICAL NEOPLASMS; VAGINA; VAGINOSIS, BACTERIAL; WOMEN'S HEALTH;

EID: 0037726568     PISSN: 0193936X     EISSN: None     Source Type: Journal    
DOI: 10.1093/epirev/mxf004     Document Type: Review

References (176)

1. Aral SO, Mosher WD, Cates W Jr. Vaginal douching among women of reproductive age in the United States: 1988. Am J Public Health 1992:82:210-14.
2. Chacko MR, McGill L, Johnson TC, et al. Vaginal douching in teenagers attending a family planning clinic. J Adolesc Health Care 1989;10:217-19.
3. Zhang J, Thomas AG, Leybovich E. Vaginal douching and adverse health effects: a meta-analysis. Am J Public Health 1997;87:1207-11.
4. Merchant JS, Oh K, Klerman LV. Douching: a problem for adolescent girls and young women. Arch Pediatr Adolesc Med 1999;153:834-7.
5. Abma JC, Chandra A, Mosher WD, et al. Fertility, family planning, and women's health: new data from the 1995 National Survey of Family Growth. Vital Health Stat 23 1997; (19):1-114.
6. Foch B, McDaniel N, Chacko M. Vaginal douching in adolescents attending a family planning clinic. J Pediatr Adolesc Gynecol 2000;13:92.
7. Foch BJ, McDaniel ND, Chacko MR. Racial differences in vaginal douching knowledge, attitude, and practices among sexually active adolescents. J Pediatr Adolesc Gynecol 2001;14:29-33.
8. Vermund SH, Sarr M, Murphy DA, et al. Douching practices among HIV infected and uninfected adolescents in the United States. J Adolesc Health 2001;29:81-6.
9. La Ruche G, Messou N, Ali-Napo L, et al. Vaginal douching: association with lower genital tract infections in African pregnant women. Sex Transm Dis 1999;26:191-6.
10. Wolner-Hanssen P, Eschenbach DA, Paavonen J, et al. Association between vaginal douching and acute pelvic inflammatory disease. JAMA 1990;263:1936-41.
11. Baird DD, Weinberg CR, Voigt LF, et al. Vaginal douching and reduced fertility. Am J Public Health 1996;86:844-50.
12. Saraiya M, Berg CJ, Kendrick JS, et al. Cigarette smoking as a risk factor for ectopic pregnancy. Am J Obstet Gynecol 1998;178:493-8.
13. Fiscella K, Franks P, Kendrick JS, et al. The risk of low birth weight associated with vaginal douching. Obstet Gynecol 1998;92:913-17.
14. Scholes D, Stergachis A, Ichikawa LE, et al. Vaginal douching as a risk factor for cervical Chlamydia trachomatis infection. Obstet Gynecol 1998;91:993-7.
15. Rosenberg MJ, Phillips RS, Holmes MD. Vaginal douching. Who and why? J Reprod Med 1991;36:753-8.
16. Rosenberg MJ, Phillips RS. Does douching promote ascending infection? J Reprod Med 1992;37:930-8.
17. Joesoef MR, Sumampouw H, Linnan M, et al. Douching and sexually transmitted diseases in pregnant women in Surabaya, Indonesia. Am J Obstet Gynecol 1996;174:115-19.
18. Perloff WH, Steinberger E. In vivo survival of spermatoza in cervical mucus. Am J Obstet Gynecol 1964;88:439-42.
19. Funkhouser E, Pulley L, Lueschen G, et al. Douching beliefs and practices among black and white women. J Womens Health Gend Based Med 2002;11:29-37.
20. Lichtenstein B, Nansel TR. Women's douching practices and related attitudes: findings from four focus groups. Women Health 2000;31:117-31.
21. Funkhouser E, Hayes TD, Vermund SH. Vaginal douching practices among women attending a university in the southern United States. J Am Coll Health 2002;50:177-82.
22. Forrest KA, Washington AE, Daling JR, et al. Vaginal douching as a possible risk factor for pelvic inflammatory disease. J Natl Med Assoc 1989;81:159-65.
