Freda Bedi Cont'd (#2)

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German Society for Racial Hygiene
by Wikipedia
Accessed: 4/1/20

The German Society for Racial Hygiene (German: Deutsche Gesellschaft für Rassenhygiene) was a German eugenic organization founded on 22 June 1905 by the physician Alfred Ploetz in Berlin. Its goal was "for society to return to a healthy and blooming, strong and beautiful life" as Ploetz put it. The Nordic race was supposed to regain its "purity" through selective reproduction and sterilization.[1] The society became defunct after World War II.


Hartheim Euthanasia Centre in 2005

History

Soon after the society was founded, it received generous support by the German imperial government and it was not the only organization of its kind in the world. Many organizations existed post WW2 with similar goals. Notable members comprised Ploetz' brother-in-law Ernst Rüdin and his childhood friend Gerhart Hauptmann, Wilhelm Bölsche, Max von Gruber, Agnes Bluhm, Wilhelm Filchner, Anastasius Nordenholz, and Ludwig Hermann Plate. The biologists Ernst Haeckel and August Weismann, as well as the gynecologist Ernst Ludwig Alfred Hegar became honorary members.

Since Ploetz wanted to establish an international movement, the society was soon renamed International Society for Racial Hygiene with branches in Berlin including Erwin Baur, in Munich, in Freiburg with the well-known human geneticists Fritz Lenz and Eugen Fischer and from 1910 in Stuttgart, which included the geneticist Wilhelm Weinberg.[2] The organization was affiliated with the British Eugenics Education Society under Francis Galton; branches in Sweden, the United States, and the Netherlands were also established in the early 20th century.[3] In 1924, the organization was named back to German Society for Racial Hygiene.[4]

The ideas represented by the society became increasingly popular after the International Hygiene Exhibition of 1911. The organization wanted to establish "racial hygiene" as a scientific subject and contributed substantially to their implementation in Germany. With both adoption of the ideas of Nazi eugenics and with concrete consultations on political racial measures, the society took direct influence on statutes like the "Law for the Prevention of Hereditarily Diseased Offspring", which were an integral part of the Action T4 "euthanasia" programme of the Nazi regime led by Adolf Hitler. By 1933, the Society for Racial Hygiene had 1,300 members, many of them academics, as well as high functionaries in the Nazi Party.[5]

References

1. Schafft, Gretchen Engle: "From Racism to Genocide: Anthropology in the Third Reich". University of Illinois Press. 2004. Pg. 42.
2. Carlson, Elof Axel: "The Unfit: a history of a bad idea". CSHL Press. 2001. Pg. 321.
3. Schafft 2002, pg. 42
4. Hubbard, Ruth: "Abortion and Disability: Who Should and Should not Inhabit the World" in Davis, Lennard J. (ed.): "The Disabilities Studies Reader". Routledge. 1997. Pg. 191.
5. Burleigh, Michael; Wippermann, Wolfgang: "The Racial State: Germany 1933-1945". Cambridge University Press. 1991. Pg. 52.
• (in German) Wolf, Caroline Wissenschaftler wider besseres Wissen in amatom Nr. 18.

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Birth control
by Molly Ladd-Taylor
Eugenicsarchive.ca
April 28, 1014

Birth control has had a complicated relationship to eugenics. While birth control makes it possible for a woman to decide for herself when (and if) to have children, eugenics puts society’s interest in reproduction above the individual’s desires. Yet proponents of birth control often used eugenic arguments while eugenicists distributed contraceptives in poor communities to reduce births among those they considered unfit. The tension between the right to choose birth control, a precondition for women’s freedom, and the coercive use of birth control as a means of population control, has shaped social policy and the politics of reproduction.

Birth Control and the Law: Criminalization and Legalization

Women and men in every society have sought to control their own reproduction. In the nineteenth and twentieth centuries, however, rising expectations for health, child welfare, and women’s rights, combined with elite anxieties about immigration and the declining birth rate among educated whites, brought personal decisions about reproduction and child welfare into the public eye. “Birth control” – that is, legal contraception, abortion, and contraceptive sterilization – entered the world of policy and politics.

Birth control and even abortion were largely unregulated in North America until the late nineteenth century. In 1873, the U.S. Congress enacted the Comstock Law, which defined contraceptives as obscene and made it a federal crime to send information about contraception or abortion through the mail or across state lines. In Canada, the Criminal Code of 1892 prohibited the advertisement or sale of any literature or device intended to prevent conception or cause abortion.

Laws against contraception and abortion generally remained in place until the 1960s. The U.S. Supreme Court overturned the prohibition on contraceptive use among married couples in 1965 and extended the right to use contraceptives to unmarried couples in 1972. A year later in Roe v. Wade (1973), the court ruled that the constitutional right to privacy included abortion (until the fetus could live outside the womb). In Canada, contraception was decriminalized and some abortions made legal in the 1969 revisions to the Criminal Code. In 1988, the Supreme Court decision R. v. Morgentaler legalized all abortions in Canada. Even so, the right to contraception and especially abortion remains hotly debated, especially in the United States.

The Question of Contraceptive Sterilization

In law, there is a distinction between eugenic and contraceptive sterilization. The U.S. Supreme Court upheld compulsory eugenic sterilization in the notorious Buck v. Bell decision in 1927, but voluntary sterilization for contraceptive purposes (like all other forms of birth control) had an ambiguous legal status until the 1970s. Most U.S. hospitals restricted voluntary sterilization to patients who met the 120 rule (a woman’s age multiplied by the number of her children had to be at least 120); voluntary sterilizations were also restricted in Canada prior to the decriminalization of contraception in 1969. In both countries, public pressure led to the relaxation of restrictions and public funding for contraceptive surgery in the 1970s, just as eugenic sterilization laws were being repealed. Sterilization quickly became one of the most popular forms of birth control. At the same time, there was a significant increase in coerced “contraceptive” sterilizations, both in the United States and, to a lesser extent, in Canada.

The legal-political status of birth control in Canada, and to a lesser extent the United States, was also shaped by the doctrine (and lobbying power) of the Catholic Church. In 1930, the papal encyclical Casti Connubii affirmed the sanctity of marriage and condemned divorce, artificial birth control, abortion, and eugenics legislation.

The Two Sides of Birth Control

Both birth control and eugenics emerged as political issues in the early twentieth century, in the context of industrialization, immigration, and the changing status of women and racialized groups. At first, conservative eugenicists opposed legal contraception because of its association with feminism. They thought that “fit” white women were already having too few children compared to the poor and uneducated and worried that expanding women’s reproductive options would lead to “race suicide.” By the 1930s, however, birth control’s association with feminism had weakened and many eugenicists saw contraception as a tool of population control.

Birth Control as Woman’s Right

In the nineteenth century, most North American women lacked the right to vote and sit on juries. Married women were economically dependent on their husbands and legally obliged to submit to their sexual needs. Elite women who objected to the idea that constant pregnancy was the married woman’s fate asserted the principle of “voluntary motherhood.” Using the language of degeneracy, they claimed that the damage caused by involuntary motherhood could be passed on to succeeding generations. Only if motherhood was truly voluntary could superior offspring be ensured.

From the 1890s to the 1910s, a small group of feminists and sex radicals, such as the American Margaret Sanger, took the radical position that women were entitled to heterosexual pleasure without fear of procreation. They claimed that “birth control,” a term coined by Sanger, was essential to women’s freedom and self-fulfillment and they openly defied the laws that made disseminating birth control information a crime. Sanger was arrested after she opened the first North American birth control clinic in Brooklyn, New York, in 1916. After a lengthy legal battle, a New York court ruled in 1923 that physicians could provide contraceptive information. Birth control was a medical decision, not a woman’s right.

Birth Control as Population Control

The idea of birth control as population control took root in the 1920s. The slogan, “more children from the fit, less from the unfit,” wrongly attributed to Margaret Sanger, reflects both many birth controllers’ deep-seated eugenicist beliefs and a politically expedient strategy designed to win support from physicians and potential donors. In the infamous Negro Project of the Birth Control Federation of America (later Planned Parenthood), the racist-eugenicist goal of reducing the birth rate of southern backs undercut Sanger’s own commitment to birth control as a woman’s right.

The population control argument for birth control was also pervasive in Depression-era Canada. Rubber manufacturer A.R. Kaufman, a prominent birth controller and eugenicist from Kitchener, Ontario, founded the Parents’ Information Bureau (PIB), which hired visiting nurses to distribute contraceptive information to poor couples with large families. In 1936, when PIB worker Dorothea Palmer was arrested in a French Canadian neighbourhood in Eastview, Ontario, Kaufman’s lawyers launched a spirited legal defense. They contended that distributing contraceptives to poor Francophone Catholics was a public good and secured Palmer’s acquittal.

Population Control vs. Women’s Rights in the Postwar Era

After the Second World War, contraceptive use became an increasingly respectable form of “family planning,” and population control advocates shifted their attention to reducing fertility in the global south.

The tensions between population control and women’s rights exploded in the 1970s. Feminists demanding easier access to abortion and contraceptive sterilizations had to confront the reality that large numbers of African Americans, Indigenous women, Latinas, and women with disabilities were being coerced into sterilization. After the sterilization of two black girls at a family planning clinic in Alabama became an international scandal in 1973, a federal judge declared that “the dividing line between family planning and eugenics is murky.” He prohibited any government-funded sterilization where the patient’s capacity for non-coerced consent was in doubt, including minors and persons with intellectual disabilities (ID). Yet social workers and trial judges have continued to pressure welfare mothers and drug users to “choose” long-term contraceptives, and some parents of children with intellectual disabilities have sought sterilization for their daughters. In 1986, the Supreme Court of Canada barred court-ordered contraceptive sterilizations of persons with ID.

The Tangled Histories of Birth Control and Eugenics

Reproductive decisions must never be coerced, and the shameful association between birth control and eugenics should be exposed. In recent years, however, Margaret Sanger’s advocacy of eugenics has been used to tarnish all publicly-funded reproductive health services, especially the U.S. Affordable Care Act (Obamacare), which requires most insurers to pay for contraception, including voluntary sterilization, as part of women’s health care. In fact, the history of birth control is two-sided. Birth control is not just another term for population control; the right to use – or not to use – birth control is also a cherished women’s right.

References

Chesler, E. (1992). Woman of valor: Margaret Sanger and the birth control movement in America. New York: Simon & Schuster.

Dyck, E. (2013). Facing eugenics: reproduction, sterilization, and the politics of choice. Toronto: University of Toronto Press.

Gordon, L. (2002). The moral property of women: a history of birth control politics in America. Urbana and Chicago: University of Illinois Press.

Kluchin, R. M. (2009). Fit to be tied: sterilization and reproductive rights in America, 1950-1980. New Brunswick, N.J: Rutgers University Press.

Ladd-Taylor, M. (2001). Eugenics, sterilization and modern marriage: the strange career of Paul Popenoe. Gender & History, 13, 298-327.

Ladd-Taylor, M. (2014). Contraception or eugenics? Sterilization and 'mental retardation' in the 1970s and 1980s. Canadian Bulletin of Medical History, 31, 189-211.

McLaren, A. (1990). Our own master race: eugenics in Canada, 1885-1945. Toronto, Ont: McClelland & Stewart.

McLaren, A., & McLaren, A. T. (1997). The bedroom and the state: the changing practices and politics of contraception and abortion in Canada, 1880-1997. Toronto: Oxford University Press.

Revie, L. (2006). 'More than just boots!' The eugenic and commercial concerns behind A. R. Kaufman's birth controlling activities. Canadian Bulletin of Medical History, 23, 119–43.

Roberts, D.E. (1997). Killing the black body: race, reproduction, and the meaning of liberty. New York: Pantheon Books.

Schoen, J. (2005). Choice and coercion: birth control, sterilization, and abortion in public health and welfare. Chapel Hill: University of North Carolina Press.

Stote, K. (2012). The coercive sterilization of Aboriginal women in Canada. American Indian Culture and Research Journal, 36, 117-150.

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Eugenics and Birth Control
by PBS.org
Accessed: 4/2/20

In 1883 a British biologist named Francis Galton combined the roots of the Greek words for "good" and "origin" to create the term "eugenics" for an applied science based on genetics and breeding. The "science" of eugenics proposed that human perfection could be developed through selective breeding. In the late nineteenth century researchers developed the idea, a blend of genetic research and social theory. Eugenics soon crossed the Atlantic and by the 1920s and 1930s was adopted by mainstream scientists, doctors and the general public.

Positive and Negative Approaches

The eugenics movement had two basic strands. Advocates of "positive" eugenics believed in promoting childbearing by the "fit" classes. Those who supported "negative" eugenics stood for the discouragement and suppression of reproduction among people of "inferior stock." Within these two camps, the definitions of who would be classified as "fit" and "unfit" varied greatly.

A Vehicle for Racism and Nativism

Some eugenicists separated the "fit" and "unfit" classes along racist and nativist lines. Under this eugenics model, those considered most worthy of rearing children were couples who were middle class or upper class Nordic-Teutonic whites. Racial minorities and ethnic immigrant groups were typically classified as unfit. The poor and physically handicapped, whose problems were classified as hereditary, were also in this negative category. Eugenics supporters pushed middle and upper-class "native" whites to have large families. In some circles eugenicists went as far as declaring birth control selfish and a form of "racial suicide." The same people believed that blacks and other minorities should not reproduce. Although eugenicists did not promote contraceptive use, fearing that the "unfit" would not use the methods properly, sterilization was often promoted as the best option to limit their numbers.

Eugenics and Birth Control

Margaret Sanger's birth control movement and quest for the Pill intersected the rise of the eugenics movement in America. At a time when birth control was still not publicly accepted in American society, some eugenicists believed birth control was a useful tool for curbing procreation among the "weak." In the 1920s and 30s, Sanger calculated that the success of the eugenics idea gave her own movement legitimacy, and tried to ally her cause with the movement. Eugenics was a dominant theme at her birth control conferences, and Sanger spoke publicly of the need to put an end to breeding by the unfit. In 1920 Sanger publicly stated that "birth control is nothing more or less than the facilitation of the process of weeding out the unfit [and] of preventing the birth of defectives."

What Did Sanger Believe?

Sanger's relationship with the eugenics movement was complex -- part strategy and part ideology. Many historians now believe that Sanger opposed eugenics along racial lines. Furthermore, Sanger opposed the belief of many eugenicists that poverty was hereditary, asserting instead that poverty, criminal behavior and other social problems were due to environmental factors and were not predetermined.

Suspect Intentions

Following World War II and the Holocaust, the science of eugenics was discredited. It was soon forgotten by many. But when Margaret Sanger was being lauded for her role in the creation of the Pill in the 1960s, many in the African American community recalled her association with eugenics. Suspicious of her intentions to begin with, some were appalled by her ongoing support of the population control movement.

