July 15, 2015
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Vaginal douches linked to increased phthalate exposure

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Women who use a vaginal douche are more likely to be exposed to endocrine-disrupting phthalates than women who do not use douche, according to research in Environmental Health.

In a cross-sectional study of women who self-reported their use of various feminine care products, researchers also found that black women were at higher risk for phthalate exposure due to more frequent use of douches compared with white and Mexican American women.

Francesca Branch , MPH, of the School of Public Health at George Washington University, and colleagues analyzed pooled data from 739 women aged 20 to 49 years who completed the National Health and Nutrition Examination Survey between 2001 and 2004, which included self-reported data on the use of feminine hygiene products.

As part of the survey, women reported whether they used tampons, sanitary napkins, vaginal douches, feminine spray, feminine powder, feminine wipes or other feminine hygiene products, and reported details about the use of each specific product. Follow-up questions assessed douching frequency; researchers used those responses to categorize participants as either no use, occasional use (once per month or less) or frequent use (two or more times per month).

Researchers also analyzed phthalate metabolites in the urine samples of participants.

Ami Zota

Ami Zota

Researchers found that black women reported a significantly higher use of vaginal douche, with 37% reporting use in the previous month compared with 14% of white women and 10% of Mexican American women. Black women also reported a higher use of feminine spray, feminine powder, wipes and other products (P < .05).

Douching was associated with increased urinary monoethyl phthalate (MEP) concentrations in adjusted and unadjusted models, and researchers found that black women had a higher geometric mean concentration of MEP and mono-n-butyl phthalate (MnBP) compared with white or Mexican American women (P < .001).

Researchers found women who reported occasional douching in the past 6 months had a 33.6% higher MEP concentration in the urine than nonusers. Women who reported frequent douching had 152.2% higher MEP concentrations than nonusers. There was not a statistically significant link between MnBP and douching, according to researchers.

“While we did not make direct connections between phthalate exposure in feminine care products and specific health outcomes in this study, our work is important because it illustrates both toxic chemical exposures in personal care products and how certain groups can have disproportionate impacts,” Ami Zota, ScD, MS, assistant professor of environmental health at George Washington University, told Endocrine Today.

Zota said the research underscores the messages of the American College of Obstetricians and Gynecologists and the American Public Health Association, both of which discourage douching because of the potential health consequences, including bacterial vaginosis, pelvic inflammatory disease, pregnancy complications and cervical cancer.

“The human health implications of our study warrant further research in experimental models and clinical studies since prior studies have not accounted for this unique and sensitive route of exposure,” Zota said. “Vaginal and vulvar tissues are highly permeable; thus, they may be particularly vulnerable to the effects of phthalate exposure. There is potential for localized effects of phthalates on the vaginal epithelium or on the chemical biological environment inside the vagina, which could also impact other female reproductive organs.”

Zota said future studies should also examine whether feminine products increase exposure to other endocrine-disrupting chemicals like triclosan or parabens. – by Regina Schaffer

Disclosure: The researchers report no relevant financial disclosures.