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MONDAY, Jan. 5 (HealthDayNews) -- For years, doctors have warned women that douching is not only unnecessary but it can also be hazardous, upsetting the vagina's natural environment of "good bacteria."

Even so, the practice is still common, reports Mary Ann Iannacchione, a clinical research nurse at Duke University Medical Center, and author of a review article, "The Vagina Dialogues: Do You Douche?" that appears in the January issue of the American Journal of Nursing.

Drawing on the last two National Surveys of Family Growth, a project of the federal government, Iannacchione found the number of women who reported douching as a common practice declined from 1988 to 1995, the latest two surveys available. In 1988, 37 percent of 8,450 participants said they douched regularly; in 1995, 27 percent of 10,857 participants said they did so.

In Iannacchione's view, that percentage is still unacceptably high. Part of the problem, she suspects, might be that the topic of douching is overlooked during routine physical exams at the gynecologist's office. "I think it's a question that is not even asked," says Iannacchione. "It isn't talked about."

In her research, she found some interesting information about who douches and why. For instance, black women are more likely than white or Hispanic women to douche. Poorer women are about twice as likely to douche as those who are more affluent. And those without health insurance are more likely to douche than those who have insurance.

Black women often credit their mothers or other relatives with recommending the practice to them early in life, Iannacchione found.

Of course, advertising may play a role, too. In her research, Iannacchione found an advertisement from 1948 promoting the use of Lysol, the disinfectant, for feminine hygiene and as a cure for "marital problems."

These days, women are more likely to use commercial products for douching than homemade solutions such as vinegar or soap, she found.

Iannacchione got interested in researching the topic while she was investigating risk factors for pre-term birth. "Douching kept coming up [in the medical literature] as a risk factor," she says.

"Douching regularly could increase your risk for infection," Iannacchione tells women who are adamant about continuing the practice. "It can overtake the good bacteria."

In her research, Iannacchione found many reasons women gave for regular douching, including cleanliness, to prevent or control odor or itchiness. Some had the mistaken believe that douching after sex would prevent pregnancy or sexually transmitted diseases.

Like Iannacchione, the American College of Obstetricians and Gynecologists (ACOG) recommends against the practice.

"It is better to let the vagina cleanse itself," says ACOG spokesman Greg Phillips. Many factors can affect the normal bacterial balance of the vagina, including douches, antibiotics, spermicides and sexual intercourse, he says.

More information

For more information on the risks of douching, visit the American Academy of Family Physicians. The Nemours Foundation has details on douching's inability to prevent pregnancy and sexually transmitted diseases.

(SOURCES: Mary Ann Iannacchione, R.N., clinical research nurse, Duke University Medical Center, Durham, N.C.; Greg Phillips, spokesman, American College of Obstetricians and Gynecologists, Washington, D.C.; January 2004 American Journal of Nursing )

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