23. Dan BB. Sex, lives, and chlamydia rates. (Editorial). JAMA 1990;263:3191-2.
24. Ness R, Brooks-Nelson D. Pelvic inflammatory disease. In: Goldman MB, Hatch MC, eds. Women & health. San Diego, CA: Academic Press, 2000:369-80.
25. Ness RB, Soper DE, Holley RL, et al. Douching and endometritis: results from the PID evaluation and clinical health (PEACH) study. Sex Transm Dis 2001;28:240-5.
26. Miller HG, Cain VS, Rogers SM, et al. Correlates of sexually transmitted bacterial infections among U.S. women in 1995. Fam Plann Perspect 1999;31:4-9, 23.
27. Horowitz BJ, Mardh PA, eds. Vaginitis and vaginosis. New York, NY: Wiley-Liss, 1991.
28. Schwebke JR. Vaginal infections. In: Goldman MB, Hatch MC, eds. Women & health. San Diego, CA: Academic Press, 2000:352-60.
29. Newton ER, Piper JM, Shain RN, et al. Predictors of the vaginal microflora. Am J Obstet Gynecol 2001;184:845-55.
30. Pavlova SI, Tao L. In vitro inhibition of commercial douche products against vaginal microflora. Infect Dis Obstet Gynecol 2000;8:99-104.
31. Juliano C, Piu L, Gavini E, et al. In vitro antibacterial activity of antiseptics against vaginal lactobacilli. Eur J Clin Microbiol Infect Dis 1992;11:1166-9.
32. Onderdonk AB, Delaney ML, Hinkson PL, et al. Quantitative and qualitative effects of douche preparations on vaginal microflora. Obstet Gynecol 1992;80:333-8.
33. Monif GR, Thompson JL, Stephens HD, et al. Quantitative and qualitative effects of povidone-iodine liquid and gel on the aerobic and anaerobic flora of the female genital tract. Am J Obstet Gynecol 1980;137:432-8.
34. Monif GR. The great douching debate: to douche, or not to douche. Obstet Gynecol 1999;94:630-1.
35. Rajamanoharan S, Low N, Jones SB, et al. Bacterial vaginosis, ethnicity, and the use of genital cleaning agents: a case control study. Sex Transm Dis 1999;26:404-9.
36. Fleury FJ. Adult vaginitis. Clin Obstet Gynecol 1981;24:407-38.
37. Amsel R, Totten PA, Spiegel CA, et al. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med 1983;74:14-22.
38. Spiegel CA, Amsel R, Eschenbach D, et al. Anaerobic bacteria in nonspecific vaginitis. N Engl J Med 1980;303:601-7.
39. Eschenbach DA, Davick PR, Williams BL, et al. Prevalence of hydrogen peroxide-producing Lactobacillus species in normal women and women with bacterial vaginosis. J Clin Microbiol 1989;27:251-6.
40. 2-producing lactobacilli, and bacterial vaginosis in pregnant women. Clin Infect Dis 1993;16(suppl 4):S273-81.
41. Fiscella K. Racial disparities in preterm births. The role of urogenital infections. Public Health Rep 1996;111:104-13.
42. Goldenberg RL, Klebanoff MA, Nugent R, et al. Bacterial colonization of the vagina during pregnancy in four ethnic groups. Vaginal Infections and Prematurity Study Group. Am J Obstet Gynecol 1996;174:1618-21.
43. Llahi-Camp JM, Rai R, Ison C, et al. Association of bacterial vaginosis with a history of second trimester miscarriage. Hum Reprod 1996;11:1575-8.
44. Hawes SE, Hillier SL, Benedetti J, et al. Hydrogen peroxideproducing lactobacilli and acquisition of vaginal infections. J Infect Dis 1996;174:1058-63.
45. Bump RC, Buesching WJ 3rd. Bacterial vaginosis in virginal and sexually active adolescent females: evidence against exclusive sexual transmission. Am J Obstet Gynecol 1988;158:935-9.
46. Schwebke JR, Richey CM, Weiss HL. Correlation of behaviors with microbiological changes in vaginal flora. J Infect Dis 1999;180:1632-6.