Legacy of Distrust

Some African Americans believed that Sanger's motive was not to aid black women but to eliminate future black generations. In promoting the development of the birth control pill in the 1950s, Sanger had heralded it as the panacea to world overpopulation, starvation and hunger. Sanger wrote: "I consider that the world, and almost our civilization for the next 25 years, is going to depend on a simple, cheap, safe, contraceptive to be used in poverty stricken slums, jungles and among the most ignorant people." Although African American women appreciated the effectiveness and reliability of oral contraceptives, and used the method in large numbers, they resented the way white-dominated organizations seemed to push the Pill in black communities.

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About Margaret Sanger
by The Margaret Sanger Papers Project
New York University
Accessed: 4/2/20
© The Margaret Sanger Papers.

-- Lysol, by Wikipedia

Margaret Louise Higgins was born on September 14, 1879 in Corning, New York to Michael Hennessey Higgins, an Irish-born stonemason with iconoclastic ideas, and Anne Purcell Higgins, a devoutly Catholic Irish-American. When Anne Higgins died from tuberculosis at the age of fifty, Margaret, the sixth of eleven children, pointed to her mother's frequent pregnancy as the underlying cause of her premature death. Margaret Higgins sought to escape what she viewed as a grim class and family heritage. With the help of her older sisters, she attended Claverack College and Hudson River Institute in 1896 and then entered the nursing program at White Plains Hospital in 1900. In 1902, just months before completing the program, she met and married architect William Sanger. Margaret Sanger and her husband had three children and the family settled in Hastings, a Westchester County suburb of New York City.

Suburban life, however, did not satisfy the Sangers. By 1910 the family moved to New York City. William Sanger wanted to give up his work as a draftsman to try his hand at painting, while Margaret Sanger returned to nursing to help support the family. The Sangers also became immersed in the pre-war radical bohemian culture flourishing in Greenwich Village. They joined a circle of intellectuals, activists, and artists that included Max Eastman, John Reed, Upton Sinclair, Mabel Dodge and Emma Goldman. Margaret Sanger became a member of the Liberal Club and a supporter of the anarchist-run Ferrer Center and Modern School. She also joined the Women's Committee of the NY Socialist Party, and took part in labor actions led by the Industrial Workers of the World, including the 1912 strike at Lawrence, MA and the 1913 strike at Paterson, NJ.

Margaret Sanger's work as a visiting nurse focused her interest in sex education and women's health. In 1912 she began writing a column on sex education for the New York Call entitled "What Every Girl Should Know." This experience led to her first battle with censors, who suppressed her column on venereal disease, deeming it obscene. Increasingly, it was the issue of family limitation that attracted Sanger's attention as she worked in New York's Lower East Side with poor women suffering the pain of frequent childbirth, miscarriage and abortion. Influenced by the ideas of anarchist Emma Goldman, Sanger began to argue for the need for family limitation as a tool by which working-class women would liberate themselves from the economic burden of unwanted pregnancy.

Shocked by the inability of most women to obtain accurate and effective birth control, which she believed was fundamental to securing freedom and independence for working women, Sanger began challenging the 1873 federal Comstock law and the various "little Comstock" state laws that banned the dissemination of contraceptive information. In March 1914, Sanger published the first issue of The Woman Rebel, a radical feminist monthly that advocated militant feminism, including the right to practice birth control. For advocating the use of contraception, three issues of The Woman Rebel were banned, and in August 1914 Sanger was eventually indicted for violating postal obscenity laws. Unwilling to risk a lengthy imprisonment for breaking federal laws, Sanger jumped bail in October and, using the alias "Bertha Watson," set sail for England. En route, she ordered friends to release 100,000 copies of Family Limitation, a 16-page pamphlet which provided explicit instructions on the use of a variety of contraceptive methods.

On arrival in England, Margaret Sanger contacted a number of British radicals, feminists, and neo-Malthusians whose social and economic theories helped Sanger develop broader justifications for the use of birth control. She was also deeply influenced by psychologist Havelock Ellis and his theories on the importance of female sexuality. Sanger broadened her arguments for birth control claiming it would fulfill a critical psychological need by enabling women to fully enjoy sexual relations, free from the fear of pregnancy.

In 1915 William Sanger was jailed for 30 days for distributing a copy of Family Limitation to an undercover postal agent. Shortly after, in October of that year, Margaret Sanger, keen to focus media attention on her trial and generate favorable public support, returned to New York to face The Woman Rebel charges. When her only daughter, five-year old Peggy, died suddenly in November, sympathetic publicity convinced the government to drop Sanger's prosecution. Denied the forum of a public trial, Sanger embarked on a nationwide tour to promote birth control. Arrested in several cities, her confrontational style attracted even greater publicity for herself and the cause of birth control

Although in 1914 Sanger had been promoting woman-controlled contraceptives, such as suppositories or douches, a 1915 visit to a Dutch birth control clinic convinced her that a new, more flexible diaphragm, carefully fitted by medically trained staff, was the most effective contraceptive device. After returning from a national tour in 1916, Sanger opened the nation's first birth control clinic in Brownsville, Brooklyn. On October 24, 1916, after only nine days in operation, the clinic was raided, and Sanger and her staff were arrested. Sanger was convicted and spent thirty days in prison. However, the publicity surrounding the Brownsville Clinic also provided Sanger with a base of wealthy supporters from which she began to build an organized movement for birth control reform. Sanger appealed the Brownsville decision and although her conviction was upheld, the New York State appellate court exempted physicians from the law prohibiting dissemination of contraceptive information to women if prescribed for medical reasons. This loophole allowed Sanger the opportunity to open a legal, doctor-run birth control clinic in 1923. Staffed by female doctors and social workers, the Birth Control Clinical Research Bureau served as a model for the establishment of other clinics, and became a center for the collection of critical clinical data on the effectiveness of contraceptives.

Sanger separated from her husband, William, in 1914, and in keeping with her private views on sexual liberation, she began a series of affairs with several men, including Havelock Ellis and H. G. Wells. In 1922 she married oil magnate James Noah H. Slee, but did so on her own terms, insuring her financial and sexual independence. Slee, who died in 1943, became the main funder of the birth control movement.

With the suppression of the radical left after World War I, Sanger decided to expand support for birth control by promoting it on the basis of medical and public health needs. In 1917 she established a new monthly, the Birth Control Review, and in 1921 she embarked on a campaign of education and publicity designed to win mainstream support for birth control by opening the American Birth Control League. She focused many of her efforts on gaining support from the medical profession, social workers, and the liberal wing of the eugenics movement. She increasingly rationalized birth control as a means of reducing genetically transmitted mental or physical defects, and at times supported sterilization for the mentally incompetent. While she did not advocate efforts to limit population growth solely on the basis of class, ethnicity or race, and refused to encourage positive race-based eugenics, Sanger's reputation was permanently tainted by her association with the reactionary wing of the eugenics movement.

In 1929 Sanger formed the National Committee on Federal Legislation for Birth Control to lobby for birth control legislation that granted physicians the right to legally disseminate contraceptives. However, most doctors remained hostile to birth control. In addition, Sanger faced strenuous opposition from the Catholic Church. In the end, her legislative campaigns and efforts to secure government support for birth control failed. Sanger did, however, succeed in the courts. In 1936, the U.S. Court of Appeals ruled that physicians were exempt from the Comstock Law's ban on the importation of birth control materials. This decision, in effect, gave doctors the right to prescribe or distribute contraceptives (though the ban on importing contraceptive devices for personal use was not lifted until 1971).

By the late 1920's, Sanger's efforts to broaden support for birth control changed the movement's focus away from radical feminism toward more conservative mainstream middle-class values. Increasingly Sanger herself was viewed as too radical for the movement she had launched. In 1928 she angrily resigned as president of the American Birth Control League and as Sanger's leadership in the movement was eclipsed by younger professionals with more mainstream agendas. With the merger of the American Birth Control League and the Birth Control Clinical Research Bureau into the Birth Control Federation of America in 1939 (later renamed the Planned Parenthood Federation of America) Sanger's role in the birth control movement became largely honorific. By 1942, Sanger was living in Tucson, AZ and had retired from active participation in the movement.

World War II refocused Sanger's attention on international aspects of the birth control movement. She had traveled extensively in the early 1920's and 1930's to lecture on birth control in Asia and Europe. In 1930 she organized the Birth Control International Information Centre with British feminist Edith How-Martyn to serve as a clearinghouse for information. By the end of the war, growing alarm over the consequences of population growth, particularly in the Third World, renewed interest in efforts to build an international birth control movement, propelling Margaret Sanger out of retirement. Working with family planning leaders in Europe and Asia, she helped found the International Planned Parenthood Federation (IPPF) in 1952 and served as its first president until 1959. At her retirement, the IPPF was the largest private international organization devoted to the promotion of family planning.

Through all her work for birth control, Sanger was consistent in her search for simpler, less costly, and more effective contraceptives. Not only did she help arrange for the American manufacture of the Dutch-based spring-form diaphragms she had been smuggling in from Europe, but in subsequent years she fostered a variety of research efforts to develop spermicidal jellies, foam powders, and hormonal contraceptives. Finally in the 1950s, her role in helping to find critical research funding made possible the development of the first effective anovulant contraceptive -- the birth control pill.

The 1965 Supreme Court decision, Griswold v. Connecticut made birth control legal for married couples. Only a few months later, on September 6, 1966, Margaret Sanger, the founder of the birth control movement, died in a Tucson nursing home at the age of 86.

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Part 1 of 2

Family Limitation
by Margaret Sanger
Eighteenth Edition
REVISED
1914

The preponderance of evidence shows an association between douching and numerous adverse outcomes. Most women douche for hygienic reasons; it can be stated with present knowledge that routine douching is not necessary to maintain vaginal hygiene; again, the preponderance of evidence suggests that douching may be harmful. The authors of the present review believe that there is no reason to recommend that any woman douche and, furthermore, that women should be discouraged from douching.

-- Vaginal Douching: Evidence for Risks or Benefits to Women's Health, by Jenny L. Martino and Sten H. Vermund

As a columnist, [Freda Bedi] addressed women's issues with a directness which was startling. Throughout 1943, she had a weekly column in the Tribune entitled 'From a Woman's Window which tackled issues -- such as childbirth and breast-feeding -- which rarely surfaced in the mainstream media at that time. But her focus on gender, and the unfair and unequal burden on India's women, was evident much earlier. Throughout her adult life, she sought to extend the bounds for women in public life. It would be difficult to describe Freda as a feminist. In her marriage, she willingly embraced a subservience to her husband and his personal and political ambitions. When she argued for women's interests, it was not on the basis of a principled demand for equality but of a measure more equity and respect. As a Tibetan Buddhist, she eventually found a comfortable niche with a distinctly patriarchal spiritual tradition which -- as with most major religions -- limited and confined women's role. Yet her championing of women, and her campaigning for the redress of women's grievances, was a consistent aspect of her life, and first became evident as an activist and writer in pre-independence Lahore.

In the spring of 1936, eighteen months after arriving in India and just a few weeks before Tilak's death, Freda was prominent in a public debate on the desirability of birth control clinics. The event was organised by the medical college students' union, and addressed a pressing issue in an era of large families and high infant and maternal mortality. 'Mrs Freda Bedi said that birth control did not mean no babies, it meant better babies; it did not mean no motherhood, but sensible motherhood. Birth control clinics should really be called "sensible motherhood clinics". Motherhood should be a glorious fulfilment of all that is best in woman and a source of vitality and joy and woman should not be condemned through relentless and machine-like production of children. The way to ensure this was to have efficient birth control clinics established in the Punjab where the service should be absolutely free.'2 There was lively opposition to her argument, with speakers expressing concern about birth control being sinful, leading to sterility and frustrating India's need for a large army, but the chair of the meeting declared that the general sentiment was in support of the clinics.

A couple of months later, Freda wrote for the Tribune's magazine section as part of a debate about the segregation of the sexes. 'All healthy minded people must agree,' she declared, 'that it is best if girls and boys can mix freely socially, while keeping a good attitude towards one another .... To my mind, co-education from childhood upwards is the only solution.' But swayed by her experience as a college teacher, she was also concerned that women students were ignoring skills such as cooking and sewing.

The trouble with the present system is that a young man is usually faced with the alternative of a young modern educated wife, who has no idea of running a home intelligently or of bringing up children well, or on the other hand of a pretty girl, very uneducated, who can cook, sew and manage and bring up children but will live a life very apart from him, and be quite unable either to act as a hostess to his friends or to educate his children in the way he would like. I believe that in modern India, a wife, if she is to be useful must be educated, but I am shocked at the way girls in college here neglect learning household affairs. After all, the majority of girls are going to be married and it is only kindness to their husbands to be and their children that they should know something of the more practical things of life.3

In comments that must have upset some of her students, Freda went on to say that the 'trouble is that, because higher education is something of a rarity here still, girls become swelled-headed and think that they are sure to marry rich husbands and that it is below their dignity to work in the house.' This combination of progressive and traditional outlooks was a hallmark of Freda's take on life, and evident in it is how she saw her own role in the household, as her husband's companion and collaborator, but also as the homemaker.

As for the role of women outside the household -- and particularly whether in such a conservative society, where purdah was still common, educated girls should pursue careers -- Freda encouraged young women to seek out occupations which did not excite 'undue opposition from the family and society'. When asked which avenues were open to women, she replied: 'All avenues, ultimately. They have to be fought for, or even just recognised. At present teaching, medicine and nursing hold the field. Journalism is also beginning to attract writers .... Journalism for women, the development of a women's angle in a daily newspaper is a work of which any woman might be proud. It is a national service.'4

That drew a sharp riposte from a student at Fateh Chand in an article provocatively headlined 'The Amazon, grave danger to womanliness':

It is significant that in its most loathsome and unacceptable form the suggestion for feminine careers has come from Mrs Freda Bedi, a Western-bred lady. Though, happily, she has united herself to an Indian, and she may be thinking she has 'naturalised' herself to Indian sentiments of life and living, yet the Western influences that moulded her in her childhood and adolescent years have indelibly determined the make-up of her mind and by the very laws of her being she cannot but look upon things with a vision that must needs have a taint of Westernism in it. Mrs Freda Bedi, let us not forget, has a good deal of selfless socio-political public service in Indian interests to her credit, and we revere her on that account. But we should be wary of accepting her views that may tend to disturb our accepted notions of social propriety that are peculiar to our native genius.5

That must have stung. A student at her own college insisting that Freda was not Indian, could never be Indian, and dismissing her arguments not simply on their merits but because they were tainted by her roots in an alien and uncomprehending West.

