Vaginal douching and preterm birth: an intriguing hypothesis

The rate of preterm birth has risen in recent years and is twice as high among black women as among white women. Neither the underlying causes nor the reasons for the racial disparity are clearly understood. Further, preventable risk factors have not been identified. We hypothesize that vaginal douching plays a key role in the risk of infection-related spontaneous preterm birth. Vaginal douching is a common behavior, twice as prevalent among black women as among white women. Douching may be an important mechanism by which vaginal pathogens gain access to the upper genital tract. Douching increases the risk of acquiring bacterial vaginosis. It may also facilitate the ascent of microorganisms into the upper genital tract, resulting in a chronic bacterial colonization inside the uterus. During pregnancy, the host inflammatory response is initiated, which stimulates preterm labor and birth. Douching, a potentially preventable risk factor, may explain a substantial proportion of the black-white disparity in preterm birth. (C) 2000 Harcourt Publishers Ltd.