Clinical pearls:
- Douching and
not talc was associated with increased risk of ovarian cancer in the sister
study.
- ACOG and NHS
both does not support douching and other vaginal washing practices that do more
harm than good by eliminating the healthy vaginal flora.
A National
Health study in US linked the age old ritual of douching to subsequent development
of ovarian cancer. Women who douche have nearly twice the risk as compared to
women who do not practice it.
According to
Department of Health and Human services(HHS) one quarter of women between the
ages of 15 and 44 practice douching. [1]
Studies have linked douching to Bacterial Vaginosis, Pelvic Inflammatory Disease(PID),
STIs, including HIV, preterm birth, ectopic pregnancy and vaginal irritation or
dryness. [2]
A meta-analysis of more than 10,000 HIV-negative women in sub-Saharan Africa
found that intravaginal use of drying agents was associated with an increased
risk of BV and HIV.[3]
American
College of Obstetricians and Gynecologists (ACOG) and most practitioners
strongly advice against douching and ACOG list it as one of the cause of
vaginitis, women continue to practice it because of they see it as a cleaning
ritual leading to positive health benefits.[4]
The NHS also advise against douching and use of scented wipes and vaginal
deodorants.
The new National
Institute of Environmental Health Sciences study published online on 20
June,2016 in the Epidemiology Journal recruited 50,884 participants
of the “Sister study” and followed them to see the link between douching and
ovarian cancer. [5]The
sister study is conducted by the National Institute of Environmental Health
Sciences of the US Department of Health and Human Services. The study enrolled 50,884 women
between ages 35–74 whose sister have breast cancer and followed them from 2003
to 2009, across all 50 US states and Puerto Rico. Due to the shared environment and genetics,
this landmark study provides a great chance of identifying risk factors for
breast cancer.
All the
women were free of breast or ovarian cancer at baseline. The women were asked
about douching and use of talc during the previous 12 months before enrolment.
At the end
of the follow up period (median 6.6 years) 154 women were diagnosed with
ovarian cancer. Women practicing douching has nearly twice the odds of
developing malignancy as compared to women who did not douche. The association
looked even stronger when only women without the breast cancer gene in the
family were analyzed.
Contrary to
previous studies, this particular study did not find any association between
talc use and ovarian cancer. (HR=0.73) although talc users were twice as likely
to practice douching. (OR=2.1)
This is the
first study to trying to find a link between douching and ovarian cancer.
Senior
author Clarice Weinberg commented: “There are a number of health reasons not to
douche, and I can’t think of any reason to do it.”
Vagina
cleans itself naturally and douching cause more harm by cleaning away the
healthy bacterial flora. The Office on Women's Health at the U.S. Department of
Health and Human Services (HHS) says that due to squirting of the douching
solution the bacteria are pushed inside uterus, fallopian tube causing PID.
A study
conducted by Brown, J et al in 2016 shows women practice intravaginal washing
due to personal hygiene and sexuality. It is common to get cleaned up after or
before sex. Majority of these women learn the practices from their mothers or electronic
or print media. Many women believe that since departmental stores aisles are
packed with these products of personal hygiene, they must be safe to use.
But douching
products do not fall under FDA regulation, as they are considered cosmetics. Hence,
these products do not have to undergo safety tests like drugs.
The pilot
study does not prove causation and larger studies are needed in the area.
Perhaps women who douche frequently might have other pathologies going on which
may be the cause for the behavior. We need to see more studies in the future.
[1]Centers for Disease Control and Prevention.
(2013). Key Statistics from the National Survey of Family Growth,
2006–2010.
[2] http://womenshealth.gov/publications/our-publications/fact-sheet/douching.html#
[3] Low
N, Chersich MF, Schmidlin K, Egger M, Francis SC, van de Wijgert JH, et al.
Intravaginal practices, bacterial vaginosis, and HIV infection in women:
individual participant data meta-analysis. PLoS medicine. 2011;8(2):e1000416.
[4] http://www.acog.org/Patients/FAQs/Vaginitis
[5] http://journals.lww.com/epidem/Abstract/publishahead/Douching,_Talc_Use,_and_Risk_of_Ovarian_Cancer_.98997.aspx