47. Hodoglugil NN, Aslan D, Bertan M. Intrauterine device use and some issues related to sexually transmitted disease screening and occurrence. Contraception 2000;61:359-64.
48. Faro S, Martens M, Maccato M, et al. Vaginal flora and pelvic inflammatory disease. Am J Obstet Gynecol 1993;169:470-4.
49. Soper DE, Brockwell NJ, Dalton HP, et al. Observations concerning the microbial etiology of acute salpingitis (with discussion). Am J Obstet Gynecol 1994;170:1008-17.
50. Sweet RL. Role of bacterial vaginosis in pelvic inflammatory disease. Clin Infect Dis 1995;20(suppl 2):S271-5.
51. Hillier SL, Kiviat NB, Hawes SE, et al. Role of bacterial vaginosis-associated microorganisms in endometritis. Am J Obstet Gynecol 1996;175:435-41.
52. Gravett MG, Nelson HP, DeRouen T, et al. Independent associations of bacterial vaginosis and Chlamydia trachomatis infection with adverse pregnancy outcome. JAMA 1986;256:1899-903.
53. Martius J, Krohn MA, Hillier SL, et al. Relationships of vaginal Lactobacillus species, cervical Chlamydia trachomatis, and bacterial vaginosis to preterm birth. Obstet Gynecol 1988;71:89-95.
54. Krohn MA, Hillier SL, Lee ML, et al. Vaginal Bacteroides species are associated with an increased rate of preterm delivery among women in preterm labor. J Infect Dis 1991;164:88-93.
55. Kurki T, Sivonen A, Renkonen OV, et al. Bacterial vaginosis in early pregnancy and pregnancy outcome. Obstet Gynecol 1992;80:173-7.
56. McDonald HM, O'Loughlin JA, Jolley P, et al. Prenatal microbiological risk factors associated with preterm birth. Br J Obstet Gynecol 1992;99:190-6.
57. Riduan JM, Hillier SL, Utomo B, et al. Bacterial vaginosis and prematurity in Indonesia: association in early and late pregnancy. Am J Obstet Gynecol 1993;169:175-8.
58. Holst E, Goffeng AR, Andersch B. Bacterial vaginosis and vaginal microorganisms in idiopathic premature labor and association with pregnancy outcome. J Clin Microbiol 1994;32:176-86.
59. Hay PE, Lamont RF, Taylor-Robinson D, et al. Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage. BMJ 1994;308:295-8.
60. Meis PJ, Goldenberg RL, Mercer B, et al. The preterm prediction study: significance of vaginal infections. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Am J Obstet Gynecol 1995;173:1231-5.
61. Bruce FC, Fiscella K, Kendrick JS. Vaginal douching and preterm birth: an intriguing hypothesis. Med Hypotheses 2000;54:448-52. (Published erratum appears in Med Hypotheses 2000;54:859).
62. Hillier SL, Nugent RP, Eschenbach DA, et al. Association between bacterial vaginosis and preterm delivery of a lowbirth-weight infant. The Vaginal Infections and Prematurity Study Group. N Engl J Med 1995;333:1737-42.
63. Hillier SL, Martius J, Krohn M, et al. A case-control study of chorioamnionic infection and histologic chorioamnionitis in prematurity. N Engl J Med 1988;319:972-8.
64. Gravett MG, Hummel D, Eschenbach DA, et al. Preterm labor associated with subclinical anmiotic fluid infection and with bacterial vaginosis. Obstet Gynecol 1986;67:229-37.
65. Silver HM, Sperling RS, St. Clair PJ, et al. Evidence relating bacterial vaginosis to intraamniotic infection. Am J Obstet Gynecol 1989;161:808-12.
66. Hillier SL, Krohn MA, Cassen E, et al. The role of bacterial vaginosis and vaginal bacteria in amniotic fluid infection in women in preterm labor with intact fetal membranes. Clin Infect Dis 1995;20(suppl 2):S276-8.
