Douche: Uses, Safety, Alternatives

A douche is a bottle or a bag that holds water or other fluids to clean an internal body cavity. Vaginal douching involves using a douche to clean the vagina, while anal douching cleans out the rectum.

Some people douche to feel clean, relieve itching, or for sexual hygiene. However, most healthcare providers don’t recommend it because it disrupts the natural pH (acid-base) balance, leading to infections and other health problems. 

Douche setups can vary include a container for the fluid and a tube or nozzle, typically made of soft plastic, rubber, or silicone. Check the product for latex if you have a latex allergy. To use a douche, gently insert the tip and squeeze the fluid upward into your vagina or rectum. 

Examples of fluid containers include:

• Bulb syringes, or anal douche bulbs
• Bottles, such as water bottles
• Bags, like hot water bottles or enema bags

Some people buy commercial douche solutions while others make theirs at home. Ingredients may include:

• Antiseptics (cleansers)
• Baking soda
• Fragrance 
• Herbs
• Plain water or saline (salt water)
• Soaps
• Vinegar

The vagina cleanses itself naturally, shedding dead cells and fluid that wash away bacteria, menstrual blood, and semen. However, some people still douche due to the following:

• Cultural or religious traditions
• More sexual pleasure
• Itch relief
• Menstrual cycle (period) hygiene
• Personal hygiene 
• Sexual hygiene
• To tighten the vagina 
• Trying to avoid sexually transmitted infections (STIs); not effective
• Trying to prevent pregnancy; not effective
• Vaginal odor

The vagina also has healthy bacteria, such as Lactobacillus, which maintain a slightly acidic pH level that protects against infections and irritation by preventing harmful bacteria and yeast from growing. Healthcare providers advise against douching because it disrupts this natural pH balance.

The American College of Obstetricians and Gynecologists (ACOG) doesn’t recommend douching because it disrupts the natural protective mechanisms of the vagina, making it more susceptible to infections, infertility, and pregnancy complications.

Bacterial Vaginosis (BV) and Yeast Infections

Douching washes away good bacteria and disrupts pH balance. As a result, the vaginal pH becomes less acidic and more neutral, which creates a better environment for harmful bacteria and yeast, causing bacterial vaginosis (BV) or yeast infections.

BV is an overgrowth of normal bacteria that are already present in the vagina, while yeast infections are an overgrowth of yeast (usually Candida).

Urethral and Vaginal Skin Irritation 

Douching with fragrances or chemicals can lead to skin irritation, microtears, dryness, and allergic reactions in the delicate tissues of the vagina and urethra (the tube that carries urine).

This skin breakdown creates openings that allow harmful bacteria, viruses, and yeast to enter, increasing the risk of infections or vaginitis (irritation and swelling of the vagina). It can also worsen existing vaginitis.

Urinary Tract Infections (UTIs)

A urinary tract infection (UTI) begins in the urethra and can spread to the bladder, causing symptoms like pain with peeing, frequent urges to pee, and pelvic discomfort. Douching increases the risk of UTIs by causing irritation and small tears in the delicate tissues of the urethra.

Since the vagina and urethra sit right next to each other, bacteria and yeast from the vagina can easily travel to the urethra, which increases the risk of developing UTIs more.

Sexually Transmitted Infections (STIs) 

Douching can make the vagina more vulnerable to sexually transmitted infections (STIs) because it disrupts its pH balance and washes away protective bacteria. Examples of STIs include chlamydia, gonorrhea, trichomoniasis, herpes, human papillomavirus (HPV), and human immunodeficiency virus (HIV).

Douching can also prolong HPV infections by disrupting the vagina’s natural defenses against viruses.

Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease (PID) is a severe infection that occurs when vaginal infections (and STIs) move up into the uterus, fallopian tubes, and ovaries. Douching can push germs further into the reproductive tract.

PID can lead to permanent damage in the female reproductive organs, leading to infertility (inability to get pregnant).

Infertility and Pregnancy Complications

Douching can wash away healthy vaginal bacteria that help sperm survive, lowering the chances of successful fertilization (sperm and egg combining). PID can also harm the fallopian tubes that transfer the egg from the ovaries to the uterus (womb), making it difficult for eggs and sperm to meet. 

During pregnancy, douching reduces the protective barrier of the cervix (opening to the uterus), making it easier for vaginal infections to move up and reach the developing baby. This can increase the risk of miscarriage, low birth weight, premature birth, and ectopic pregnancy (nonviable pregnancy where the embryo implants outside the uterus). 

Risks of anal douching include:

• Tissue damage and rectal bleeding: Harsh chemicals, pressure, and a large fluid volume can irritate the delicate tissues of the rectum and anus, leading to inflammation, allergic reactions, or tearing. It also increases the risk of rectal bleeding after anal sex.
• Infection: Similar to vaginal douching, anal douching can disturb the balance of bacteria in the rectum, potentially increasing the chances of an infection. Disruption of the rectal tissue can also increase the vulnerability to STIs, including HIV.
• Dehydration: Enemas can lead to diarrhea and dehydration.

To keep the vaginal area clean and odor free without douching, gently wash the vulva (outer area) daily with warm water using your fingers or a soft cloth. You don’t need to use soap. If you prefer soap, choose one that is mild and fragrance free.

For sensitive skin or after childbirth, consider using a peri bottle (squirt bottle) or sitz bath (a warm, shallow bath in a basin placed on the toilet or in a bathtub).

Here are some additional tips: 

• Avoid scented tampons, pads, powders, and sprays to reduce irritation
• Avoid wearing wet clothing for extended periods 
• Change pads and tampons regularly during your menstrual period
• Get regular STI screenings if you are sexually active
• Opt for breathable cotton underwear and loose-fitting clothes 
• Practice safe sex using condoms or other barrier methods
• Pee after sex to reduce the risk of UTIs
• Wipe from front to back when using the restroom to prevent bacteria from spreading from the anus to the vagina or urinary tract

Regularly washing the external anal area with warm water and fragrance-free soap is enough to keep it clean. Regularly pooping helps keep the rectum naturally clean. You might also try a bidet for thorough cleaning with water. Keep washes short and use low water pressure to avoid discomfort, itching, or bowel control issues.

Healthy vaginal discharge is typically clear to white with a mild odor. If the odor becomes strong and you’re trying to mask it, it might indicate a medical condition needing treatment.

Contact a healthcare provider if you experience:

• Abnormal vaginal discharge (different from your usual)
• Bumps, sores, or warts in the genital area
• Fever or chills with vaginal symptoms
• Vaginal odor despite hygiene practices
• Painful sex
• Pain in the pelvic area or lower belly
• Pain or burning when peeing
• Redness, swelling, or unusual sores in the vaginal area
• Symptoms that persist despite home care
• Thick or frothy vaginal discharge
• Vaginal pain, itching, irritation, or burning
• Yellow, green, or gray discharge

Rectal or anal symptoms that indicate a need to see a provider include:

• Incontinence (loss of bowel control)
• Lumps or bumps
• Pain or itching in the anal or rectal area
• Rectal bleeding, regardless of amount or color
• Persistent constipation, diarrhea, or mucus in the stool

Vaginal and anal douching involves rinsing the areas with water or solutions. While some believe it improves hygiene or treats odor, healthcare providers typically advise against it.

Douching can disrupt natural pH levels, leading to infections and complications. Safer alternatives are gentle cleansing with water and mild soap for the outer areas.