The opportunities particularly for educated young women, and the need to balance the desire for a career with domestic and household skills, was becoming an increasing focus of Freda's writing. In the summer of 1938, she published a 150-page book entitled the Modern Girl's Guide to Home-Making -- an advert declared that this 'profusely illustrated and practical book should be given to every bride in her dowry and to every growing girl for her birthday'. She also became chief advisory editor to a new Lahore-based monthly journal, Modern Girl.6 No copies of either have been located, so their contents have to be gauged on the basis of reviews. The market for English books and journals was necessarily restricted to Lahore's educated elite. This was not an attempt to address village India, or even the emerging lower middle class, but more the graduates of Fateh Chand and their families.

The reviewer in the Tribune was unconvinced by Freda's Guide. The book addressed the problems of home-making and how they could be surmounted; included recipes, 'exclusively English'; and dealt with home decorating, furnishing and colour schemes in a manner which suggested that 'only a large house and a lot of furniture of different kinds can make a home'. That wasn't the only aspect of the book that jarred. 'She has given an illustration of a typical English kitchen which is rare in India, as also the bath-room and the lavatory. It is submitted that such things are not suited to this country where the poor constitute an overwhelming majority. Besides it is not possible, except for the very rich, to have a sitting-room, dining-room or a bed-room of the type illustrated.' When Freda herself lived so simply in the Model Town huts, it's surprising that she chose to commend a vastly more expensive lifestyle -- this was perhaps the brief that the publisher had insisted upon. The book also offered advice about diet and menus, though the food recommended was expensive and made no provision for vegetarians; there was a 'slimming without tears' section; and a guide for domestic staff about 'how to wait at tables'.7

The monthly magazine appears to have had a similar style and agenda -- though it was received more warmly by the Tribune, which said it filled 'a long-felt want in Lahore society circles and should be eagerly read by educated women all over India. As Mrs Freda Bedi has put it, the "Modern Girl" aims at pointing the way to the true modern girl, the Indian wife and young mother, who has the future of the nation in her pretty hands.' The articles in the first issue covered fashion, the 'place of art in Indian homes', and a topic 'dear to every young girl ... "How to become a Modern Venus"'.8 The journal didn't prosper. A year after its launch, Freda wrote on 'Modern Girl' headed paper to tell Olive Chandler that the magazine had closed.

I had no financial interest, being in an advisory capacity only, but it had a lot of me in it, + really fulfilled a long felt need -- practical home-keeping, child-upbringing, modern news + views, for that rather pathetic creature the 'educated' Indian girl, who is brought up on books + examinations + is often unable to create a new + satisfactory home life for herself in the midst of old prejudices + antiquated methods. It was widely appreciated + quite unique but alas! However, I don't despair. They are seeds, + somewhere, somehow, they will bear some kind of fruit.9

Freda had identified a need, and a way of addressing it, but the readership simply wasn't there in sufficient numbers. It was another twenty years before Femina found a way of making a women's magazine work in the Indian market.

-- The Lives of Freda: The Political, Spiritual and Personal Journeys of Freda Bedi, by Andrew Whitehead

There are three methods of birth control:

1. Absolute continence.

2. Sterilization.

3. The use of appliances that prevent conception.

INTRODUCTION

Birth Control or family limitation has been recommended by some of the leading physicians of the United States and of Europe. While the medical profession as a whole has not yet taken a united stand upon the subject, we know that the practice of birth control has already been incorporated into the private moral code of millions of the most intelligent and respected families in every country.

There is little doubt but that its general practice among married persons will shortly win full acceptance and sanction by public authorities, who will encourage the practice among the diseased and unfit and help to direct the movement into its proper channels.

In cases of women suffering from serious ailments, such as Bright's disease, heart disease, or tuberculosis, the physician usually warns the woman to guard herself against pregnancy. It is an established fact that two-thirds of the women who die from the above-named diseases do so because they have become pregnant. Therefore, it is imperative that physicians should not only warn women suffering from these diseases against pregnancy, but they should see that they are properly instructed in methods to prevent conception. Such responsibility on the part of physicians would reduce the maternal mortality of the world tremendously.

While the above-named diseases are not considered transmissible from the mother to the child, there are certain other diseases and conditions such as insanity, syphilis, idiocy and feeble-mindedness which are passed to the next generation.

When either the man or the woman is afflicted with any one of these diseases, it is absolutely wrong to allow a child to be born. In such cases the man or the woman should be sterilized.

The patient should understand that such an operation does not deprive him or her of sexual desire or expression. It simply renders the patient incapable of producing children.

To conserve the lives of mothers and to prevent the birth of diseased or defective children are objects for which we need a sound educational campaign for Birth Control.

We hold that children should be:

1. Conceived in love.

2. Born of the mother's conscious desire.

3. And only begotten under conditions which render possible the heritage of health.

We want parents to be conscious of their responsibility to the race in bringing children into the world. Instead of being a blind and haphazard consequence of uncontrolled instinct, parenthood must be made the responsible and self-directed means of human expression and regeneration.

TO THE WORKING WOMAN

The need for safe practical information on birth control is more urgent today among women than it has ever been before.

The working man and woman have begun to realize the difficulty of supporting a family of eight or ten children on a wage scarcely sufficient to decently keep two or three. They have begun also to realize that no increase of wages, obtained through long days of toil or through strikes or lockouts, can keep pace with the increased cost of living or the cost of an ever-increasing family.

It is the big battalions of unwanted babies that make life so hard for the wife of the workingman. It is the ever-increasing number of children, coming year after year into her life, that perpetuates poverty and misery and ignorance from generation to generation.

The working mother knows through her natural instinct that she should not have more children than her husband's wages can support, yet she does not know what she can do to prevent conception. When she asks her friends or neighbors for advice, she is given remedies, usually unscientific, unauthoritative and unreliable, which her experience or knowledge warns her may be injurious.

So she is thrust back upon the possibility of taking drugs for producing abortion, or resigning herself to all the children nature will give her, which can mean from ten to twenty in one woman's lifetime.

These women resent the fact that the educated women are able to obtain safe, scientific, harmless information of birth control, while Society condemns its use among the working women who need it most. Present-day society is generous in doling out pittances for the unfit and diseased, thus encouraging their multiplication and perpetuation, while it prevents and discourages the use of scientific knowledge which would enable mothers to avoid bringing into the world children they cannot feed, clothe or care for.

I give herewith the knowledge obtained through study and through more than fourteen years' experience as a trained nurse in U.S.A.

Next, she applied for a job as a nurse-probationer at a small local hospital. Again, though, Margaret’s careless and nomadic rootlessness was telling. Hospital work proved to be even more vexing and taxing than teaching. She never finished her training. In later years, however, she would claim to be a trained and practiced nurse. Nearly forty pages of her Autobiography were devoted to her varied, often heroic, experiences as a seasoned veteran in professional health care. But they were little more than Margaret’s well-realized fantasies.

In fact, her actual exposure to medicine was almost nonexistent: she never got beyond running errands, changing sheets, and emptying bedpans. Like so much else in the mythic fable of her rise to prominence, her career as a nurse was little more than perpetrated fraud.

-- Killer Angel: A Biography of Planned Parenthood's Founder Margaret Sanger, by George Grant

With the help of her older sisters, she attended Claverack College and Hudson River Institute in 1896 and then entered the nursing program at White Plains Hospital in 1900. In 1902, just months before completing the program, she met and married architect William Sanger. Margaret Sanger and her husband had three children and the family settled in Hastings, a Westchester County suburb of New York City.

-- About Margaret Sanger, by The Margaret Sanger Papers Project

My own experience as a mother of three children has modified some of the advice given in books.

It is my intention to present the facts to the reader in the simplest language, leaving out dogmas or religious accompaniment.

While there are various mechanical instruments such as the gold, ideal or wishbone pessary, the uterus button, etc., often used to prevent conception, I will not describe them here, because my experience has taught me that they are likely to cause irritation and trouble to the woman. There is sufficient information given here, which, if followed, will prevent a woman from becoming pregnant unless she wishes to do so. It must not be forgotten that the best results can be obtained only when the woman will see that, in every case, she follows directions. She must not get careless even once, for it needs only one union in twelve months, unprotected, to give a woman a baby each year. Therefore, to protect herself from pregnancy the woman must use care constantly.

While it may be troublesome to get up to douche, and a nuisance to have to watch the date of the menstrual period, and to some it may seem sordid and inartistic to insert a pessary or a suppository in anticipation of the sexual act, it may be far more sordid and the condition far worse than inartistic a few years later for the mother to find herself burdened down with half a dozen "accidental" children, unwanted, helpless, shoddily clothed, sometimes starved or undernourished, dragging at her skirt, while she becomes a wornout shadow of the woman she once was.

It takes but a few years of continued pregnancies to break a woman's health. The drain on the family income is continually increasing and the standard of the whole family is lowered.

Mothers! Do not be oversentimental in this important phase of hygiene. Learn the facts of pregnancy. The inevitable fact is that, unless you prevent the male sperm from entering the womb, you are liable to become pregnant.

Women of the working class should not have more than two children today. The conditions of society do not render possible the proper care of more than this number. The average wage-earner can take care of no more than this in decent fashion.

It has been my experience that women desire only the number of children they can properly care for, but that they are compelled to have them from carelessness or through ignorance of the methods to prevent conception.

It is only the workers who are ignorant of the means to prevent bringing children into the world. It is also mainly their children who fill the child labor records, the factories, mills, jails, hospitals, poor houses. It is the workers' children who compete with their parents in the labor market for their daily bread, thereby reducing the wages of the parents — an inevitable consequence when the supply is greater than the demand.

Women of the world arise! Let us close the gates of our bodies against the diseased, the unfit, and bring to birth only the best, as we know it, which should be, at least, a child with a sound body and a sound mind.

IS THERE A SAFE PERIOD?

There is current among people an idea that conception does not take place at certain times of the month. For instance: the interval between ten days after the menstrual period, and four or five days before the next period. This is not to be relied upon at all, for it has been proven again and again that some women conceive at any time in the month. Do not depend upon this belief, for there is no scientific foundation for it. There is also the knowledge that nursing, after child-birth, prevents the return of the menstrual flow for several months and conception does not take place. It is well not to depend upon this too much, especially after the fifth month, for often a woman conceives again without having "seen anything" or without her realizing that she has become pregnant. She thus finds herself with one at the breast and another in the womb. Use some preventive.

COITUS INTERRUPTUS

Perhaps the most commonly used preventive, excepting the use of the condom is "Coitus Interruptus" or withdrawal of the penis from the vagina shortly before the ejection of the semen. No one can doubt that in theory this should be a perfectly safe method; and we also find authorities who claim it is not injurious to the man, but who object to it on the grounds of lack of satisfaction to the woman.

The claim is that if she has not completed her desire, she is under a highly nervous tension, her whole being is perhaps on the verge of satisfaction when she is left in a dissatisfied state. This, without doubt, does her injury. A mutual and satisfied sexual act is of great benefit to the average woman, the magnetism of it is health-giving.

When it is not desired on the part of the woman and she gives no response, it should not take place. The submission of her body without love or desire is degrading to the woman's finer sensibility, all the marriage certificates on earth to the contrary notwithstanding.

During several years past, however, I have come in contact with thousands of men and women who have given me their confidence and experience along these lines. The consensus of experience seems to be that there are many men who prefer to practise the method of withdrawal and have been able to control the ejaculation until after the woman's orgasm. If this is done all objections affecting the woman's satisfaction are of course removed. But the fact remains that even in such cases, with the strongest control on the part of the man, we find that pregnancy does take place. This is often due to some slight disposal on the part of the man to a seminal leakage, in which the spermatozoa escape from the male organs without the man's knowledge and before the ejaculation.

A woman physician examined a vaginal passage and found sperm deposits when absolutely no ejaculation had taken place. The results of these inquiries are sufficient for us to say that the practice of withdrawal cannot always be counted upon as a safe preventive.

Again, while in the quest of information regarding this practice, I have had many men say that their nervous system had suffered decidedly bad effects from this method and upon using another, at once an improved condition was felt.

Here we see how very individual all methods of contraception really are. What may give happiness and good results to one may prove injurious to another. But coitus interruptus or withdrawal, is by no means to be counted upon as either the safest or the best method of preventing conception. There are other methods more to be recommended.

A DOUCHE IS A CLEANSER— NOT A PREVENTIVE

Although an antiseptic douche is an important factor in preventing conception, it should not be relied upon as a preventive measure in itself. A douche is a cleanser, but it is not of itself to be advised as a reliable method to prevent conception. When one understands how conception takes place, it can be seen at once that it is quite possible for a woman to be in a state of pregnancy before she leaves the bed, or before she can reach a douche, unless the womb has been previously covered with the rubber pessary, or by the ingredients of a suppository.

Nevertheless, every woman should learn to cleanse herself thoroughly by means of the vaginal douche. Some women object to the use of the suppository because of its lubricant effect; this can be modified greatly by the use of a warm salt douche, taken just previously to inserting the suppository, cleansing the parts thoroughly of any secretion already there.

Every woman should possess a good two-quart douche bag, called a fountain syringe. Hang it high enough to secure a good, strong, steady flow.

Bulb syringes, such as the whirling spray syringes have been found satisfactory by many women for the purpose, especially where there is no bath room or toilet conveniences, as the bulb syringe can easily be used in the privacy of one's bedroom over a vessel. Directions for use come with each syringe.

HOW TO TAKE A DOUCHE

If you have bathing conveniences, go as quickly as possible to the bathroom after the sexual act and prepare a douche. Lie down upon the back in the bath tub. Hang the filled douche bag high over the tub, and let the water flow freely into the vagina, to wash out the male sperm which was deposited during the act.

Do not be afraid to assist the cleansing by introducing the first finger with the tube and washing out the semen from the folds of the membrane. One can soon learn to tell by the feeling when it is sufficiently clean. It is said, that the French women are the most thorough douchers in the world, which helps greatly in keeping the organs in a clean and healthy condition, as well as preventing the male sperm from reaching the womb to mate with the ovum.

When there are no bath room conveniences, a douche can be taken over the toilet, or, when that is impossible, it can be taken over a vessel in a squatting position.

DOUCHES

Many women have been advised by physicians to use an antiseptic douche as a means to prevent conception. I do not advise any woman, who desires to avoid pregnancy, to rely upon a douche for a contraceptive. I wish to emphasize again that a douche used alone is not a contraceptive, because the germ from the male may already have entered the mouth of the womb before a woman can use a douche. Therefore it is absolutely necessary that some method be used to cover the womb.