67. Hauth JC, Goldenberg RL, Andrews WW, et al. Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis. N Engl J Med 1995;333:1732-6.
68. Kekki M, Kurki T, Pelkonen J, et al. Vaginal clindamycin in preventing preterm birth and peripartal infections in asymptomatic women with bacterial vaginosis: a randomized, controlled trial. Obstet Gynecol 2001;97:643-8.
69. Kurkinen-Raty M, Vuopala S, Koskela M, et al. A randomised controlled trial of vaginal clindamycin for early pregnancy bacterial vaginosis. BJOG 2000;107:1427-32.
70. Goldenberg RL, Andrews WW. Intrauterine infection and why preterm prevention programs have failed. (Editorial). Am J Public Health 1996;86:781-3.
71. Goldenberg RL, Vermund SH, Goepfert AR, et al. Choriodecidual inflammation: a potentially preventable cause of perinatal HIV-1 transmission? Lancet 1998;352:1927-30.
72. Holzman C, Leventhal JM, Qiu H, et al. Factors linked to bacterial vaginosis in nonpregnant women. Am J Public Health 2001;91:1664-70.
73. Fonck K, Kaul R, Keli F, et al. Sexually transmitted infections and vaginal douching in a population of female sex workers in Nairobi, Kenya. Sex Transm Infect 2001;77:271-5.
74. Royce RA, French JI, Savitz DA, et al. Vaginal douching, bacterial vaginosis, and preterm birth. (Abstract 574). Am J Epidemiol 2001;153:S161.
75. Stevens-Simon C, Jamison J, McGregor JA, et al. Racial variation in vaginal pH among healthy sexually active adolescents. Sex Transm Dis 1994;21:168-72.
76. Brunham RC, Maclean IW, Binns B, et al. Chlamydia trachomatis: its role in tubal infertility. J Infect Dis 1985;152:1275-82.
77. Sellors JW, Mahony JB, Chernesky MA, et al. Tubal factor infertility: an association with prior chlamydial infection and asymptomatic salpingitis. Fertil Steril 1988;49:451-7.
78. Kelver ME, Nagamani M. Chlamydial serology in women with tubal infertility. Int J Fertil 1989;34:42-5.
79. Recommendations for the prevention and management of Chlamydia trachomatis infections, 1993. Centers for Disease Control and Prevention. MMWR Recomm Rep 1993;42(RR-12):1-39.
80. Tubal infertility: serologic relationship to past chlamydial and gonococcal infection. World Health Organization Task Force on the Prevention and Management of Infertility. Sex Transm Dis 1995;22:71-6.
81. Chow JM, Yonekura ML, Richwald GA, et al. The association between Chlamydia trachomatis and ectopic pregnancy. A matched-pair, case-control study. JAMA 1990;263:3164-7.
82. Burstein G, Rompalo A. Chlamydia. In: Goldman MB, Hatch MC, eds. Women & health. San Diego, CA: Academic Press, 2000:273-84.
83. Peters SE, Beck-Sague CM, Farshy CE, et al. Behaviors associated with Neisseria gonorrhoeae and Chlamydia trachomatis: cervical infection among young women attending adolescent clinics. Clin Pediatr (Phila) 2000;39:173-7.
84. Beck-Sague CM, Farshy CE, Jackson TK, et al. Detection of Chlamydia trachomatis cervical infection by urine tests among adolescents clinics. J Adolesc Health 1998;22:197-204.
85. Stergachis A, Scholes D, Heidrich FE, et al. Selective screening for Chlamydia trachomatis infection in a primary care population of women. Am J Epidemiol 1993;138:143-53.
86. Gresenguet G, Kreiss JK, Chapko MK, et al. HIV infection and vaginal douching in central Africa. AIDS 1997;11:101-6.
87. Harrison HR, Costin M, Meder JB, et al. Cervical Chlamydia trachomatis infection in university women: relationship to history, contraception, ectopy, and cervicitis. Am J Obstet Gynecol 1985;153:244-51.
88. Louv WC, Austin H, Perlman J, et al. Oral contraceptive use and the risk of chlamydial and gonococcal infections. Am J Obstet Gynecol 1989;160:396-402.
