For a lot of us, douching (rinsing out the vagina with water or a special solution) is a regular part of our lives as women. We may douche after our menstrual period, before or after sexual intercourse, or when we have a vaginal infection or that infamous "not-so-fresh" feeling. If we grew up seeing the women in our family use douches, we may have started using them too when we first began our periods. Many of us have heard that women need to douche, that douching is necessary to keep ourselves clean and smelling nice. But douching disrupts our body's natural protective cleansing system and rinses away the bacteria and yeast that are always present in our vaginas. The resulting irritation can make it easier for us to get STDs, bacterial and yeast infections, and HIV infection. Women with HIV are already at greater risk for gyne problems; douching can complicate the vaginal infections common to women living with HIV/AIDS, possibly leading to serious health problems or an increase in viral load. Douching can also rinse away the vaginal secretions that can give us information about our overall health, especially where our hormonal cycles are concerned. For women who have HIV, this can mean losing out on clues which may be helpful in determining how HIV disease and/or medications are affecting their immune system.
Since many women associate douching with cleanliness and good hygiene, it may come as a surprise to learn that douching can actually be dangerous. But the truth is, we're not dirty, and our vaginas can take care of themselves. The best thing to do for our health is to leave our vaginas alone and let our natural system work. There's supposed to be stuff in there -- left to their own devices, they keep each other from overgrowing and promote healthy vaginal pH balance (strong enough for a man, but made by and for a woman!). And there's supposed to be stuff coming out of us, too -- different stuff throughout our menstrual cycle. In fact, vaginal secretions can actually help us know when we're in good health, if we know what to look for.
The Dangers of Douching
The dangers of douching are threefold. First of all, douching can cause irritation and inflammation of vaginal tissues, which make it easier for STDs and HIV to set up shop in our bodies. Secondly, douching can actually cause an infection by disrupting the natural balance of bacteria and yeast in the vagina. Infections lead to an immune response, which for women with HIV could in turn lead to increased viral replication. Women who have irregular cycles because of hormonal changes or medications may also find that they experience more vaginal dryness, which can also lead to irritation, tears, and an increased risk of STDs, HIV, or vaginal infection. Douching on top of vaginal dryness is doubly dangerous for women of all ages and HIV status! So if your vagina feels dry or intercourse is uncomfortable, throw douches out the window and pile on the water-based lubricants -- they help keep you safer, and they're more fun!
Thirdly, douching can complicate an existing infection, perhaps even to the point of serious health risk. If you notice an unusual vaginal discharge, do NOT douche! The discharge may be a sign that your vagina is trying to re-balance itself, and washing it away could slow down your body's healing process. If the discharge is caused by an infection, douching could push the germs causing the infection up into the cervix or uterus, increasing the chance of PID (pelvic inflammatory disease, a serious infection of the uterus, fallopian tubes, and/or ovaries). Women with immune systems weakened by HIV/AIDS are at special risk for developing PID, which may be more difficult to treat and more likely to cause long-term damage in HIV positive women than in women without HIV. If you think you might have a vaginal infection -- especially if you have low abdominal pain, pain with intercourse, or abdominal pain with fever and chills -- go to a doctor or clinic to have your symptoms properly diagnosed and treated.
But if a woman's been douching since she started menstruating, she may not be familiar with her normal secretions. So where do we start? How do we know what's healthy, and what's not?
Normal Vaginal Secretions
In general, healthy secretions are clear or light-colored, with mild or no odor. Vaginal secretions change throughout the menstrual cycle, and these changes may become very noticeable if you don't douche. The secretions differ depending on the level of estrogen and progesterone (female hormones) in our bodies. Ovulation (the ripening and releasing of eggs from the ovaries) is also controlled by these hormones; therefore, secretions will differ depending on whether or not a woman ovulates.
Your cycle starts with Day 1 of your menstrual bleeding, and ends the day your next bleeding starts. Between bleeds, ovulating women will often notice a pattern in their secretions. For the first few days, secretions may be whitish and sticky (maybe even pasty, or perhaps nonexistent!). Your vagina may feel pretty dry. Then there'll be a few days of increasingly creamy whitish secretions, followed by mucous that looks and feels a lot like egg whites. This is fertile mucous, and means that we're near ovulation. This is the time of month when we are most likely to become pregnant, so if you want to become pregnant, watch for the fertile mucous! If you don't want to get pregnant, watch for the fertile mucous and either avoid sexual activity that puts semen in or around your vagina, or use a barrier birth control method (diaphragm, cervical cap, male or female condom). After the fertile mucous comes the creamy whitish secretion again, followed by the pasty-or-nonexistent secretions. And then you bleed again. It's incredibly cool.
Women who use hormonal birth control methods (birth control pills, Depo shots, or Norplant) usually don't ovulate. Post-menopausal women (gone through "the change") don't ovulate at all. They will still have vaginal secretions, but they may be consistently creamy, pasty or fairly dry, and that egg-white stuff won't come down (note: hormonal birth control methods -- especially "mini-pills" -- suppress ovulation but may not keep you from ovulating every single month). Women who are post-menopausal no longer have menstrual bleeding, while women using hormonal birth control may have irregular bleeding (Norplant, Depo), extremely regular bleeding (birth control pills), or no bleeding at all (Depo, Norplant).
Abnormal Vaginal Secretions
Changes in the amount, color, consistency or smell of vaginal secretions are often a sign of infection. Yellowish, greenish, brownish or bloody discharge (when you're not having your menstrual bleeding) can indicate an infection, as can discharges that are bubbly, foamy, or chunky like cottage cheese. Sometimes vaginal discharges might look normal but smell fishy, yeasty, or just plain bad. Yeast infections (vulva inflammation and/or itching with whitish, cottage-cheesy, yeast-smelling discharge) are a common experience for most women, but can be a special nuisance for women with HIV/AIDS.
Sometimes we might also have vaginal infections that don't produce a discharge, so also watch out for itching, redness, irritation, blisters/sores, and discomfort or stinging when you urinate. If you do douche and you notice any of these symptoms afterward, it's safest not to have sex until you no longer feel itching or discomfort -- you might be irritated from the douche, and the tiny breaks in your genital skin can make it easier for you to get an STD or HIV. If you do have sex while you have discomfort or signs of an infection, using male or female condoms and extra water-based lube can help protect you.
Occasionally, gynecologists or nurse practitioners may prescribe douches for specific reasons -- under certain circumstances, rinsing the vagina with herbal or iodine solutions may be appropriate. But the kinds of douches that are sold in stores are unnecessary at best. They are part of a whole industry that's financed by encouraging women to feel embarrassed by their natural secretions and odors, and that's where your money goes when you buy douches not specifically prescribed by a medical practitioner. As long as we bathe regularly and are in good health, we don't stink -- we smell like people, which is what we are. So the next time you're watching TV or reading a magazine and you see that "not-so-fresh" ad, ask yourself why you'd want to smell like flowers anyway -- especially if smelling like flowers could make you sick.
Viva la Vulva!
Note: While the information in this article may be helpful in increasing a woman's awareness of her cycles, it is not intended as instruction in fertility.