Ditch the Douche

Today we are going to talk about douching. The word "douche" is the French verb for "to clean". In the United States and many other parts of the world, douching is the act of flushing out the vagina with water, vinegar, "feminine washes", or other liquids. Douching is still relatively common with 1 in 4 women between the ages of 15 and 44 regularly practicing it in the US. Women of color are more likely to douche than their Caucasian counterparts, and teenagers of all races commonly do it1. With so many people engaging in the practice of douching, it is important to take a look at the impact that douching can have on your health and wellness, and the reasons why people started doing it in the first place.

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This is a douche

History of the douche and why people use them
Vaginal flushing or "washing" has been used since ancient times (some sources even trace it back to the time of Hippocrates) as a means of keeping the vagina clean.  The thing to keep in mind here, is that during that time, hygiene practices were not what they are today.  Most people could not bathe on a regular basis, and the same clothes were often worn for weeks (or longer) at a time without proper washing.  This led to an higher risk of developing infections and diseases.  Douching during this time may or may not have helped with hygiene.  There is no way to know for certain. 

Douching in contemporary times seems to have been brought back around 1832 when it was recommended by a doctor that women douche to prevent pregnancy.2  With the passage of the Comstock Law in 1872, references to birth control were outlawed because they were deemed to be immoral and obscene.3 Of course, just because it was now illegal to discuss birth control, didn't mean that women stopped caring about it.  Now that they could not use any references to preventing pregnancy, people began using euphemisms, some of the most common being "preventing odors", "uterine tonics", "curing pregnancy", "removing obstructions", and "private difficulties".  Before the era of reliable birth control, so any time before the rise of the modern condom in the early 20th century, women passed down (usually unreliable) tips on how to avoid getting pregnant.  This has led to many misconceptions (forgive the pun) about how babies are made (you can still get pregnant if the woman is on top, if you have sex in water, regardless of what you eat or drink afterward, or if you jump up and down after sex).The practice of douching to prevent pregnancy had a huge resurgence in the 1920's during the sexual revolution, and continued being practiced widely through the 1950's.  In fact, by 1940, douching was the most popular form of birth control in the United States.4

The premise behind the idea of using douching to prevent pregnancy is that you can wash the sperm out of the vagina, and therefore, not get pregnant.  Before we continue, let's break down what happens physiologically during sex to explain why this doesn't work.  When you have sex, the vagina creates fluid designed to keep sperm alive and move them toward their goal (the egg).  Around the time of ovulation, this fluid is at it's peak, and you may notice that your vagina is a bit wet even when you are not aroused.  The cervix (neck of the uterus) is open around the time of ovulation as well, to allow the sperm in.  When you have sex, your uterus contracts to make a vacuum which literally sucks the sperm into it.  Meaning, that by the time you are finished, and he pulls out, there are already sperm inside your uterus.  Therefore, rinsing your vagina out, will not be effective at preventing pregnancy.

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Fun fact:  Did you know that when it was first created, Lysol was used as not only a household cleaner, but as a douching fluid?  Lysol even started marketing it as a form of birth control (although they were not allowed to call it "birth control" and instead used the accepted euphemism that it "prevents odors" ) making it one of the most common fluids used.  In 1933, there was a study that found that of the 507 women questioned who used Lysol douching as a form of birth control nearly half got pregnant.  There were nearly 200 reported cases of Lysol poisoning from douching, and at least 5 deaths before 1911. Those are only the cases that were discovered and reported, and forensics and record keeping were far less sophisticated in the very early 20th century.  In 1952, after many hushed up lawsuits, Lysol changed it's formula to make it 1/4 as toxic, meaning that what we have now is far safer than what women were flushing out their vaginas with in the early 20th century.  Would you use Lysol that way now?  (DO NOT USE LYSOL AS A DOUCHE!) 4

This is a douche where it belongs

Once the Pill became readily available in 1960, there was a sharp decline in women douching.  Since the primary reason for douching was to prevent pregnancy, now that there was an easier and more effective option, what reason was there to still douche?  Companies who made douches had to figure out a way to get women to continue buying their products.  As early as the 1920's douche brands were telling women that they were dirty and smelled bad, but this message was secondary to the birth control issue.  Now that there were more effective methods of birth control, companies started doubling down on the dirty and smelly theme.  New ad campaigns were released to push this assertion, and douches were given scents and sometimes flavors to back it up.  This myth still persists today and is one of the most common reasons that women give for douching.

Here's the thing... your vagina smells like a vagina, and that is what it is supposed to smell like.  The smell/taste may change a bit based on what you eat, but for the most part, it smells exactly the way that it is supposed to.  That being said, if it starts to smell remarkably different especially in a bad way, this is not the time to reach for a douche, but to reach for a phone to call your doctor.  There are certain infections that can cause the vagina to smell bad, and these should be addressed by a healthcare professional, and not by just squirting perfume in there.

