Few
studies have been conducted to assess3–5 the independent
association between douching and PID.
In the current case– control studies, after adjustment for
confounding factors, one study involving predominantly
white women reported a substantial elevation in risk (odds
ratio [OR] 2.1 for douching in the previous 3 months),4 and
two studies separately analyzing black women and white
women found the risk limited to white women.3,5 However,
this finding may have resulted from the limited sample sizes
within race-specific strata or the relatively small number of
black control women who douched. Moreover, several retrospective
studies and a meta-analysis have related douching
to infertility or ectopic pregnancy, both reproductive
consequences from PID.6–13
Douching may alter the number and type of microorganisms
inhabiting the vagina.14 An outstanding question is
whether douching predisposes to PID through this mechanism.
One prospective study of vaginal microecology
showed that douching predisposes to bacterial vaginosis.15
Douching also increased the risk of PID, but not PID
associated with Neisseria gonorrhoeae or Chlamydia trachomatis
in one study.3
This article reports cross-sectional comparisons of douching
patterns between women with clinical PID enrolled in
the PID Evaluation and Clinical Health (PEACH) Study
who were found to have endometritis and/or gonococcal or
chlamydial upper genital tract infection (UGTI) and women
who had neither endometritis nor UGTI.