Is the vaginal cleansing product industry causing harm to women?

Abstract

Over the counter vaginal cleansing products are part of a growing market. In the United States, for example, consumers spend over two billion dollars a year on douches, deodorant sprays, washes, personal wipes, and powders [1]. Advertising for these types of products tends to construct vaginal cleansing as both desirable and trendy for women [2]. Perhaps more concerning, the advertising of vaginal cleansing products often suggests to women that they are necessary for vaginal hygiene. This messaging is typically conveyed using terms like 'clean' and 'fresh' in product names and descriptions. For example, products like Vagisil Clean Scent Feminine Wash, RepHresh Clean Balance Douche, Summer's Eve Fresh Scent Douche, and Femfresh Freshness Deodorant all demonstrate the use of this 'clean and fresh' marketing [3]. The implied association in this branding between product use and vaginal cleanliness/freshness capitalizes on cultural messages that women's bodies are problematic, unclean, inadequate, and require intervention through the use of cosmetic products to improve their bodies [4-6]. These messages are not new and are linked to a long history of vaginal douches first being commercialized and marketed to women in the United States during the 20 th century as a form of vaginal deodorization, freshness, and cleanliness [7]. There has been accumulating evidence to suggest that many vaginal cleansing products have adverse health effects. The harms of douching, in particular, have been documented since the 1980's [e.g. 8]. Some of these early medical studies connected adverse health outcomes to the added antibacterial ingredient hexachlorophene in douches which can cause nausea, vomiting, spasms, coma, and even death [7]. While the Food and Drug Administration (FDA) banned the use of hexachlorophene in cosmetics in the USA in 1971, over-the-counter douches today continue to be linked to adverse health effects; yet they are widely sold throughout Canada, the United States and internationally [7,9]. Adverse health effects include bacterial vaginosis, cervical cancer related to increased risks of contracting human papillomavirus infection (HPV), upper genital tract infections which can result in tubal factor infertility and ectopic pregnancy among others [10-14] As most research in this context has focused on douches, much less is known about the health effects of other vaginal cleansing products despite the fact that products like vaginal wipes and sprays are used very commonly by women. For example,

Color, Scent and Size: Exploring Women's Preferences Around Design Characteristics of Drug-Releasing Vaginal Rings

“…Similar to color, preferences for scented vaginal products varied. Some women did not want to use products that contained scents, and these concerns were largely linked to perceptions that chemicals in the scents could cause vaginal irritation for themselves and their male partners [ 39 ]. Preference for intensity of scent was also related to perceptions as to whether more intense scents had higher chemical compounds and more likelihood of being unsafe.…”

“…Careful selection of scents for incorporation into rings is necessary, given (i) the propensity of certain functional groups within molecules to react with silicone elastomer materials [ 36 – 38 ], (ii) the potential for evaporation of volatile organic scent molecules during high-temperature manufacture of the rings; and (iii) the risk of mucosal irritation with certain scent substances [ 39 ]. Scents are already added to certain marketed condoms and vaginal wash products.…”

Maintaining vulvar, vaginal and perineal health: Clinical considerations

“… 23 , 93 , 114 Indeed, a cross-sectional study of 1183 women with chronic vulvar pain found that IBS was the a common comorbidity present in 27.3% of women with chronic vulvar pain. 70 Exogenous factors include infection with invasive bacteria, 108 semen, 115 number of partners, 50 intrauterine devices, 116 antibiotics, 117 certain cleansing products or practices 118 , 119 and diet. 94 …”

Topical Probiotics for Women’s Urogenital Health: Selection of an Oil-based Carrier

“…They are marketed for daily use or to relieve issues such as malodour. Although these products are intended to maintain vaginal comfort, many of them may induce adverse effects and disrupt the vaginal microbiota, inducing a state of dysbiosis [2][3][4] that can predispose women to bacterial vaginosis (BV), urinary tract infection (UTI), pregnancy complications [5], and sexually transmitted diseases [6], as well as have a negative emotional impact on wellbeing [7]. Therefore, new topical over-the-counter (OTC) therapies could be beneficial if they relieve the cause of aberrant symptoms and signs, and if they help maintain and restore vaginal homeostasis.…”