89. Moss GB, Clemetson D, D'Costa L, et al. Association of cervical ectopy with heterosexual transmission of human immunodeficiency virus: results of a study of couples in Nairobi, Kenya. J Infect Dis 1991;164:588-91.
90. Critchlow CW, Wolner-Hanssen P, Eschenbach DA, et al. Determinants of cervical ectopia and of cervicitis: age, oral contraception, specific cervical infection, smoking, and douching. Am J Obstet Gynecol 1995;173:534-43.
91. Jacobson DL, Peralta L, Farmer M, et al. Cervical ectopy and the transformation zone measured by computerized planimetry in adolescents. Int J Gynaecol Obstet 1999;66:7-17.
92. Moscicki AB, Ma Y, Holland C, et al. Cervical ectopy in adolescent girls with and without human immunodeficiency virus infection. J Infect Dis 2001;183:865-70.
93. Soper DE, Brockwell NJ, Dalton HP, et al. Observations concerning the microbial etiology of acute salpingitis (with discussion). Am J Obstet Gynecol 1994;170:1008-17.
94. Thomason JL, Gelbart SM, Scaglione NJ. Bacterial vaginosis: current review with indications for asymptomatic therapy. Am J Obstet Gynecol 1991;165:1210-17.
95. Jossens MO, Schachter J, Sweet RL. Risk factors associated with pelvic inflammatory disease of differing microbial etiologies. Obstet Gynecol 1994;83:989-97.
96. Pletcher JR, Slap GB. Pelvic inflammatory disease. Pediatr Rev 1998;19:363-7.
97. Washington AE, Katz P. Cost of and payment source for pelvic inflammatory disease. Trends and projections, 1983 through 2000. JAMA 1991;266:2565-9.
98. 1998 guidelines for treatment of sexually transmitted diseases. Centers for Disease Control and Prevention. MMWR Recomm Rep 1998;47(RR-1):1-111.
99. Sweet RL. Role of bacterial vaginosis in pelvic inflammatory disease. Clin Infect Dis 1995;20(suppl 2):S271-5.
100. Ivey JB. The adolescent with pelvic inflammatory disease: assessment and management. Nurse Pract 1997;22:78, 81-4, 87-8, passim; quiz 92-3.
101. Eschenbach DA, Harnisch JP, Holmes KK. Pathogenesis of acute pelvic inflammatory disease: role of contraception and other risk factors. Am J Obstet Gynecol 1977;128:838-50.
102. Neumann HH, DeCherney A. Douching and pelvic inflammatory disease. (Letter). N Engl J Med 1976;295:789.
103. Aral SO, Mosher WD, Cates W Jr. Self-reported pelvic inflammatory disease in the United States, 1988. JAMA 1991;266:2570-3.
104. Scholes D, Daling JR, Stergachis A, et al. Vaginal douching as a risk factor for acute pelvic inflammatory disease. Obstet Gynecol 1993;81:601-6.
105. Quan M. Pelvic inflammatory disease: diagnosis and management. J Am Board Fam Pract 1994;7:110-23.
106. Jossens MO, Eskenazi B, Schachter J, et al. Risk factors for pelvic inflammatory disease. A case control study. Sex Transm Dis 1996;23:239-47.
107. Foxman B, Aral SO, Holmes KK. Interrelationships among douching practices, risky sexual practices, and history of selfreported sexually transmitted diseases in an urban population. Sex Transm Dis 1998;25:90-9.
108. Hirst DV, Bluffs C. Dangers of improper vaginal douching. Am J Obstet Gynecol 1952;64:179-83.
109. Grodstein F, Rothman KJ. Epidemiology of pelvic inflammatory disease. Epidemiology 1994;5:234-42.
110. Paisamtantiwong R, Brockmann S, Clarke L, et al. The relationship of vaginal trichomoniasis and pelvic inflammatory disease among women colonized with Chlamydia trachomatis. Sex Transm Dis 1995;22:344-7.
