Cox News Service

- Her mother did it, so Monica McGhee always believed that douching was the only means of washing away feminine odor. Besides, a doctor once told her that the age-old practice was the equivalent of washing one's hands.

"I grew up believing that that was how you kept yourself clean," said McGhee, who no longer douches.

But a growing body of research suggests that douching has no benefits and that money spent on feminine hygiene sprays, powders and wipes is money wasted. Some doctors and researchers suggest that douching may even be harmful, but their position is disputed by others and by manufacturers. The federal government has said only that more research needs to be done.

"Women should think hard about whether they need to do this, discuss it with their doctor," said Dr. Juliette S. Kendrick, medical epidemiologist at the U.S. Centers for Disease Control and Prevention in Atlanta. "And without question, women who have an odor or feel discomfort should seek medical care."

According to Kendrick, some 16 million American women, or 27 percent of those ages 15 to 44, douche regularly; other estimates put the number closer to 40 million. The rate is highest among African-American and Southern women, such as McGhee, and among those with little education.

Though the numbers may have fallen since the late 1980s, when surveys suggested that at least 37 percent of women douched, sales of douching products still total more than $144 million a year. And, in a recent guide published to help drugstores identify items they should always keep in stock, three of the five feminine care products listed are commercial douches.

The reasons women douche are not well understood, but when queried, most cite cleanliness. Most use commercial products containing vinegar and water, advertised to make them feel "fresh as a summer's eve." They also do it because their mothers did or to keep themselves clean after their periods or sexual intercourse.

In her 1997 novel "How Stella Got Her Groove Back," Terry McMillan devoted nearly half a page to feminine sprays, wipes and douching, writing, "I don't care what those gynecologists say about using up good bacteria and increasing your risks for infection."

But, in fact, the vagina cleanses itself through normal discharge. And douching may "use up good bacteria" and leave women open to the infection bacterial vaginosis. It can also leave them vulnerable to sexually transmitted diseases, because the naturally occurring bacteria provide some protection.

Kendrick said that douching is associated with bacterial vaginosis, and research has shown that women with the infection are at risk for pre-term delivery of their babies and possibly at increased for HIV and pelvic inflammatory disease, also known as PID.

Some studies, Kendrick said, indicate that douching can cause ectopic pregnancy (in which the fertilized egg attaches inside the fallopian tube instead of the uterus), infertility or low birth weight.

The possibility of having a pre-term baby was suggested in a recently completed study of douching by Kendrick and Julie Gazmararian, vice president of the USQA Center for Healthcare Research at Aetna. Their research found that 24 percent of black participants in the study douched at least once a week, and 26 percent of them had delivered a pre-term baby. Among white women, 15 percent douched at least once a week and 7 percent had delivered a pre-term baby.

The study participants - 34 black and 27 white women from managed care clinics in Memphis - did not perceive any satisfactory alternative to douching, and their resistance to discontinuing douching was strong. A larger nationwide study is being planned with the University of Alabama to gather more data; results are expected in three years.

Research showing adverse effects of douching was published as early as the 1940s. By the early 1990s, numerous studies had found correlations between douching and adverse gynecological effects. But doctors remain divided over the scientific data.

"The data is right. The interpretation is wrong," said Dr. Gilles Monif, former special interest consultant for the American College of Obstetricians and Gynecologists. "It's wrong because it does not factor in that a significant percentage of these women, particularly those who present to family planning clinics, also have a sexually transmitted disease, primarily chlamydia trachomatis."

Gilles, president of Infectious Diseases Inc., a research company, said that epidemiological studies have established an association between douching and some adverse outcomes.

"However, guilt by association is not proof. The question of "to douche or not to douche' has not been addressed properly or answered conclusively."

The U.S. Food and Drug Administration, which regulates douching products (they're labeled as cosmetics), agrees. It reviewed data about douching in 1997 and has not yet issued a ruling.

"The general feeling was that more study needed to be done," said Susan Cruzan, FDA public affairs specialist.

Leslie Ashburn, a spokeswoman for GlaxoSmithKline, the maker of Massengill douches, the leading brand with 45 percent of the market, said there is no "credible scientific or medical basis for concluding that douching in general, or the use of the Massengill product in particular, has any causal relationship with PID or other health problems."

But Ashburn said that because GlaxoSmithKline understands that women might have concerns, Massengill package inserts describe the warning signs of sexually transmitted diseases and vaginal infections. The company has added a warning to the product label about the reported link between douching and PID and has established a toll-free telephone number for women who have questions about feminine hygiene issues and product use.

In 1997, the manufacturer faced a legal challenge from the National Black Nurses Association for the unauthorized use of the organization's name and logo in advertisements in Essence and Heart & Soul magazines. The nurses have since issued an emergency resolution opposing vaginal douching. Neither the association nor GlaxoSmithKline would comment on the legal challenge or its outcome.

Copyright 2001 Cox News Service. All rights reserved.