A douche is a cleanser. It is a means of hygiene rather than a preventive. Do not depend upon a douche to prevent conception. Some women have been successful in using this for many years and then later on, to their surprise, find that pregnancy has occurred. The explanation is as follows:

When the womb is placed high out of the vagina it is not so easy for the germ from the man to reach directly into the womb. In such cases it is possible for a woman to get up and prepare a douche before the germ from the male enters the womb. There are times, however, when a woman has been standing on her feet, washing or ironing or working, and becomes over-tired. Under such circumstances the womb is pulled or dragged down into the canal of the vagina. At such times if intercourse takes place, it is much easier for the seed from the male to enter directly into the womb, unless there is some protection. It is then that a woman who has previously depended upon a douche as a preventive finds it has failed.

My advice is: Never depend upon a douche alone. It should be used after the use of a suppository or before the removal of the pessary.

Cold water douches are not advisable, as there is a tendency to chill and shock the nervous system. A warm or moderate douche is better.

Warm soapsuds as a douche are used by women in France in the rural districts — just plain common soap, as a cleansing douche after the act.

SOLUTIONS FOR DOUCHING

Following are some of the solutions to be used for the douche, which, when carefully used, will kill the male sperm or prevent its entering the womb:

Cresol is said to be the equivalent, chemically, of lysol and is likely to be obtained at a lower cost. Directions are much the same as those for the use of lysol.

Zonite. — This fluid can be obtained at drug stores and is recommended as a douche and for hygienic purposes generally. A quarter of a glassful to two quarts of warm water is enough, though a stronger solution will do no harm.

Chapter X: Lysol and Zonite

Mrs. Robert Smith, married for two months, and living in a small Colorado town, was turning the pages of the Ladies Home Journal. She came to a picture of the Dionne quintuplets. She was a normal young woman and these engaging babies appealed to her. But just the same she found herself hoping that she wouldn’t have a baby until Robert was earning a little more than $28 a week. Their old family doctor had been of no help, and Mrs. Robert Smith had never heard of a birth control clinic, so she clipped the coupon at the bottom of the page and sent for the booklet containing “facts about Feminine Hygiene and other uses of Lysol.”

“Your ritual of personal antisepsis,” the booklet told Mrs. Smith, “Must cleanse thoroughly, destroy germ-life, and leave you soothed and refreshed. Obviously, the effectiveness of your practice of feminine hygiene depends on the preparation you employ in your douche. LYSOL is ideal for this purpose.”

Mrs. Smith bought a bottle of Lysol. She was sure that it must be a good product or it would not be advertised in the Ladies Home Journal and other magazines that she and her mother had read for years.

Just what is this Lysol, used by the Mrs. Robert Smiths of our country “as a means to intimate feminine daintiness and peace of mind”? It consists essentially of cresol, a distillate of wood and coal, which has been made soluble in water by treating it with soap. Cresol was discovered through the attempts of scientists to find a substance which would not be so poisonous as carbolic acid and yet as effective in killing germs. It is now recognized to be almost, if not equally, as dangerous as carbolic acid itself; swallowing Lysol has come to be a common – but extremely painful – means of committing suicide.

Lysol is “SAFE,” says the Lehn and Fink Company, makers of this product. It takes more than the word “safe” in capital letters to refute the many cases, in medical literature, of injury and even death from Lysol. The United States Dispensatory reports the death of a woman from using Lysol in a vaginal douche. As long ago as 1911 Witthaus and Becker stated in Medical Jurisprudence, Forensic Medicine and Toxicology that they had collected the reports of eleven poisonings from uterine irrigations with Lysol. Five of the poisoned women died. In the Journal of the American Medical Association (June 29, 1935), Dr. Louis Pancaro tells of the death of a young woman who injected Lysol into her uterus in order to bring about an abortion. Within half an hour of doing so, the girl became delirioius and unconscious, and died two days afterward without regaining consciousness.

Any antiseptic should be considered not only from the point of view of its effect on bacteria, but also from the point of view of its action on the body tissues. Obviously, any antiseptic which does more damage to the body tissues than it does to the invading bacteria is dangerous. Dr. John R. Conover and Dr. John L. Laird in the Therapeutic Gazette for February, 1924, had this to say of the phenol group of antiseptics: “Members of this group while efficient in destroying bacteria are equally deleterious to animal tissues … Phenol and cresol, as well as the modified preparations, Lysol, kreso, izal, creolin, etc., have an irritating and toxic action …”

The mucous membranes of the vagina are considered so sensitive and easily injured that the Council on Pharmacy and Chemistry of the American Medical Association will not authorize the advertising of any antiseptic to the public for use on the genito-urinary tract. Yet Lehn and Fink, makers of Lysol, urge frequent vaginal douching with their caustic product.

As pointed out in Chapter 8, douches containing strong antiseptics are a common cause of leucorrhea. Dr. Samuel R. Meaker reports in the Journal of Contraception (March, 1936) that he has seen four or five cases of severe inflammation of the vagina “following the employment of a coal-tar-product widely advertised to the laity for feminine hygiene.” He does not name the product, but the description would fit either Lysol or some very similar product. The woman who follows instructions enclosed with each package of Lysol and douches “several times a week” will not find the treatment “soothing.” But she may discover that the douches have brought on an inflammation of an originally healthy vagina.

If the vagina is already inflamed, and the woman troubled with leucorrhea, douching with a caustic substance such as Lysol is apt to aggravate the condition. Dr. James E. King in the New York State Journal of Medicine for February 11, 1933, said that even doctors sometimes err in this direction in their treatment of leucorrhea. “He [the physician] fails to visualize the irritated vaginal walls and the denuded areas, and prescribes a douche that is irritating. Iodine, Lysol, or some douche powder is often his choice.” Dr. King points out that the use of such agents on inflamed surfaces is so irritating that it actually increases the amount of discharge.

“It is used in delicate childbirth when feminine membranes are most sensitive. Then surely it is safe for normal everyday use.” This, or a similar statement, has appeared in many Lysol advertisements in an attempt to reassure women regarding the safety of the product. A truer statement would be that it has been used in childbirth, but that this use is now largely discredited. Dr. Lawrence P. Garrod, Lecturer in Biology at the St. Bartholomew’s Hospital in England says: “To those familiar with the properties of germicides the use of Lysol in obstetrics has always appeared mistaken. It is the most caustic of all antiseptics in clinical use, with the single exception of phenol, and the limitations imposed by this property on the strengths of solutions employable bring them dangerously near a point at which they are ineffective.” Dr. Garrod, in a study which he made of the efficiency of antiseptics used in midwifery, found that a dye known as brilliant green proved to be over fifty times as effective in killing germs as Lysol. Dr. J.M. Munro Kerr reports that when St. Mary’s Hospital in Manchester, England, substituted Lysol for another antiseptic at childbirth, the fever rate became very much higher.

Many doctors have abandoned the use of antiseptics in the vaginal canal during childbirth, for they have found that frequently the damage to the delicate cells of the vagina and cervix is greater than the damage to the bacteria which may be present. Too often the antiseptics cause the very infection they are supposed to prevent.

Every reader of the popular women’s magazines probably remembers the long series of ads which the Lysol makers ran a year or two ago called “frank talks by eminent women physicians,” which were all based on the inference that women could free themselves of the fear of unwanted pregnancies by using Lysol douches. These advertisements were strikingly similar in some respects. For instance, in all that we have seen the doctors quoted were from foreign countries: Dr. Anne Marie Durand-Wever, “distinguished German gynecologist;” Dr. Anna Baltischurler, “leading gynecologist of Switzerland;” Dr. Clotilde Delaunay, “leading gynecologist of Paris;” Dr. Paul Karniol-Shubert, “one of the most distinguished gynecologists of Austria;” Dr. Louise Foucart-Fassin, “leading gynecologist of Brussels;” Dr. Amparo Monmeneu, “famous gynecologist of Madrid, Spain.” One would think that America had no gynecologists of distinction; or perhaps American names are not sufficiently bizarre to embellish a Lysol advertisement.

Another marked similarity is the sameness of the testimonials from these doctors, even in the phrases they use. Thus the Austrian, Dr. Paula Karniol-Shubert, says of one of her patients: “Sound advice on marriage hygiene was all she needed. And that was all I gave her. In two little words: Use ‘Lysol.’” And Dr. Clotilde Delaunay of Paris says that her advice to her scores of patients “is given in two short words – use ‘Lysol.’” That two doctors of different countries should express themselves in such nearly identical language should certainly be investigated by the Society for Psychical Research as a striking illustration of thought transference.

“The Lysol advertising, playing up the testimonials of foreign physicians, is reminiscent,” says the Bureau of Investigation of the American Medical Association, “of what the Fleischmann people were doing in recent years, and some others long before them. It seems likely that ‘patent medicine’ concerns have to resort to testimonials from foreign physicians because reputable ones in America will not sell themselves out to such schemes. It appears, also, that the foreign physicians’ testimonials are not often found in publications issued in their own countries. Possibly they hope that their fellow countrymen will not see their testimonials in American periodicals.”

In these, and many other advertisements, it is implied that Lysol is a safe contraceptive measure. The same inference is made in the leaflet in the Lysol package when it says: “The douche should follow married relations as a cleansing and antiseptic agent.” We have already pointed out in the chapter on douching that no douche, no matter what it contains, is an effective contraceptive, for frequently the spermatozoa have entered the uterus, made their way into the Fallopian tubes and impregnated the ovum before any douche can reach them. Or they may have found their way into some of the innumerable folds of the vagina. No douche can be depended upon to penetrate all of these folds, despite the very brash and positive assertion that “Lysol has that rare quality of penetrating into ever crevice and furrow of the membranes, destroying germ-life even in the presence of organic matter.”

Even putting aside the fact that the douche is an unreliable contraceptive, Lysol is less effective than many other chemicals. In a study of the spermicidal powers of a group of chemicals, Dr. John R. Baker has found that seventeen are more efficient than cresol in killing spermatozoa. (As said before, Lysol and cresol are essentially the same.) Such a harmless substance as the citric acid of lemons ranks ahead of cresol. Yet the manufacturers of Lysol advertise:

Women are sensitive – shy. Down deep in their hearts they know what’s the matter. But something keeps them from telling – even their doctor – and from listening to her advice when she has guessed the truth. Such a case came to my notice recently. I could see my patient thought it ‘wasn’t nice’ to face the problem of marriage hygiene frankly. So I sent for her husband. ‘I’m sorry I had to send for you,’ I told him. ‘But your wife won’t listen. Now you must teach her what to do.’ I explained about ‘Lysol’ – the antiseptic that can always be trusted. I told him how safe it is – how gentle. I told him that the whole medical world approves, uses, recommends it. He went away comforted. And when I next saw his wife, her fears had vanished like dew in the sun. They had both grown young again.

Such sentimental trash would be laughable were it not for the tragedy of the many women who have become pregnant because they have relied upon antiseptic douches.

Two doors from the home of the hypothetical Mrs. Robert Smith who bought Lysol lived Mrs. David Jones – also a typical American wife. Her attention was caught by the picture of a beautiful and radiant woman proclaiming, “Now I’m so much happier.” Mrs. Jones, who had four children, was also struck by the caption, “It’s never too late for a wife to learn.” She read the advertisement and found that Zonite is both “safe and powerful.” And so she bought a bottle.

What is Zonite which the Mrs. Joneses of the country have been told provides the “ideal combination of strength and safety” needed for the purpose of feminine hygiene? It is essentially sodium hypochlorite in water, a very cheap solution. For many years hypochlorite solutions have been known to be of value in the treatment of infections, but they were also known to have decided drawbacks – they were unstable and deteriorated rapidly, and they contained free alkali, which is irritating to body tissue. During the war two surgeons evolved a hypochlorite solution which has been named after them – the Dakin-Carrel solution, and it was used with success on wounds. Zonite is essentially a double-strength Dakin-Carrel solution.

The Zonite Corporation claims that Zonite “keeps its strength indefinitely.” William H. Zabel has reported the experience of St. Luke’s Hospital in Chicago with hypochlorite solutions. St. Luke’s Hospital has tried various processes for making Dakin’s solution, and has also investigated the “concentrated stabilized solutions that are available to be diluted for use.” The judgment formed as the result of this investigation was that “Dakin’s solution, regardless of the method of preparation, loses its efficiency after forty-eight hours, and on longer standing, secondary products form which irritate the wound. Adding chemicals to stabilize the solution interferes with the reaction on micro-organisms.” It is difficult to see in the face of such evidence (confirmed by reports from other scientists) how the claim that Zonite keeps its strength indefinitely can be substantiated. And the chance that a woman can get a fresh bottle of Zonite is extremely small. Quite possibly the bottle has stood on the druggist’s shelf for several weeks, or even longer. At the best it is as old as the time it has taken it to pass through the hands of the manufacturer, the wholesaler, and the druggist.

Zabel reports that Dakin’s solution can be made with an electrolytic cell for about four cents a gallon. Zonite, also manufactured by an electrolytic process, sells for 30 cents for a two and one-half ounce bottle and 60 cents for the six-ounce size. According to Zabel’s cost estimate, and allowing for Zonite’s double strength, the bottle retailing at 60 cents contains about one-half cent’s worth of the solution.

All doctors know that if Dakin’s solution is to be used successfully it must not contain caustic alkali, and its strength must be maintained within a very narrow range. If it is too weak, it is ineffective; if too strong, it seriously irritates the tissues. Many doctors do not use Dakin’s solution because it is difficult to get just the right strength. It seems almost unnecessary to say that the woman who measures her Zonite with a tablespoon and who makes a rough estimate of the water by merely filling up her douche bag is not able to improve on the doctor’s technique.

What about the claims of Zonite that it is non-irritating? In treating wounds with Dakin’s solution it is necessary to cover the surrounding normal tissue with gauze soaked in Vaseline in order to protect it. Any antiseptic that may injure the skin may certainly irritate the mucous membranes of the vagina. Dr. Robert A. Lambert has reported in the Journal of Experimental Medicine that Dakin’s solution is among the antiseptics which are more injurious to tissue cells than to bacteria. Any woman who douches often with Zonite is running a risk because douching frequently with any antiseptic may be harmful. By killing or injuring the protective Doderlein bacilli, and by possibly irritating the mucous membranes, she is inviting an attack of vaginitis. When the Zonite Products Corporation states that “the douche has become a fixed part of the feminine toilet, recognized as a wholesome, healthful routine;” when they claim that Zonite when used as indicated in the vaginal douche is “non-irritating” and “exercises no harmful effect on the delicate membranes and tissues of the vaginal tract,” they are guilty either of ignorance or a callous indifference to the health of the countless women whom they are trying to enlist as steady buyers.