111. Mueller BA, Luz-Jimenez M, Daling JR, et al. Risk factors for tubal infertility. Influence of history of prior pelvic inflammatory disease. Sex Transm Dis 1992;19:28-34.
112. Cates W Jr, Wasserheit JN, Marchbanks PA. Pelvic inflammatory disease and tubal infertility: the preventable conditions. Ann N Y Acad Sci 1994;709:179-95.
113. Baird DD, Strassmann BI. Women's fecundability and factors affecting it. In: Goldman MB, Hatch MC, eds. Women & health. San Diego, CA: Academic Press, 2000:126-37.
114. Westrom L, Joesoef R, Reynolds G, et al. Pelvic inflammatory disease and fertility. A cohort study of 1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results. Sex Transm Dis 1992;19:185-92.
115. Westrom L. Incidence, prevalence, and trends of acute pelvic inflammatory disease and its consequences in industrialized countries. Am J Obstet Gynecol 1980;138:880-92.
116. Carr RJ, Evans P. Ectopic pregnancy. Prim Care 2000;27:169-83.
117. Parazzini F, Tozzi L, Ferraroni M, et al. Risk factors for ectopic pregnancy: an Italian case-control study. Obstet Gynecol 1992;80:821-6.
118. Ankum WM, Mol BW, Van der Veen F, et al. Risk factors for ectopic pregnancy: a meta-analysis. Fertil Steril 1996;65:1093-9.
119. Pisarska MD, Carson SA, Buster JE. Ectopic pregnancy. Lancet 1998;351:1115-20.
120. Chow WH, Daling JR, Weiss NS, et al. Vaginal douching as a potential risk factor for tubal ectopic pregnancy. Am J Obstet Gynecol 1985;153:727-9.
121. Daling JR, Weiss NS, Schwartz SM, et al. Vaginal douching and the risk of tubal pregnancy. Epidemiology 1991;2:40-8.
122. Phillips RS, Tuomala RE, Feldblum PJ, et al. The effect of cigarette smoking, Chlamydia trachomatis infection, and vaginal douching on ectopic pregnancy. Obstet Gynecol 1992;79:85-90.
123. Kendrick JS, Atrash HK, Strauss LT, et al. Vaginal douching and the risk of ectopic pregnancy among black women. Am J Obstet Gynecol 1997;176:991-7.
124. Bosch FX, Munoz N. Cervical cancer. In: Goldman MB, Hatch MC, eds. Women & health. San Diego, CA: Academic Press, 2000:932-41.
125. American Cancer Society. What are key statistics about cancer of the cervix? (February 2000). (http://www3cancer.org/cancerinfo/load_cont.asp?st=wi&ct=8&Language= ENGLISH#stats).
126. National Cancer Institute. Cervical cancer backgrounder: facts and figures. (February 1999). (http://rex.nci.nih.gov/massmedia/backgrounders/cervical.html).
127. Haverkos H, Rohrer M, Pickworth W. The cause of invasive cervical cancer could be multifactorial. Biomed Pharmacother 2000;54:54-9.
128. Graham S, Schotz W. Epidemiology of cancer of the cervix in Buffalo, New York. J Natl Cancer Inst 1979;63:23-7.
129. Peters RK, Thomas D, Hagan DG, et al. Risk factors for invasive cervical cancer among Latinas and non-Latinas in Los Angeles County. J Natl Cancer Inst 1986;77:1063-77.
130. Brinton LA, Hamman RF, Huggins GR, et al. Sexual and reproductive risk factors for invasive squamous cell cervical cancer. J Natl Cancer Inst 1987;79:23-30.
131. Herrero R, Brinton LA, Reeves WC, et al. Sexual behavior, venereal diseases, hygiene practices, and invasive cervical cancer in a high-risk population. Cancer 1990;65:380-6.
132. Gardner JW, Schuman KL, Slattery ML, et al. Is vaginal douching related to cervical carcinoma? Am J Epidemiol 1991;133:368-75.
133. Slattery ML, Gardner JW. Risk factors for cervical carcinoma: does detection bias play a role? Epidemiology 1991;2:293-6.
