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To douche or not?

October 2, 2008 |  3:29 pm

Among our always-compelling health mail, we just received word of a breakthrough that at last, we're told, offers hope to the "millions of women" who have been "suffering in silence because of embarrassing feminine odor," finally "making this difficult subject worth talking about."

The breakthrough? "An FDA-approved device that neutralizes vaginal odor by using tap water combined with a medical-grade stainless steel nozzle" that could serve as a "safe and effective alternative to commercial chemical-based douching products," the release explains. In a study, we further learn, women who cleansed themselves with this device "experienced a significant reduction and/or elimination of vaginal odor compared to those who used placebo only." The device is called WaterWorks and is endorsed in press materials by celebrity sexual health urologist Dr. Jennifer Berman of Beverly Hills, who says it could help women boost their “genital self esteem.”

Maybe I'm being insensitive. Or maybe no one's yet drawn me aside to have a quiet word in my ear. But really, is this "difficult subject" as difficult as it's made out to be in the copious WaterWorks press materials? Or is this perhaps another example of what some would call an over-medicalization of the natural state of the human body? (Some body parts, let's face it, emit odors.) And although "FDA-approved" may sound fancy, this may not mean more than the FDA declaring something safe. Given where this device is being put, we would hope very much it was so.

Here are some statements on vaginal douching by various groups/agencies:

The U.S. Department of Health and Human Services advises women not to do it: "Most experts believe that douching increases a woman's chances of infection. The only time a woman should douche is when her doctor recommends it ... it is important to note that even healthy, clean vaginas may have a mild odor."

The American College of Obstetricians and Gynecologists advises against douching in a number of its educational pamphlets, including the one above in which it notes that douching can alter the balance of microbes in the vagina, and another in which it says "To help clear up certain vulvar problems or prevent them from coming back, you doctor may ask you to ... not douche or use feminine sprays or talcs."

Here's an article on MedicineNet.com that says most doctors don't advise douching. "Doctors and the ACOG suggest women avoid douching completely. Most experts believe that douching increases a woman's chances of infection. The only time a woman should douche is when her doctor recommends it," the article states. And it adds, in case of odor, "Douching will only cover up the smell. It will not make it go away. If your vagina has a bad odor, you should call your doctor right away. It could be a sign of a bacterial infection, a urinary tract infection, an STD or a more serious problem."

WaterWorks, through avoiding use of irritating fragrances and cleansers, claims to avoid some of the issues of commercial douches. A four-week pilot study, published 2006 in the journal Infectious Diseases in Obstetrics and Gynecology, examined whether the number of good, lactobacillus bacteria went down, whether there were more adverse events than in the placebo, including development of bacterial vaginosis, caused by an imbalance of bacteria in the vagina. It reported it found no significant differences but that women in the study reported reduced vaginal odor.

But this was a study on 10 women for four weeks, and the odor change was self-reported by the women -- the study authors themselves note that this was a methodological drawback. Abbott, which manufactures the device, has done a larger study since then -- again, for four weeks -- on about 100 women, but as far as I can tell, it hasn't been published.

In any case, it is not clear that this means any change in mainstream medical opinions on the issue.

-- Rosie Mestel

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