“Nearly every woman at one time or another is afflicted by leucorrhea (‘whites’), characterized by a whitish, viscous discharge. A Zonite douche will help to relieve the inflammation and to disinfect and cleanse the affected parts. When convenient, a tampon of absorbent cotton may be used. This should be moistened well with the solution…” says “Facts for Women,” the booklet put out by the Zonite Corporation. We have already pointed out the dangers of self-treatment of leucorrhea. Use of the tampon, which would keep Zonite in prolonged contact with the mucous membranes, is particularly unwise. “Caution,” read the Zonite leaflets. “Do not let Zonite come in contact with dyed fabrics; the active principle is a powerful bleaching agent.” Yet no caution is given regarding the possible injury resulting from the introduction into the vagina of a tampon saturated with a solution of the same powerful bleaching agent.

The Zonite people at the present time are basing their appeal to women on the inference that Zonite is a good contraceptive. “Many a home is peaceful and happy … when fear and doubt no longer cloud the young wife’s outlook.” The continuous barrage of such statements justifies a final reminder that the douche is not a reliable contraceptive measure. One advertisement reads: “There are sensitive women everywhere who do not trust the superficial information that is going around about feminine hygiene. These deep-natured women want the whole truth from the scientific standpoint. They must depend on themselves to sift out the read facts.” It is to be hoped that enough has been said to make women, deep-natured or otherwise, realize that for the facts they must go elsewhere than to the Zonite Products Corporation.

-- Douching with Lysol and Zonite, Chapter X, in Facts and Frauds in Woman's Hygiene, by Rachel Lynn Palmer and Sarah K. Greenberg, M.D., The Sun Dial Press, New York, 1936

Salt Solution. — Mix four tablespoonfuls of table salt in one quart of warm water and dissolve thoroughly. This is good, and cheap.

I douched with salt water yesterday as I suffer with terrible thrush, now I'm feeling swollen and a bit discormfort. I'm not sure if I did the right thing.

OUR EXPERT SAYS: This is not ideal. You could try one or two drops of tea tree oil in your bath. Otherwise use Canesten pessaries.

-- Douching with salty water, by health24.com

Vinegar Solution. — Many peasants in Europe use vinegar as an antiseptic almost exclusively. One glassful to two quarts of water is the strength usually desired. Douche afterward with clear water.

Acetic acid being the sperm-killing agent in vinegar, may also be used and with the certainty of more uniformity than can be depended upon in the various grades of vinegar. A good solution is one and a half teaspoonfuls of 36 per cent acetic acid to two quarts of warm water.

Plain Water Douche. — This will sometimes remove the semen quite effectively without the aid of an antiseptic. But as the semen can hide itself away in the wrinkled lining of the vaginal cavity, the plain water will only impede its progress for a time. Some ingredient which will kill the sperm is to be more relied upon.

Some women use the douche before the sexual act as a preventive. If this is done, any astringent such as boric acid, alum, citric acid, hydrochlorate of quinine used in the solution will do. Only a pint of solution is needed for this purpose, following the act a larger douche is used as a cleanser. This can also be done with the regular antiseptic douche.

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Part 2 of 2

THE USE OF THE CONDOM OR "COVERS"

These are made of soft tissues which envelope the male organ (penis) completely and serve to catch the semen at the time of the act. In this way the sperm does not enter the vagina nor the womb.

The condoms are obtainable at all drug stores at various prices. There are some of skin gut and some of rubber tissue. While the rubber condom is best known, there is found to be least objection to the use of those made of soft skin gut. The skin condom is made more durable and more agreeable to use, if kept in denatured alcohol. Alcohol sterilizes and toughens the membrane. The condom should be washed before and after putting it into the jar of alcohol and should be kept tightly corked. It is almost impossible to keep skin condoms satisfactorily if they are dried. If properly adjusted they will not break. Fear of breaking is the main objection to their use. If space has not been allowed for expansion of the penis, at the time the semen is expelled, the tissue is likely to split and the sperm finds its way into the uterus. The woman becomes pregnant without being conscious of it. If on the other hand care is given to the adjustment of the condom, not fitting it too close, it will act as a protector against both conception and venereal disease. Care must be exercised in withdrawing the penis after the act, not to allow the condom to peel off, thereby allowing the semen to pass into the vagina.

It is desirable to discard the condom after it has been once used unless certain precautions are taken. If it is to be used again care must be taken to wash the condom in an antiseptic solution before drying it and placing it away for further use. A weak solution of Zonite is excellent for the condom.

The condom should be well lubricated with oil before penetration. While any lubricant will do, it is more convenient to use the Lactic Acid Jelly or the commonly known KY jelly. Smear it well over the condom before insertion. It should always be tested for holes or breaks before using.

The condom is one of the most commonly known preventives in the United States. It has another value quite apart from prevention in decreasing the tendency in the male to arrive at the climax in the sexual act before the female.

There are few men and women so perfectly mated that the climax of the act is reached together. It is usual for the male to arrive at this stage earlier than the female, with the consequence that he is further incapacitated to satisfy her desire for some time after. During this time the woman is in a highly nervous condition, and it is the opinion of the best medical authorities that a continuous condition of this unsatisfied state brings on or causes disease of her generative organs, besides giving her a horror and repulsion for the sexual act.

Thousands of well-meaning men ask the advice of physicians as to the cause of the sexual coldness and indifference of their wives. Nine times out of ten it is the fault of the man, who through ignorance or selfishness and inconsiderateness, has satisfied his own desire and promptly gone off to sleep. The woman in self defense has learned to protect herself from the long hours of sleepless nights and nervous tension by refusing to become interested in the act.

The condom will often help in this difficulty, and repulsion from which it takes some time to this subject, no idea of the physiology of intercourse, who upon any contact of the semen have a disgust and repulsion, from which it takes some time to recover. Much depends upon the education of the girl, but more depends upon the attitude of the man toward the relation.

THE PESSARY— RUBBER WOMB CAP

One of the best means of prevention is the pessary or the rubber womb cap. These come in various forms and sizes, the Dutch Mensinga with its ten or twelve sizes, the Matrisalus, used also in Holland and Germany, the French cap-shaped, the Haire pessary used largely in England and the Mizpah largely used in U.S.A. While the French and Mizpah pessary (see cut) may be conveniently used in many cases with satisfaction, I now find the Mensinga and Ramses (both diaphragm pessaries) more reliable and more generally adjustable than the cervical or cap pessary.


French Pessary

The chief objection to the use of the pessary is the difficulty of adjusting it. It is very important that the proper size be prescribed for each individual case. This can only be done after a thorough gynecological examination. The condition of the perineum and the position of the cervix must be ascertained before the proper size can be recommended. This should be done by a physician and then the woman should be instructed how to introduce and remove it herself. It takes but a few minutes for the woman to learn how to do this.

The pessary can be inserted in the evening and allowed to remain in place until the following morning when it should be removed.

Before removing it, she should take part of a warm water douche and continue the douche after the pessary is out.

This method is the most practical of any known.

In my estimation a well fitted pessary is one of the surest methods of preventing conception. I have known hundreds of women who have used them for years with the most satisfactory results. The trouble is women are afraid of their own bodies, and are of course ignorant of their physical construction.

They are silly in thinking the pessary can go up too far, or that it could get lost, etc., etc., and therefore discard it. It cannot get into the womb, neither can it get lost. The only thing it can do is to come out. And even that will give warning by the discomfort of the bulky feeling it causes, when it is out of place.

Before inserting a pessary inject into the cap a small amount of lactic acid jelly or a small quantity of bicarbonate of soda. This will act as a cement to help seal the mouth of the womb for the time being and thus doubly insure prevention.

Lactic acid gel is a registered medical device consisting of a colourless viscous gel administered through an intravaginal tube applicator. Known side effects of lactic acid gel include vaginal irritation, e.g. redness, stinging and itching. In rare cases an allergic skin reaction, e.g. severe redness, swelling or burning, may occur.

-- Metronidazole versus lactic acid for treating bacterial vaginosis (VITA): protocol for a randomised controlled trial to assess the clinical and cost effectiveness of topical lactic acid gel for treating second and subsequent episodes of bacterial vaginosis, by Lindsay Armstrong-Buisseret, Clare Brittain, Miruna David, Gillian Dean, Frances Griffiths, Trish Hepburn, Louise Jackson, Joe Kai, Alan Montgomery, Tracy Roberts, Sukhwinder Thandi & Jonathan D. C. Ross

Finger touching mouth of womb, a — womb; b — mouth of womb.

In inserting the French or Mizpah pessary it is well to get in a position which will make the entrance easy. One foot resting on a low chair opens the parts considerably, also a squatting position brings the uterus lower and makes the fitting of the pessary easier. Do not use vaseline or oils on rubber, they decay it. Glycerine or soap rubbed on its surface makes it smooth enough to slip easily into place.

It's a good idea to avoid perfumed soaps, gels and antiseptics as these can affect the healthy balance of bacteria and pH levels in the vagina and cause irritation. Use plain, unperfumed soaps to wash the area around the vagina (the vulva) gently every day. The vagina will clean itself inside your body with natural vaginal secretions (discharge).

-- Keeping your vagina clean and healthy, by NHS.uk

After the pessary has been placed into the vagina deeply, it can be fitted well over the neck of the womb. One can feel it is fitted by pressing the fingers around the soft part of the pessary, which should completely cover the mouth of the womb.

If you do not feel the head of the womb through the rubber then the pessary is not on right. It should be moved backward a little or forward until the head can be felt covered. If you still cannot feel it then remove and use some other preventive, or take it to your physician and ask for instructions. The uterus may be turned or tipped back so far that a pessary could not cover the cervix.

If it is properly adjusted there will be no discomfort, the man will be unconscious that anything is used, and no germ or semen can enter the womb.

A douche is to be taken either immediately after the act or the following morning. Take part or about a quart of antiseptic douche BEFORE the pessary is removed; after removing it continue the douche and cleanse thoroughly. If a douche is inconvenient allow the cap to remain in place at least 12 hours after the act and then remove without douching.

There are some well-meaning advocates of birth control who have more theories than practical knowledge, who urge or advise that the pessary be left in the body for several days and claim that in this way a douche is not necessary.

The theory may work well in women who belong to the class where standing long hours on the feet is not necessary and where a daily bath in a tub of clear water helps to keep the parts clean. But my experience in the nursing field among working women has given evidence that the pessary cannot remain in place long when a woman stands on her feet, as in washing or ironing. The strain pulls the muscles of the womb down into the vagina and the pessary loses its hold and position. Also the constant contact of the rubber with the natural secretions causes an odor to emanate from the parts, which is not pleasant. It is not advisable to wear the pessary all the time. Take it out after using, and wear it only when needed. A little experience will teach one that to place it is a simple matter.

Wash the pessary in soapy warm water, rinse and dry well and place away in the box. One should last two years, if cared for.

I consider the use of the pessary one of the most convenient, as well as the cheapest and the safest method of prevention. Any nurse or doctor will teach one how to adjust it.

The use of the pessary has many advantages over other methods of prevention. There are few women whose generative organs are in a healthy, normal condition, but who cannot find one of the various kinds of pessaries to fit her convenience.

While the pessary can be used only in cases where the womb is in its normal position — the sponge can be used to great advantage even when the womb is tipped back or out of its usual position.

The usual sponge used for the purpose of preventing conception has a tape attached to it. These are to be had at nearly all drug stores. They should be soaked in an antiseptic solution for a few minutes before coitus and then introduced into the vagina far up as they can be placed. Some physicians have recommended the use of the cotton plug, instead of the sponge, to be soaked in an antiseptic solution. Some of the peasants in Europe use the sponge soaked in vinegar for the same purpose and find it satisfactory. In this country a boric acid solution has been used with satisfactory results. Of course this requires a saturated solution, as, for instance, one teaspoonful of the powder to a cup of water stirred until dissolved.

Possible side effects and risks

Although boric acid suppositories are generally safe for adults to use, minor side effects are possible. You may experience: burning at the insertion site; watery discharge; redness in the vaginal area.

-- Can You Use Boric Acid for a Yeast Infection?, by healthline.com

Sponges and cotton plugs can be recommended as safe, if followed by an antiseptic douche before the removal of the plug or sponge, thus preventing the sperm from entering the womb. The problem is to kill the male sperm upon entering the vagina, or to wash it out or to kill it directly afterwards. A weak solution of zonite may also be used for cotton plugs and sponges, also carbolated vaseline.

It is virtually certain that the physical pressure of douching can facilitate ascension of pathogens.

-- Vaginal Douching: Evidence for Risks or Benefits to Women's Health, by Jenny L. Martino and Sten H. Vermund

Any objection to the use of the small tape sponge can be overcome by the use of a large sponge, divided into parts three or four inches in diameter and a half inch in thickness. Cut into parts while new — boil for ten minutes, as the sponge is never considered hygienically clean until boiled. Push one part up into the vagina as far as it will go, pack it tight around the mouth of the womb so that it covers completely. Douche thoroughly before and after its removal. Always keep these sponges in a solution of vinegar half and half.

One of the cheapest methods of birth control is the use of a large sponge.

SUPPOSITORIES OR SOLUBLE PESSARIES

These are becoming more generally used than any other method of prevention. There is reason to believe these can be greatly improved upon, and the results obtained far more satisfactory than is at present prevalent in England especially.

These may be found at any reliable pharmacy. The majority of them are made from cocoa butter or gelatine, which makes it necessary that they be deposited in the vagina several minutes before the act, in order for them to melt. Special ingredients negate the effect of the male seed.

Birth control forced lovers of the past to get creative. The Talmud, the ancient Jewish how-to guide to life, recommended lemon-juice soaked sponges inserted just prior to intercourse. Speaking of citrus and sex, Giacomo Casanova (1725-1798), that notorious Italian lover and leaver of legend, was known to use a half-lemon as a cervical cap to prevent pregnancy in his many partners.

The always crafty ancient Egyptians had methods of their own. The Ebers Papyrus (circa 1550 BCE) describes a virtual plethora of pessaries, with ingredients as varied and sweet-sounding as acacia root and honey, to more stomach-churning inserts soaked in donkey’s milk or crocodile dung. Onion juice applied to the foreskin was also recommended. These last few were likely quite effective forms of birth control in that they also served to repel one’s partner so completely that sex was nearly impossible. The lovers in ancient China fared even worse -- women sometimes drank hot mercury as their birth control method of choice. Presumably, this worked well too -- if maternal death can be considered a way to prevent pregnancy.

-- Contraception: silly to sensational. The long evolution from lemon-soaked pessaries to the Pill, by Jackie Rosenhek, 8/14

One of the objections to the suppository is the greasy feeling the cocoa butter gives. This can be overcome by douching the parts thoroughly before the suppository is inserted.

While some women object to the suppository because of the lubricant effect, other women who have a tendency to a "dry vagina" approve of the suppository because of this tendency and effect.