134. Stone KM, Zaidi A, Rosero-Bixby L, et al. Sexual behavior, sexually transmitted diseases, and risk of cervical cancer. Epidemiology 1995;6:409-14.
135. Cameron DW, Simonsen JN, D'Costa LJ, et al. Female to male transmission of human immunodeficiency virus type 1: risk factors for seroconversion in men. Lancet 1989;2:403-7.
136. Laga M, Manoka A, Kivuvu M, et al. Non-ulcerative sexually transmitted diseases as risk factors for HIV-1 transmission in women: results from a cohort study. AIDS 1993;7:95-102.
137. Grosskurth H, Mosha F, Todd J, et al. Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial. Lancet 1995;346:530-6.
138. Cohen CR, Duerr A, Pruithithada N, et al. Bacterial vaginosis and HIV seroprevalence among female commercial sex workers in Chiang Mai, Thailand. AIDS 1995;9:1093-7.
139. Sewankambo N, Gray RH, Wawer MJ, et al. HIV-1 infection associated with abnormal vaginal flora morphology and bacterial vaginosis. Lancet 1997;350:546-50. (Published erratum appears in Lancet 1997;350:1036).
140. Royce RA, Thorp J, Granados JL, et al. Bacterial vaginosis associated with HIV infection in pregnant women from North Carolina. J Acquir Immune Defic Syndr Hum Retrovirol 1999;20:382-6.
141. Klebanoff SJ, Coombs RW. Viricidal effect of Lactobacillus acidophilus on human immunodeficiency virus type 1: possible role in heterosexual transmission. J Exp Med 1991;174:289-92.
142. Hill JA, Anderson DJ. Human vaginal leukocytes and the effects of vaginal fluid on lymphocyte and macrophage defense functions. Am J Obstet Gynecol 1992;166:720-6.
143. Helfgott A, Eriksen N, Bundrick CM, et al. Vaginal infections in human immunodeficiency virus-infected women. Am J Obstet Gynecol 2000;183:347-55.
144. Tevi-Benissan C, Belec L, Levy M, et al. In vivo semen-associated pH neutralization of cervicovaginal secretions. Clin Diagn Lab Immunol 1997;4:367-74.
145. Baird DD. The great douching debate: to douche, or not to douche. (Letter). Obstet Gynecol 2000;95:473-4.
146. Osborne NG, Wright RC. Effect of preoperative scrub on the bacterial flora of the endocervix and vagina. Obstet Gynecol 1977;50:148-51.
147. Beaton JH, Gibson F, Roland M. Short-term use of a medicated douche preparation in the symptomatic treatment of minor vaginal irritation, in some cases associated with infertility. Int J Fertil 1984;29:109-12.
148. Manzardo S, Girardello R, Pinzetta A, et al. Activity and tolerability of tetridamine vaginal lavage in rats and women. Boll Chim Farm 1992;131:113-16.
149. Vaginal douching. Presented at the Nonprescription Drug Advisory Committee, Gaithersburg, Maryland, April 15, 1997. (http://www.fda.gov/cder/foi/adcomm/97/joint_ndac_041597_slides_handout- 1.pdf;http://www.fda.gov/cder/foi/adcomm/97/joint_ndac_041597_slides_ handout-2.pdf).
150. Stray-Pedersen B, Bergan T, Hafstad A, et al. Vaginal disinfection with chlorhexidine during childbirth. Int J Antimicrob Agents 1999;12:245-51.
151. Dykes AK, Christensen KK, Christensen P, et al. Chlorhexidine for prevention of neonatal colonization with group B streptococci. II. Chlorhexidine concentrations and recovery of group B streptococci following vaginal washing in pregnant women. Eur J Obstet Gynecol Reprod Biol 1983;16:167-72.
152. Sweeten KM, Eriksen NL, Blanco JD. Chlorhexidine versus sterile water vaginal wash during labor to prevent peripartum infection. Am J Obstet Gynecol 1997;176:426-30.
153. Taha TE, Biggar RJ, Broadhead RL, et al. Effect of cleansing the birth canal with antiseptic solution on maternal and newborn morbidity and mortality in Malawi: clinical trial (with discussion). BMJ 1997;315:216-20.