As for being "dirty", this is a myth as well.  Your vagina is a perfectly balanced ecosystem of it's own full of fluids and good bacteria and flora that are designed to keep it clean.  The vagina is often referred to as a "self-cleaning oven" of sorts.  As long as you let it do it's thing, it will stay clean.  Introducing things like "feminine washes" to your vagina can actually kill the good bacteria, introduce bad bacteria and lead to in increase in infections.  Using douches actually increases your likelihood of developing urinary tract infections (UTIs), vaginal infections, pelvic inflammatory disease (PID), pregnancy complications, infertility, vaginal cancer, cervical cancer, and even STDs/STIs. 1,2,4,5

This idea that you are a dirty and that douching will help, has lead to some very unhealthy practices, mainly using douches to prevent STDs.  This practice became very popular in the late 1980's in response to the AIDS epidemic. Douches  do not, I repeat, DO NOT prevent sexually transmitted diseases and infections.  The best way to prevent STDs/STIs is by using condoms (male and female versions are both available) and dental dams, and by getting yourself tested regularly if you or your partner is having sex with more than one person.  There is NO shame in regular testing, and it is important to prevent the spread of so many of these diseases and infections.  Most infections are easily treated with anti-biotics, or can be managed with medications and safe practices. 4 

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What's in a douche?
How many of you look at the ingredient list on all of the products you buy?  Many people are starting to look at the ingredients of the food they consume, but fewer people realize that it is just as important to pay attention to beauty and hygiene products.  I generally say "What goes on your body, goes in your body" because products on your skin are absorbed and metabolized by your body, but in this case, a douche is something that you are quite literally putting into your body.

Over the years, many liquids have been used for douching.  Some of these include:

• Lysol/Bleach
• Coca-cola
• Vinegar
• Water
• Salt water
• And a lot more...

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To the right is a series of pictures of ingredients lists on various brands of (top to bottom) wipes, douches, sprays, and washes.  A good rule of thumb:  If you wouldn't ingest it, you probably shouldn't insert it anywhere else.  Would you ingest any of these? (DO NOT INGEST THESE!)

Alternatives to douching
​​​Luckily, while it is still widely practiced, the rates of douching are going down. What happened the last time that douching rates went down?  Companies rebranded and changed the focus.  We see that happening again.  A lot of companies that make douches are starting to make external products like shampoos and wipes.  We even see companies making wet wipes that "should be used" not only after sex, but after using the bathroom.  These are a bad idea.  Regardless of what the packages say, "flushable wipes" do not decompose and cause very extensive and very costly damage to our pipe and sewer systems.6  The wipes basically build up and get stuck in pipes causing blockages not to mention the environmental impact that all of these "flushable" wipes cause when they get into our water sources.  These external products DO NOT lead to a decrease in diseases or infections but much like their parents (douches) they can actually lead to an increased likelihood of developing them. 

As another alternative, many women are turning to vaginal, or yoni, steams.  This is just another variation of the douche, and once again, they are completely unnecessary.  They do not clean your vagina, and much like their douche and external cleaning relatives, they can lead to an increase in the rates of infections.  Some places that do the steams are also not careful and can have stools that are too close to the steam or make the steam to hot, which can lead to burning and blistering of the vulva.  Just let your vagina do its thing.  It will take care of itself.  

If you have just had a surgery or delivered a baby, your doctor or midwife may suggest herbal sitz baths.  These are different.  The blend of herbs is designed to help with healing to an area that has experienced trauma and can be very helpful.  If you doctor or midwife has recommended sitz baths or perineal sprays to help with healing, they should be safe to use.  Always read the labels and make sure that there is nothing questionable.  Any herb bundle or spray that you get should have an ingredient list.  If you cannot find a list of ingredients, do not use it.  If there are any ingredients you are unsure of, ask your care provider.  If you have not had trauma to your pelvic floor and a doctor has not prescribed their use, there is not really a reason to use these products.

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Do you douche?  What are your thoughts?  Tell us in the comments!

Sources:
​1: "Douching." Womenshealth.gov. US Department of Health and Human Services, 18 Apr. 2017. Web. 18 June 2017.
      https://www.womenshealth.gov/a-z-topics/douching
2: Kati. "So Fresh & So Clean: A Brief History of Douchebags." Girls Are Awesome, 17 May 2017. Web. 21 June 2017.
    https://girlsareawesome.com/people/fresh-clean-investigating-history-douchebags/
3: The Editors of Encyclopædia Britannica. "Comstock Act." Encyclopædia Britannica. Encyclopædia Britannica, Inc.,       15 Feb. 2017. Web. 21 June 2017. https://www.britannica.com/event/Comstock-Act
4: Buck, Stephanie. "The Sexist, Toxic History of Douching – Timeline." Timeline. Timeline, 14 Aug. 2016. Web. 21           June 2017.  https://timeline.com/sexist-history-douching-bcc39f3d216c
5: "Vaginal Douching: Helpful or Harmful?" WebMD. WebMD, n.d. Web. 21 June 2017.
    http://www.webmd.com/women/guide/vaginal-douching-helpful-or-harmful
6: Watson, Bruce, and A New York-based Writer Who Reports on Finance, Food and Culture for the Guardian,                 Esquire, and DailyFinance. "Don't Believe the Label 'flushable': Disposable Wipes Clog Sewers around the                   World." The Guardian. Guardian News and Media, 26 May 2015. Web. 21 June 2017.
    https://www.theguardian.com/sustainable-business/2015/may/26/disposable-wipes-sewer-toilet-cities-flushable