It is advisable, in the use of suppositories, which are always to be injected before the sexual act, that immediately after the completion of the act a mild antiseptic douche be used to cleanse out the secretions. This is a procedure in the use of all suppositories, and while it is true that a douche is troublesome, it is certain to give better results in preventing pregnancy, than to depend upon the suppository alone.

JELLIES

Medicated jellies are being used quite extensively at the present time either alone or in conjunction with pessaries. This combination constitutes the most reliable method.

Jellies usually consist of a spermaticidal substance incorporated in a water soluble base. The chemicals most usually employed for that purpose are chinosol, acetic acid, lactic acid and boric acid.

Jellies are supplied in collapsible tubes to which a glass or hard rubber nozzle may be attached. By compressing the bottom of the tube either by hand or by means of a key accompanying the tube, the jelly is forced up into the glass nozzle. The nozzle is introduced into the vagina and a definite amount of the jelly (about half a turn of the key) is deposited within the vagina around the neck of the womb. The jelly destroys the motility of the sperm cells and prevents them from entering the womb. Jelly should be injected prior to coitus. A warm water douche should always be taken in the morning to cleanse the vagina from the jelly and secretions.



SOME QUESTIONS OFTEN ASKED

1. What is the best preventive?

A. There is no one preventive to be recommended for everyone in every case. There are good and harmless preventives, any one of which can be made safe, according to the intelligence applied in using them.

I would advise the use of a recommended suppository or contraceptive jelly for the first few months in the case of a bride, until the parts are in a condition where a pessary may be inserted and worn with comfort. Sometimes it is advisable to use suppositories during the early months of marriage, using the pessary only after children have been born.

2. Is a douche necessary after the use of the suppository?

A. To be certain of good results, I would advise a douche as soon as convenient, under all conditions.

3. Are any of these methods recommended injurious to the health of the man or woman?

A. The only method which physicians claim may be injurious to one or both is the continued practice of withdrawal. This method is not generally recommended, though it is practiced largely in France and England.

4. Which method is safest?

A. All are safe if you use care and intelligence in applying them.

5. Which the least troublesome?

A. The pessary can be recommended as the least troublesome, as after it is inserted it may be left to cover the cervix until the next day.

6. Is there a safe period?

A. There is no absolutely safe period between the menstrual periods where intercourse can take place without pregnancy occurring, at least not for all women. Some women claim this period exists in themselves, but unless you know this positively I would not advise a woman to depend upon it.

7. How soon after menstruation ceases should intercourse occur?

A. This should be left as in all cases, to the natural desire of the woman.

8. Does nursing a baby prevent pregnancy?

A. It is claimed that pregnancy does not so easily occur during the nursing period, especially during the first three or four months. There are many women, however, who have conceived, immediately giving birth to another baby eleven months after the other. I would not advise depending upon this at all. Use some preventive at once and control intelligently the time for the next baby's arrival, instead of leaving it to chance.

9. Does fear of pregnancy affect the child?

A. Fear affects everything. We do not yet know the effect upon the human race which the fear of pregnancy has caused.

10. Is it harmful to take drugs during the first few weeks after menstruation has stopped?

A. It is considered especially harmful, not only to the mother, but to the child in cases where the drugs have not the desired effect. It stands to reason that a drug which is powerful enough to eject the fertilized ovum out of the uterus must have power to affect other organs. We often find children wetting the bed up to a late age, as well as suffering from other organic weaknesses, which may be traced back to the mother's frantic attempt to "come around."

11. Should the woman or the man take the precautions?

A. Either or both, but preferably the woman. The methods to be used by the man — withdrawal and the condom — have their objections for many people. While it is true that the employment of either of these methods lessen the trouble for the woman, they also deprive her of that great sacred closeness or spiritual union which the full play of magnetism gives when not checked by fear, as in withdrawal, or interfered with, as in the use of the condom.

Some sensitive men object to the use of these methods, as also do many women. It is for each couple to decide. Many men prefer to use the condom in consideration of the woman, to lessen her trouble in douching.

12. Should a woman have joy in the union?

A. Yes.

13. Why does she not?

A. Either because her mind is occupied with fear of the results, or because of the awkwardness and ignorance of the man.

14. Can this be overcome?

A. Yes; first, by using a contraceptive which gives confidence so there shall be freedom from fear of pregnancy; second, by making the husband understand that a greater love and joy is created in the relation when the union is consummated only when the woman desires it naturally.

I have given in the foregoing pages the most commonly known means of prevention. Personally I recommend every poor woman who has had at least one child to use a well fitted pessary and learn to adjust it.

Books by Margaret Sanger

READ: "Woman and the New Race" $1.00
"Happiness in Marriage" .75
"What Every Boy and Girl Should Know" 1.50
"What Every Mother Should Know" (Paper Cover) .30
"The Pivot of Civilization" 1.25
"Motherhood in Bondage" .50
"My Fight for Birth Control" 1.00
The above can he obtained from
MARGARET SANGER
17 West 16th Street, New York City

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The sexist, toxic history of douching: “You ever get that not-at-all-necessary feeling down there?”
by Stephanie Buck
Timeline.com
Aug 14, 2016

The preponderance of evidence shows an association between douching and numerous adverse outcomes. Most women douche for hygienic reasons; it can be stated with present knowledge that routine douching is not necessary to maintain vaginal hygiene; again, the preponderance of evidence suggests that douching may be harmful. The authors of the present review believe that there is no reason to recommend that any woman douche and, furthermore, that women should be discouraged from douching.

-- Vaginal Douching: Evidence for Risks or Benefits to Women's Health, by Jenny L. Martino and Sten H. Vermund

-- Lysol, by Wikipedia

The douching wive’s tale just won’t die.

No matter how many times medical professionals tell us not to douche, people still insist it’s fine. Our moms told us it was fine. And her mom told her it was fine. And her mom’s vulva burned a little bit but she was mostly fine, too.

But it was only the past few decades that douching was marketed primarily for “freshness.” Since ancient times, people with vaginas primarily douched as a form of birth control. (Warning: It doesn’t prevent pregnancy.)

Douching involves flushing the inside of the vagina with fluid, often squirted from a bottle, bag or tube. Ancient women across many cultures douched with honey, olive oil, or even wine in an effort to prevent pregnancy. It was common for medieval prostitutes to douche between clients, as STIs were rampant. (Warning: It doesn’t prevent infection.)


Éguisier irrigator (Case Western Reserve University)

When American physician Charles Knowlton officially sanctioned the douche in 1832 as a contraceptive after sex — a Victorian version of Plan B — commercial development took off. French obstetrician Maurice Éguisier released a self-acting douche in 1843, a porcelain pump and rubber hose that would remain popular for the next 75 years. Until people discovered Lysol.

Starting in the early 1900s women and other vagina-havers used the household disinfectant to douche. And the brand even sanctioned it for that purpose, creating jelly, spray, and foam versions. Ads claimed Lysol would guard against “odors,” a universally understood euphemism for birth control.

By 1940 the douche would become the most popular “contraceptive” in the US. A 1933 study of 507 women who used Lysol for birth control resulted in nearly half getting pregnant. Meanwhile, doctors had reported 193 poisonings and 5 deaths from Lysol douching before 1911. Women routinely complained of vaginal burning and blisters, though lawsuits were overturned and reports covered up. Never admitting fault, Lysol nonetheless changed its formula in 1952 to become a quarter as toxic as before.

Besides Lysol, women douched with water mixed with iodine, baking soda, or vinegar. Rumors persisted into the 1980s that a Coca-Cola douche was an effective contraceptive. A criticized Harvard Medical School experiment (read: overrated Mythbusters episode) mixed sperm with three types of Coca-Cola and found that Classic Coke killed sperm more quickly. ‘’The experiments were obviously half in jest — we explicitly said we did not recommend Coca-Cola douches as a means of contraception,’’ Dr. Sharee Umpierre, an obstetrician who led the research, told Domestic News.


Mid-century Lysol campaigns shamed women into “disinfecting” their vaginas.

With the widespread availability and social acceptance of actual, effective contraception — particularly the pill — marketers had to reinvent the selling of douches. They turned to an age-old strategy: making women feel horrible about their bodies.

From the 1920s, Lysol had pushed the “unclean” message. Ads chided women for “intimate neglect,” insinuating their husbands lost interest because their vaginas didn’t smell or look like a cute little strawberry in a pink bow. “A man marries a woman because he loves her,” one Lysol ad reads. “So instead of blaming him if married love begins to cool, she should question herself.”

In the 1970s and 1980s — without the pregnancy-prevention off-label use — ads doubled down on this approach, preying on women’s insecurities around “freshness” and sexual idealism.



Magazine advertisements from the 70s sold douching as a convenient way to feel sexy.

It worked. In 1988 sales of feminine hygiene deodorants rose 21.3% in drug stores, and feminine douches rose 3.9%. That same year, the people behind Comfort Stations bet big; these bathroom vending machines stocked contraceptives and genital hygiene products, and sales exploded in reaction to the AIDS crisis. (Again, Summer’s Eve towelettes and douches will not prevent disease.)

Today, we know any type of douching can lead to serious health concerns, and most doctors do not recommend the practice. Douching can alter the natural, healthy balance of bacteria and acidity in the vagina, which help protect the body from infection. The vagina is self-cleaning, like a boss. Just let it do its thing. Ironically, douching can create more harmful bacteria and lead to vaginal infections that increase the risk of pelvic inflammatory disease, HIV, and other serious health problems.

Some women turn to douching and vaginal shampoos in hopes of eliminating odor or discharge, but this is not recommended. Most vaginal odors are normal, and when they’re not, douching rarely eliminates the medical issue. Go see a doctor instead. They’ve seen it all.

(Some medically prescribed rinses are necessary for people who’ve had gender confirmation surgery.)

Neither will douching protect from STIs or pregnancy. We can’t say this enough.

Despite 30-plus years of doctors’ warnings, women are still douching en masse. One in four American women between 15 and 44 douches today (And the number is higher in African-American and Hispanic populations.)


Feminine hygiene products continue to command serious shelf space. (Flickr)

And the messaging is still muddled. Though enough women still douche as to deem it a health concern, the figures are declining. So, brands like Summer’s Eve shifted yet again — this time to invest in more external vaginal hygiene solutions, like wipes, shampoos, and vulva deodorant. In 2011 external products claimed 60% of the brand’s market, and douches 40%.

Let’s hope the numbers keep declining overall, and that customers question products that portray women as toads who smell and taste like fish bits—not to mention calling out vacuous celebrity endorsements of $50 vagina steams.

No, Gwyneth Paltrow. Douching is still a bad idea, no matter what your mom told you.

[admin]

Lysol
by Wikipedia
Accessed: 4/2/20

The preponderance of evidence shows an association between douching and numerous adverse outcomes. Most women douche for hygienic reasons; it can be stated with present knowledge that routine douching is not necessary to maintain vaginal hygiene; again, the preponderance of evidence suggests that douching may be harmful. The authors of the present review believe that there is no reason to recommend that any woman douche and, furthermore, that women should be discouraged from douching.

-- Vaginal Douching: Evidence for Risks or Benefits to Women's Health, by Jenny L. Martino and Sten H. Vermund

Lysol
Product type: Disinfectant, all-purpose cleaners
Owner: Reckitt Benckiser
Country: U.S.
Introduced: 1889; 131 years ago
Markets: Worldwide
Previous owners: Lehn & Fink (later subsidiary of Sterling Drug)
Tagline: "Healthing"
Website: http://www.lysol.com

Lysol (/ˈlaɪsɒl/ LY-sol; d.b.a. Lizol in India[1]) is a brand name of cleaning and disinfecting products distributed by the Reckitt Benckiser company. The line includes liquid solutions for hard and soft surfaces, air treatment, and hand washing. The active ingredient in many Lysol products is benzalkonium chloride, but the active ingredient in the Lysol "Power and Free" line is hydrogen peroxide. Lysol has been used since its invention in the late 19th century as a household and industrial cleaning agent, and previously as a medical disinfectant.

History


A 1935 advertisement from Canada promoting Lysol as a feminine hygiene product, using the slogan "The poise that knowledge gives"

The Poise that Knowledge Gives
Fastidiously well-groomed, obviously sure of herself in every detail, is the woman whose habits of cleanliness including a knowledge of feminine hygiene. This intimate phase of every woman's toilette is too often neglected, through lack of knowledge of the daintiness, self-assurance and poise it brings.
Every modern woman should know the facts about feminine hygiene. So much of beauty, charm and self-confidence is lost to the woman who remains ignorant of these facts so vital to her well-being. To make these facts available to every woman, the makers of "Lysol" Disinfectant have prepared a booklet on "Feminine Hygiene," which contains important statements by three eminent women doctors.
"Lysol" passes the crucial test of a true germicide, in that it is effective in the presence of organic matter. You can depend on "Lysol" to keep its antiseptic strength under conditions that cause some other preparations to lose their efficacy, partly or even totally.
In order to obtain this simply written, informative booklet on the scientific way to fastidious personal cleanliness, just send the coupon below and it will be mailed to you in a plain wrapper
Be sure you get the genuine "Lysol" in the brown bottle with the orange label and carton.
"LYSOL" IS SAFE
A germicide that is used in the most delicate operations -- even childbirth -- where the danger of infection is higher than at any other time -- has to be safe and sure. For nearly fifty years, "Lysol" Disinfectant has had the acceptance of the medical profession throughout the world. It is the standard antiseptic in modern hospitals in every country. Its continued leadership is based upon the confidence of the most prominent doctors. "Lysol" is the reliable germicide.
Lysol (Canada) Ltd., Dept., NH-5
Please send me the "Lysol" Health Library, consisting of "Keeping a Healthy Home," "Feminine Hygiene" and "Preparation for Motherhood."
Lysol Disinfectant

The first Lysol Brand Antiseptic Disinfectant was introduced in 1889 by Dr. Gustav Raupenstrauch to help end a cholera epidemic in Germany. The original formulation of Lysol contained cresols.[2]

Cresols (also hydroxytoluene) are organic compounds which are methylphenols. They are a widely occurring natural and manufactured group of aromatic organic compounds, which are categorized as phenols (sometimes called phenolics). Depending on the temperature, cresols can be solid or liquid because they have melting points not far from room temperature. Like other types of phenols, they are slowly oxidized by long exposure to air, and the impurities often give cresols a yellowish to brownish red tint. Cresols have an odor characteristic to that of other simple phenols, reminiscent to some of a "coal tar" smell. The name cresol reflects their structure, being phenols, and their traditional source, creosote.

Creosote is a category of carbonaceous chemicals formed by the distillation of various tars and pyrolysis of plant-derived material, such as wood or fossil fuel. They are typically used as preservatives or antiseptics.

