The current finding is inconsistent with the hypothesis that bacterial vaginosis mediates the association between douching and upper genital tract disease. If that were the case, douching women with bacterial vaginosis would be more likely to have upper genital tract findings. However, an explanation could be that douching initiates endometritis by increasing the ascension of vaginal bacteria into the upper genital tract. Women with bacterial vaginosis may already have high rates of bacterial movement into the endometrium, but women with normal or intermediate vaginal flora may not. Therefore, inciting upward bacterial movement may initiate endometritis in women with normal or intermediate flora, but may not alter the rates of endometritis in women who already have bacterial vaginosis. Similarly, women with gonococcal or chlamydial cervicitis may get upper genital tract disease independent of douching, whereas in women without these pathogens, douching may initiate nongonococcal, nonchlamydial upper genital tract disease.
The current finding is inconsistent with the hypothesis that bacterial vaginosis mediates the association between douching and upper genital tract disease. If that were the case, douching women with bacterial vaginosis would be more likely to have upper genital tract findings. However, an explanation could be that douching initiates endometritis by increasing the ascension of vaginal bacteria into the upper genital tract. Women with bacterial vaginosis may already have high rates of bacterial movement into the endometrium, but women with normal or intermediate vaginal flora may not. Therefore, inciting upward bacterial movement may initiate endometritis in women with normal or intermediate flora, but may not alter the rates of endometritis in women who already have bacterial vaginosis. Similarly, women with gonococcal or chlamydial cervicitis may get upper genital tract disease independent of douching, whereas in women without these pathogens, douching may initiate nongonococcal, nonchlamydial upper genital tract disease.
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