154. Gaillard P, Mwanyumba F, Verhofstede C, et al. Vaginal lavage with chlorhexidine during labour to reduce mother-tochild HIV transmission: clinical trial in Mombasa, Kenya. AIDS 2001;15:389-96.
155. Biggar RJ, Miotti PG, Taha TE, et al. Perinatal intervention trial in Africa: effect of a birth canal cleansing intervention to prevent HIV transmission. Lancet 1996;347:1647-50.
156. Obaidullah M. A study to determine the effect of Betadine Vaginal Cleansing Kit on cervical flora after insertion of an intrauterine contraceptive device. J Int Med Res 1981;9:161-4.
157. Walker MA. Pneumoperitoneum following a douche. J Kansas Med Soc 1942;43:55.
158. Natenshon AL. Extreme shock and near death resulting from a douche. West J Surg 1947;55:187-8.
159. Forbes G. Air embolism as a complication of vaginal douching in pregnancy. BMJ 1944;2:529-31.
160. Czerwinski BS. Adult feminine hygiene practices. Appl Nurs Res 1996;9:123-9.
161. Majeroni BA. Douching frequency. (Letter). J Fam Pract 1997;45:168-9.
162. Safran M, Braverman LE. Effect of chronic douching with polyvinylpyrrolidone-iodine on iodine absorption and thyroid function. Obstet Gynecol 1982;60:35-40.
163. Udoma EJ, Umoh MS, Udosen EO. Recto-vaginal fistula following coitus: an aftermath of vaginal douching with aluminium potassium sulphate dodecahydrate (potassium alum). Int J Gynaecol Obstet 1999;66:299-300.
164. Wright FW, Lumsden K. Recurrent pneumoperitoneum due to jejunal diverticulosis. With a review of the causes of spontaneous pneumoperitoneum. Clin Radiol 1975;26:327-31.
165. American College of Obstetricians and Gynecologists. Technical bulletin - vaginitis. Washington, DC: The American College of Obstetricians and Gynecologists, 1996.
166. Novitt-Moreno A. American Medical Association health insight: vaginitis. (October 1999). (http://www.ama-assn.org/insight/h_focus/wom_htlh/pelvic/vaginit2.htm).
167. Kendrick JS, Atrash HK, Strauss LT, et al. Summary: vaginal douching and the risk of ectopic pregnancy among black women. (1997). (http://www.cdc.gov/nccdphp/drh/rem_douch.htm).
168. Centers for Disease Control and Prevention. Sexually transmitted disease facts - bacterial vaginosis. (September 2000). (http://www.cdc.gov/nchstp/dstd/Fact_Sheets/FactsBV.htm).
169. Pelvic inflammatory disease: guidelines for prevention and management. MMWR Recomm Rep 1991;40(RR-5):1-25.
170. Centers for Disease Control and Prevention. Family planning methods and practice: Africa. Atlanta, GA: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services, 2000.
171. National Institute of Allergy and Infectious Diseases. Vaginitis. (April 2000). (http://15640883/publications/pubs/vag5htm).
172. National Institutes of Health, Baird DD, Voight LF, et al. NIH study: among women who want to get pregnant, douching may delay conception. (October 1996). (http://www.niehs.nih.gov/oc/news/douche.htm).
173. National Institute of Allergy and Infectious Diseases. Fact sheet - pelvic inflammatory disease. (July 1998). (http://www.niaid.nih.gov/factsheets/stdpid.htm).
174. National Institute of Allergy and Infectious Diseases. Fact sheet - an introduction to sexually transmitted diseases. (July 1999). (http://www.niaid.nih.gov/factsheets/stdinfo.htm).
175. National Institute of Allergy and Infectious Diseases. Fact sheet - vaginitis due to vaginal infections. (June 1998). (http://www.niaid.nih.gov/factsheets/stdvag.htm).
176. National Women's Health Information Center. Douching. (December 2000). (http://www.4woman.gov/faq/douching.htm).