Some creosote types were used historically as a treatment for components of seagoing and outdoor wood structures to prevent rot (e.g., bridgework and railroad ties, see image). Samples may be found commonly inside chimney flues, where the coal or wood burns under variable conditions, producing soot and tarry smoke. Creosotes are the principal chemicals responsible for the stability, scent, and flavor characteristic of smoked meat; the name is derived from Greek κρέας (kreas), meaning 'meat', and σωτήρ (sōtēr), meaning 'preserver'.

The two main kinds recognized in industry are coal-tar creosote and wood-tar creosote. The coal-tar variety, having stronger and more toxic properties, has chiefly been used as a preservative for wood; coal-tar creosote was also formerly used as an escharotic, to burn malignant skin tissue, and in dentistry, to prevent necrosis, before its carcinogenic properties became known. The wood-tar variety has been used for meat preservation, ship treatment, and such medical purposes as an anaesthetic, antiseptic, astringent, expectorant, and laxative, though these have mostly been replaced by modern formulations.

Varieties of creosote have also been made from both oil shale and petroleum, and are known as oil-tar creosote when derived from oil tar, and as water-gas-tar creosote when derived from the tar of water gas.[citation needed] Creosote also has been made from pre-coal formations such as lignite, yielding lignite-tar creosote, and peat, yielding peat-tar creosote.

-- Creosote, by Wikipedia

-- Cresol, by Wikipedia

This formulation may still be available commercially in some parts of the world.[3] Formulations containing chlorophenol are still available in the United Kingdom.[4]

A chlorophenol is any organochloride of phenol that contains one or more covalently bonded chlorine atoms. There are five basic types of chlorophenols (mono- to pentachlorophenol) and 19 different chlorophenols in total when positional isomerism is taken into account. Chlorophenols are produced by electrophilic halogenation of phenol with chlorine.

Most chlorophenols are solid at room temperature. They have a strong, medicinal taste and smell. Chlorophenols are commonly used as pesticides, herbicides, and disinfectants.

-- Chlorophenol, by Wikipedia

In 1911, poisoning by drinking Lysol was the most common means of suicide in Australia and New York.[5] One of the active ingredients, benzalkonium chloride, is highly toxic to fish (LC50 = 280 μg ai/L), very highly toxic to aquatic invertebrates (LC50 = 5.9 μg ai/L), moderately toxic to birds (LD50 = 136 mg/kg-bw), and slightly toxic ("safe") to mammals (LD50 = 430 mg/kg-bw).[6]

Use during the 1918 Spanish flu pandemic

In 1918, during the Spanish flu pandemic, Lehn & Fink, Inc. advertised Lysol disinfectant as an effective countermeasure to the influenza virus. Newspaper advertisements provided tips for preventing the spread of the disease, including washing sick-rooms with Lysol, as well as everything that came in contact with patients. A small (US50¢) bottle made 5 US gallons (19 l; 4.2 imp gal) of disinfectant solution, and a smaller (US25¢) bottle made 2 US gallons (7.6 l; 1.7 imp gal). The company also advertised the "unrefined" Lysol F. & F. (Farm & Factory) for use in factories and other large buildings – a 5-US-gallon (19 l; 4.2 imp gal) can, when diluted as directed, made 50 US gallons (190 l; 42 imp gal) of disinfecting solution.[7]

Use as a feminine hygiene product

In the late 1920s Lysol disinfectant began being marketed as a "feminine hygiene" product by maker Lysol, Inc. and distributor Lehn & Fink, Inc. It was claimed vaginal douching with a diluted Lysol solution prevented infections and vaginal odor, and thereby preserved youth and marital bliss.[8] This Lysol solution was also used as a birth control agent, as post-coital douching was a popular method of preventing pregnancy at that time.[9] In his 1938 textbook, American obstetric physician Joseph Bolivar DeLee encouraged the use of Lysol during labor as a disinfectant: "[J]ust before introducing the hand, the vagina is liberally flushed with 1 per cent lysol solution squeezed from pledgets of cotton, the idea being to reduce the amount of infectious matter unavoidably carried into the puerperal wounds and up into the uterus by the manipulations."[10] The use of Lysol was later discouraged by the medical community as it tended to eliminate the bacteria normal to the healthy vagina, thus allowing more robust, health-threatening bacteria to thrive, and may have masked more serious problems that certain odors indicated in the first place.[11]

The Smithsonian Institution in 2013 included the Lysol feminine hygiene ads among others which were "hilarious and shocking" in hindsight.[12]

Use as an abortifacient

Earlier formulations of Lysol contained cresol, a compound that can induce abortions, and it was widely used by women who could not otherwise obtain legal abortions in the United States, although the medical community was relatively unaware of the phenomenon for the first half of the 20th century.[13][14] By the 1960s, published medical literature had acknowledged the common use of Lysol and other soaps to induce abortions, which could lead to fatal renal failure and sepsis.[15]

Kidney failure, also known as end-stage kidney disease, is a medical condition in which the kidneys are functioning at less than 15% of normal. Kidney failure is classified as either acute kidney failure, which develops rapidly and may resolve; and chronic kidney failure, which develops slowly. Symptoms may include leg swelling, feeling tired, vomiting, loss of appetite, and confusion. Complications of acute and chronic failure include uremia, high blood potassium, and volume overload. Complications of chronic failure also include heart disease, high blood pressure, and anemia.

-- Kidney failure, by Wikipedia

Sepsis is a life-threatening condition that arises when the body's response to infection causes injury to its tissues and organs. Common signs and symptoms include fever, increased heart rate, increased breathing rate, and confusion. There may also be symptoms related to a specific infection, such as a cough with pneumonia, or painful urination with a kidney infection. The very young, old, and people with a weakened immune system may have no symptoms of a specific infection, and the body temperature may be low or normal instead of having a fever. Severe sepsis is sepsis causing poor organ function or blood flow. The presence of low blood pressure, high blood lactate, or low urine output may suggest poor blood flow. Septic shock is low blood pressure due to sepsis that does not improve after fluid replacement.

-- Sepsis, by Wikipedia

Use during the 2020 coronavirus pandemic

Given its popularity as a disinfectant, Lysol has had a major ongoing role in household and medical sanitation throughout the COVID-19 pandemic. Several of Lysol's products are on the EPA's list of registered disinfectants: Lysol brand Heavy-Duty Cleaner Disinfectant Concentrate, Lysol Disinfectant Max Cover Mist, and Lysol brand Clean & Fresh Multi-Surface Cleaner.[16]

Product innovations

• 1930: Lysol Brand Disinfectant Liquid was introduced to drug stores and hospitals.
• 1957/58 Lysol purchased the rights to private label National Laboratories, Inc's Disinfectant spray.
• 1962: Lysol released the Lysol Disinfectant Spray, which used a new method of aerosol application.
• 1968: Lysol began creating bathroom cleaners and released the Lysol Toilet Bowl Cleaner.
• 1985: Lysol All Purpose Cleaner was released.
• 1988: Lysol began shipping aerosol disinfectants to humid areas such as Houston, to combat "lung rot".
• 2000: Lysol introduced Lysol Disinfecting Wipes, pre-moistened cleaning wipes for use on hard, non-porous surfaces.
• 2009: Lysol began producing hand soaps.

Ownership: Lehn & Fink was acquired by Sterling Drug in 1967 and Reckitt & Colman acquired L&F in 1994 when Bayer acquired Sterling-Winthrop. As of 2015 Lysol products were distributed by Reckitt Benckiser LLC of Parsippany, New Jersey.

Ingredients

Different Lysol products contain different active ingredients. Examples of active ingredients used in Lysol products:

• Ethanol/SD Alcohol, 40 1–3%; fluid that acts as sanitizer
• Isopropyl alcohol, 1–2%; partly responsible for Lysol's strong odor; acts as sanitizing agent and removes odor
• p-Chloro-o-benzylphenol, 5–6%; antiseptic
• o-Phenylphenol, 0.1%; antiseptic; in use circa 1980s
• Potassium hydroxide, 3–4%
• Alkyl (50% C14, 40% C12, 10% C16) dimethylbenzyl ammonium saccharinate, 0.10%; microbiocide
• Alkyl (C12-C18) dimethylbenzylammonium chloride, 0.08%; antiseptic
• Alkyl (C12-C16) dimethylbenzylammonium chloride, 0.02%; antiseptic
• Lactic acid as an antiseptic.
• Hydrogen Peroxide

Products

• Disinfectants: Lysol Disinfectant products are used to kill surface and air bacteria. Products include:
o Lysol Disinfectant Spray
o Lysol Disinfecting Wipes
o Lysol Concentrate Disinfectant
• Cleaners: Lysol distributes several multi-purpose cleaners, kitchen cleaners, and bathroom cleaners. These include:
o Lysol Power & Free
o Lysol All-Purpose Cleaner
o Lysol Multi-Surface Cleaner Pourable
o Lysol Power Kitchen Cleaner
o Lysol Bathroom Cleaner
o Lysol Toilet Bowl Cleaner
o Lysol Mold & Mildew Remover
• Hand Soaps: Lysol recently developed a line of disinfecting hand soaps. Products include:
o Lysol No Touch Hand Soap System
o Lysol Touch of Foam Hand Wash

Competition

Lysol's major competitors include Lysoform, Clorox, Febreze, Oust, Mr. Clean, Cif, Pine-Sol, OxiClean, Simple Green, Domestos and Tilex.

References

1. "Media Corner." Lyzol India, 20 September, 2006. Accessed January 13, 2020.
2. SIMMONS, W.H. (1908). THE HANDBOOK OF SOAP MANUFACTURE no. SCOTT, GREENWOOD & SON.
3. "Disinfectant, Disinfectants, antiseptics and disinfectants". GMP Chem Tech Pvt. Ltd., India. Retrieved 22 April 2008."Material Safety Data Sheets (L)". ReSource Colorado (a full service flooring contractor). Retrieved 22 April 2008.
4. "Material Safety Data Sheet, Lysol(R) Brand Concentrate, Original Scent" (PDF). 18 April 1997. Retrieved 22 April 2008.
5. "LYSOL POISONING". Melbourne (Australia) Argus (newspaper). 10 January 1912. Retrieved 7 May 2013.
6. Frank T. Sanders, ed. (August 2006). Reregistration Eligibility Decision for Alkyl Dimethyl Benzyl Ammonium Chloride (ADBAC) (PDF) (Report). U.S. Environmental Protection Agency Office of Prevention, Pesticides, and Toxic Substances. p. 114. Archived from the original (PDF) on 24 October 2009. Retrieved 31 March 2009.
7. "Fight Spanish Influenza With Daily Disinfection" (advertisement). The New York Times. 30 October 1918, p. 9. (Accessed via ProQuest, New York Times (1857–Current file), Document ID 97039401)
8. "Lysol Douche Advertisements". 26 August 2005. Retrieved 19 July 2016.
9. Sanger, Margaret H. Family Limitations, Sixth Edition. 1917. Accessed January 13, 2020.
10. DeLee, Joseph B., A.M., M.D. The Principles and Practice of Obstetrics. 7th ed. Philadelphia: W. B. Saunders Company, 1938, p. 319.
11. Finley, Harry. "Lysol douche ad, 1928, U.S.A.". The Museum of Menstruation and Women's Health, 1998. Accessed 22 March 2007.
12. Eveleth, Rose (30 September 2013). "Lysol's Vintage Ads Subtly Pushed Women to Use Its Disinfectant as Birth Control". smithsonianmag.com. Retrieved 2 February 2015.
13. Flanagan, Caitlin (December 2019). "The Dishonesty of the Abortion Debate." The Atlantic. Accessed January 13, 2020.
14. Presley, J. A.; Brown, W. E. (September 1956). "Lysol-Induced Criminal Abortion". Obstetrics & Gynecology. 8 (3): 368–370. Retrieved 14 January 2020.
15. Bartlett, Robert H.; Yahia, Clement (2 October 1969). "Management of Septic Chemical Abortion with Renal Failure: Report of Five Consecutive Cases with Five Survivors". The New England Journal of Medicine. 281 (14): 747–53. doi:10.1056/nejm196910022811401. PMID 5807922.
16. Zdanowicz, Christina. "Here's a list of disinfectants you can use against coronavirus". CNN. Retrieved 30 March 2020.

External links

• Official website

[admin]

This Early Use For Lysol Is Wild: What we know as a home cleaning product was once marketed to women for something very different.
by Caroline Bologna
Huffington Post
04/03/2018 06:48pm EDT

The preponderance of evidence shows an association between douching and numerous adverse outcomes. Most women douche for hygienic reasons; it can be stated with present knowledge that routine douching is not necessary to maintain vaginal hygiene; again, the preponderance of evidence suggests that douching may be harmful. The authors of the present review believe that there is no reason to recommend that any woman douche and, furthermore, that women should be discouraged from douching.

-- Vaginal Douching: Evidence for Risks or Benefits to Women's Health, by Jenny L. Martino and Sten H. Vermund

-- Lysol, by Wikipedia

Lysol was used as a disinfectant during the cholera and flu epidemics before it was promoted as a feminine hygiene product.

It’s officially spring cleaning time, and you might be knee-deep in Lysol wipes and sprays. But did you know that Lysol wasn’t always just a home cleaning brand?

Lysol manufacturer Lehn & Fink once marketed its antiseptic disinfectant as a vaginal douche, according to vintage advertisements from the early to mid-20th century.

Women, the ads suggest, were having marital problems because of feminine hygiene issues and genital odors that repulsed their husbands, and thus, they needed to clean themselves using Lysol.


This ad tells women, "instead of blaming him if married love begins to cool, [a wife] should question herself."

"PLEASE, DAVE... PLEASE DON'T LET ME BE LOCKED OUT FROM YOU!"
[Lock of] DOUBT
[Lock of] INHIBITIONS
[Lock of] IGNORANCE
Often a wife fails to realize that doubts due to one intimate neglect shut her out from happy married love
A man marries a woman because he loves her. So instead of blaming him if married love begins to cool, she should question herself. Is she truly trying to keep her husband and herself eager, happy married lovers? One most feminine allure is by practicing complete feminine hygiene as provided by vaginal douches with a scientifically correct preparation like "Lysol." So easy a way to banish the misgivings that often keep married lovers apart.
Germs destroyed swiftly
"Lysol" has amazing, proved power to kill germ-life on contact... truly cleanses the vaginal canal even in the presence of mucous matter. Thus "Lysol" acts in a way that makeshifts like soap, salt or soda never can.
Appealing daintiness is assured, because the very source of objectionable odors is eliminated.
Use whenever needed!
Yet gentle, non-caustic "Lysol" will not harm delicate tissue. Simple directions give correct douching solution. Many doctors advise their patients to douche regularly with "Lysol" brand disinfectant, just to insure feminine daintiness alone, and to use it as often as necessary. No greasy aftereffect.
For feminine hygiene, three times more women use "Lysol" than any other liquid preparation. No other is more reliable. You, too, can rely on "Lysol" to help protect your married happiness... keep you desirable!
For complete Feminine Hygiene rely on... "Lysol" Brand Disinfectant
A Concentrated Germ-Killer
Product of Lehn & Fink
NEW! ... FEMINE HYGIENE FACTS!
FREE! New booklet of information by leading gynecological authority. Mail coupon to Lehn & Fink, 192 Bloomfield Avenue, Bloomfield, N.J.

