Douching and endometritis: Results from the PID evaluation and clinical health (PEACH) study

Background: Douching has been related to risk of pelvic inflammatory disease (PID). Goal: To examine the association between douching and PID in a large, multicenter, clinical trial of PID after adjustment for race/ethnicity. Study Design: Interviews were conducted with 654 women who had signs and symptoms of PID. Vaginal Gram stains and upper genital tract pathology/cultures were obtained from all the women. Women with evidence of plasma cell endometritis and/or gonococcal or chlamydial upper genital tract infections were compared with women who had neither endometritis nor upper genital tract infection. Results: Women with endometritis or upper genital tract infection were more likely to have douched more than once a month or within 6 days of enrollment than women who never douched. These associations remained after adjustment for confounding factors, after analysis of black women only; and among women with normal or intermediate vaginal flora but not bacterial vaginosis. Conclusion: Among a predominantly black group of women with clinical PID, frequent and recent douching was associated with endometritis and upper genital tract infection.