Pelvic disease and douching - pap smears, ginseng and sexual interest, safety of oral contraceptives - From the Doctor's Casebook

Nutrition Health Review, Wntr, 1991 by Edwin Flatto

Q: Can regularly administered douching cause problems?

A: There is no hygienic or medical reason for routine douching. The normal vagina is a self-cleansing mechanism so long as the natural flora is not disturbed or upset.

Recently, a study conducted at the University of Washington School of Medicine confirmed that regular douching is associated with pelvic inflammatory disease. An earlier study had shown a significant association between vaginal douching and ectopic pregnancy. Pelvic inflammatory disease is also a major factor in ectopic pregnancy.

In a comparison of 100 women with confirmed pelvic inflammatory disease (PID) and 762 randomly selected controls, at Harborview Medical Center in Seattle, the investigators report that women who douche once or twice a month were 2.5 times more likely to have PID than those who douched less than once a month. However, the risk of PID does not appear to increase with more frequent douching.

Q: I am a postmenopausal woman. How accurate are Pap smears for the elderly?

A: The lack of estrogen, or the hypoestrogenic condition in postmenopausal women can bring about atrophic changes similar to those associated with premalignant or malignant lesions making it difficult to interpret the Pap smear. A coloscopically guided biopsy of the cervix and endocervical curettage are often necessary to evaluate these atrophic changes. Should these tests prove negative, application of vaginal estrogen cream nightly for two weeks will usually reverse the atrophic change. [1]

Q: The rumors say the herb Ginseng improves sexual interest and ability. Is this true for a 50-year-old man?

A: Ginseng is a stimulant and is reported to have steroid-like qualities. It has been even been reported to cause bleeding in post-menopausal women. Cancer researchers are looking into Ginseng's apparent ability to retard certain tumor cells. Some undesirable side effects in large doses are a tendency to raise blood pressure, sleeplessness, and diarrhea. However, if you would like to experiment with Ginseng in small quantities, I do not anticipate much of a risk in using this substance in moderation. You should, however, consult your doctor. His access to your history enables him to view the possibility of future problems.

Q: I am 40 years old and have been using oral contraceptives for more than 20 years. Is it safe to continue taking them as I age?

A: The answer to your question is highly controversial at present. The American College of Obstetricians and Gynecologists and the FDA's Fertility and Maternal Health Drugs Advisory Committee decided that age 40 is not necessarily a point for cessation of oral contraceptive use provided:

a) The woman is in good health.

b) She does not smoke (warnings continue to be issued for women over 35 who smoke).

c) She has regular Pap smears (long-term use of oral contraceptives is related to cervical cancer).

d) The formulation she is taking is low dose (containing less than 50 mcg, of estrogen).

Other specialists say tyhat research provides inadequate support for changing the age limit. Low-dose pills, they charge, may pose hazards with long-term use.