But the full story is even wilder than that.

To back up a little, Lysol brand antiseptic disinfectant first appeared on the scene in 1889 as a way to help end a cholera epidemic in Germany. In 1918, ads touted it as an effective means to fight the flu virus during the influenza pandemic. Twelve years later, Lysol disinfectant liquid reached drug stores and hospitals, and in 1962, the company released an aerosol spray version.

In the 1920s, ads for Lysol as a feminine hygiene product started appearing in women’s magazines, encouraging housewives to wash their genitals with disinfectant liquid.

“A man marries a woman because he loves her. So instead of blaming him if married love begins to cool, she should question herself,” read one ad. “Is she truly trying to keep her husband and herself eager, happy married lovers? One most effective way to safeguard her dainty feminine allure is by practicing complete feminine hygiene as provided by vaginal douches with a scientifically correct preparation like ‘Lysol.’”

Clearly, Lysol’s ads spread a seriously antiquated and problematic viewpoint that a husband’s infidelity or dissatisfaction with a marriage could only be due to his wife’s failings ― like her odors or fertility.

As another ad reads, “Sue was furious at Tom for the way he’d been treating her. But she was really to blame! She should have known better, for she was no stranger to feminine hygiene. It was just that she had been neglectful!”


Another vintage Lysol ad.

"Held in a web of indifference..."
Day after heartbreaking day I was held in an unyielding web ... a web spun by my husband's indifference. I couldn't reach him any more! Was the fault mine? Well ... thinking you know about feminine hygiene, yet trusting to now-and-then care, can make all the difference in married happiness, as my doctor pointed out. He said never to run such careless risks ... prescribed "Lysol" brand disinfectant for douching -- always.
"But I broke through it!"
Oh, the joy of finding Tom's love and close companionship once more! Believe me, I follow to the letter my doctor's advice on feminine hygiene ... always use "Lysol" for douching. I wouldn't be satisfied now with salt, soda or other homemade solutions! Not with "Lysol," a proved germ-killer that cleanses so gently yet so thoroughly. It's easy to use, too, and economical. The very best part is -- "Lysol" really works!
Many doctors recommend "LYSOL" for Feminine Hygiene ... for 6 reasons
Reason No. 5: DEPENDABLE UNIFORMITY ... Uniform in strength, "Lysol" is made under continued laboratory control -- is far more effective than homemade douching solutions.
Note: Douche thoroughly with correct "Lysol" solution ... always!
For Feminine Hygiene use "Lysol" always!

However, this call for douching was apparently code for something else as well: birth control.

In her 2001 book, Devices and Desires: A History of Contraceptives in America, historian Andrea Tone explains that feminine hygiene was a euphemism for contraception.

Those early Lysol ads included negative references to odors or germs, which referred to sperm, Tone wrote. So, keeping your body “germ-free” or maintaining your “dainty feminine allure” meant preventing pregnancy.

Tone’s findings are in line with the history of contraception in the U.S. In the early 20th century, birth control methods like condoms and diaphragms were costly and difficult to acquire.

This is at least in part due to the Comstock Act of 1873, a federal law that branded contraceptive devices or information as “obscene” and prohibited their distribution across state lines or via mail. Twenty-four states subsequently passed similar legislation to further restrict access and information to birth control.

As these laws effectively banned the selling and advertising of birth control, manufacturers marketed their contraceptive offerings as “feminine hygiene” products.


"Sue was furious at Tom for the way he'd been treating her. But she was really to blame!" this Lysol ad says.

OOH! DOMESTIC CRISIS!
Sue was furious at Tom for the way he'd been treating her. But she was really to blame! She should have known better, for she was no stranger to feminine hygiene. It was just that she had become neglectful! Her doctor straightened her out. "It's foolish to risk your marriage happiness by being careless about feminine hygiene -- even once!" he said. Then he advised her to use Lysol disinfectant for douching -- always.
AH! DOMESTIC BLISS!
Heavenly is the word for Sue and Tom's home life now! Wise Sue immediately took her doctor's advice. Always, she uses Lysol for douching ... knows for herself how thoroughly this proved germ-killer cleanses, yet how gently! Lysol is far more dependable than salt, soda, or other homemade solutions. "What's more," says Sue, "it's easy to use -- economical, too!"
Check these facts with your Doctor
Proper feminine hygiene care is important to the happiness and charm of every woman. So douche thoroughly with correct Lysol solution…always! Powerful cleanser—Lysol’s great spreading power means it reaches deeply into folds and crevices to search out germs. Proved germ-killer—uniform strength, made under continued laboratory control…far more dependable than homemade solutions. Non-caustic—Lysol douching solution is non-irritating, not harmful to vaginal tissues. Follow easy directions. Clean odor—disappears after use; deodorizes. More women use Lysol for feminine hygiene than any other method. (For FREE feminine hygiene booklet, write Lehn & Fink, 483 Fifth Avenue, New York, N.Y.)

Postcoital douching became a popular method to prevent pregnancy. In fact, douching was the most common form of birth control from 1940 until the FDA approved the oral contraceptive pill in 1960. And between the 1930s and 1960s, the leading “feminine hygiene” product in the U.S. was ― you guessed it ― Lysol.

If the idea of cleaning your lady parts out with Lysol makes you cringe, you have the right instinct. Prior to a formula change in 1952, Lysol’s soap solution contained cresol, which Tone described as “a constituent of crude carbolic acid, a distillate of coal and wood” that, in high concentrations, could cause severe burning, inflammation and even death.

By 1911, doctors had recorded hundreds of Lysol-related deaths, including five from “uterine irrigation.”


Lysol ads like this one promised that the product was "non-caustic" and "gentle" -- but until 1952, the product contained harmful cresol that could cause burns and even death.

Love-quiz ... For Married Folks Only
WHY DOES SHE SPEND THE EVENINGS ALONE?
A. Because she keeps her home immaculate, looks as pretty as she can and really loves her husband, BUT she neglects that one essential --- personal feminine hygiene.
Q. Is this really important to married happiness?
A. Wives often lose the precious air of romance, doctors say, for lack of the intimate daintiness dependent on effective douching. For this, look to reliable "Lysol" brand disinfectant.
Q. Is "Lysol" safe and gentle as well as extra effective?
A. Yes, the proved germicidal efficiency of "Lysol" requires only a small quantity in a proper solution to destroy germs and odors, give a fresh, clean, wholesome feeling, restore every woman's confidence in her power to please.
Q. How about homemade douching solutions, such as salt and soda?
A. They have no comparison with the scientific formula of "Lysol" which has proved efficiency in contact with organic matter.
ALWAYS USE "LYSOL" in the douche, to help give the assurance that comes with perfect grooming ... confidence in "romance appeal."
Check these facts with your doctor
Many doctors recommend "Lysol," in the proper solution, for Feminine Hygiene. Non-caustic, gentle, "Lysol" is non-injurious to delicate membrane. It's clean, antiseptic odor quickly disappears. Highly concentrated, "Lysol" is economical in solution. Follow easy direction for correct douching solution.
For Feminine Hygiene -- always use "Lysol"

Lehn & Fink was subject to a number of complaints and even lawsuits over Lysol’s use as a feminine hygiene product. In a 1935 lawsuit filed by a woman who experienced burns from Lysol douching, the company defended itself by stating that the burns must have been the result of “an allergy to Lysol.”

In 1961, a man complained to Lehn & Fink after a Lysol douche caused his wife’s vagina to blister and bleed. The company’s vice president responded by telling him that this report was “the first of its kind on record.”

Lehn & Fink also blatantly lied in the content of its feminine hygiene ads, many of which contained endorsements and testimonials from “eminent” physicians. An investigation by the American Medical Association found that these “experts” did not in fact exist.

To boot, Lysol wasn’t effective as contraception. In her book, Tone cited a 1933 study at Newark’s maternal health center that found that nearly half of the 507 women who used Lysol for birth control wound up pregnant.


Another Lysol ad warning women of the dangers of "intimate physical neglect."

IGNORANCE
DOUBT
MISGIVINGS
INHIBITIONS
DO INHIBITIONS (Doubts) THREATEN MARRIED LOVE?
One small intimate physical neglect can rob a wife of her husband's love
Yes, your married love is strong today. But married love can wither swiftly when a wife lets one small neglect stand in the way of full, normal romance.
And every wife invites that sadness ... if she neglects effective feminine hygiene, like regular vaginal douches with reliable "Lysol" ... complete hygienic protection that assures dainty allure. This is perhaps the easiest way to make a wife confident of her daintiness ... banishing the unsureness that can separate loving mates.
Germs destroyed swiftly
"Lysol" has amazing, proved power to kill germ-life on contact ... truly cleanses the vaginal canal even in the presence of mucous matter. Thus "Lysol" acts in a way that makeshifts like soap, salt or soda never can.
Appealing daintiness is assured, because the very source of objectionable odors is eliminated.
Use whenever needed!
Yet gentle, non-caustic "Lysol" will not harm delicate tissue. Simple directions give correct douching solution. Many doctors advise their patients to douche regularly with "Lysol" brand disinfectant, just to insure daintiness alone, and to use it as often as they need it. No greasy aftereffect.
Three times as many women use "Lysol" for intimate feminine hygiene as any other liquid preparation! No other is more reliable. You, too, can rely on "Lysol" to help protect your married happiness ... keep you desirable!
For complete Feminine Hygiene rely on ... "Lysol" Brand Disinfectant
A Concentrated Germ-Killer
Product of Lehn & Fink

In the 1960s and 1970s, “the pill” took the American contraceptive world by storm, and two major Supreme Court decisions improved access to birth control in the U.S.

In 1967, Sterling Drug acquired Lehn & Fink, and Lysol began its foray into bathroom cleaning with the launch of its toilet bowl cleaner in 1968. The brand has continued to focus on home cleaning and today is a product of Reckitt Benckiser.

In response to HuffPost’s inquiry about Lysol’s past use as a vaginal douching and contraceptive product, Reckitt Benckiser marketing director Rory Tait shared the following statement:

“For more than 100 years, Lysol has been dedicated to protecting families from the harmful consequences of germs – from cholera at the turn of the 20th century, to the flu virus in the present day. Like many consumer household brands, as knowledge of health and personal care evolved over the last century, so did the usage of Lysol. Lysol has evolved from a personal care and surface care brand to primarily a surface care brand, with Lysol cleansers, disinfectants and hand soaps being used widely in homes, schools and businesses around the world.”

Tait also encouraged consumers to read Lysol product labels carefully to learn about their intended uses.

[admin]

Chapter X: Lysol and Zonite
Facts and Frauds in Woman's Hygiene
by Rachel Lynn Palmer and Sarah K. Greenberg, M.D.
The Sun Dial Press, New York, 1936

Mrs. Robert Smith, married for two months, and living in a small Colorado town, was turning the pages of the Ladies Home Journal. She came to a picture of the Dionne quintuplets. She was a normal young woman and these engaging babies appealed to her. But just the same she found herself hoping that she wouldn’t have a baby until Robert was earning a little more than $28 a week. Their old family doctor had been of no help, and Mrs. Robert Smith had never heard of a birth control clinic, so she clipped the coupon at the bottom of the page and sent for the booklet containing “facts about Feminine Hygiene and other uses of Lysol.”

“Your ritual of personal antisepsis,” the booklet told Mrs. Smith, “Must cleanse thoroughly, destroy germ-life, and leave you soothed and refreshed. Obviously, the effectiveness of your practice of feminine hygiene depends on the preparation you employ in your douche. LYSOL is ideal for this purpose.”

Mrs. Smith bought a bottle of Lysol. She was sure that it must be a good product or it would not be advertised in the Ladies Home Journal and other magazines that she and her mother had read for years.

Just what is this Lysol, used by the Mrs. Robert Smiths of our country “as a means to intimate feminine daintiness and peace of mind”? It consists essentially of cresol, a distillate of wood and coal, which has been made soluble in water by treating it with soap. Cresol was discovered through the attempts of scientists to find a substance which would not be so poisonous as carbolic acid and yet as effective in killing germs. It is now recognized to be almost, if not equally, as dangerous as carbolic acid itself; swallowing Lysol has come to be a common – but extremely painful – means of committing suicide.

Lysol is “SAFE,” says the Lehn and Fink Company, makers of this product. It takes more than the word “safe” in capital letters to refute the many cases, in medical literature, of injury and even death from Lysol. The United States Dispensatory reports the death of a woman from using Lysol in a vaginal douche. As long ago as 1911 Witthaus and Becker stated in Medical Jurisprudence, Forensic Medicine and Toxicology that they had collected the reports of eleven poisonings from uterine irrigations with Lysol. Five of the poisoned women died. In the Journal of the American Medical Association (June 29, 1935), Dr. Louis Pancaro tells of the death of a young woman who injected Lysol into her uterus in order to bring about an abortion. Within half an hour of doing so, the girl became delirioius and unconscious, and died two days afterward without regaining consciousness.

Any antiseptic should be considered not only from the point of view of its effect on bacteria, but also from the point of view of its action on the body tissues. Obviously, any antiseptic which does more damage to the body tissues than it does to the invading bacteria is dangerous. Dr. John R. Conover and Dr. John L. Laird in the Therapeutic Gazette for February, 1924, had this to say of the phenol group of antiseptics: “Members of this group while efficient in destroying bacteria are equally deleterious to animal tissues … Phenol and cresol, as well as the modified preparations, Lysol, kreso, izal, creolin, etc., have an irritating and toxic action …”

The mucous membranes of the vagina are considered so sensitive and easily injured that the Council on Pharmacy and Chemistry of the American Medical Association will not authorize the advertising of any antiseptic to the public for use on the genito-urinary tract. Yet Lehn and Fink, makers of Lysol, urge frequent vaginal douching with their caustic product.

As pointed out in Chapter 8, douches containing strong antiseptics are a common cause of leucorrhea. Dr. Samuel R. Meaker reports in the Journal of Contraception (March, 1936) that he has seen four or five cases of severe inflammation of the vagina “following the employment of a coal-tar-product widely advertised to the laity for feminine hygiene.” He does not name the product, but the description would fit either Lysol or some very similar product. The woman who follows instructions enclosed with each package of Lysol and douches “several times a week” will not find the treatment “soothing.” But she may discover that the douches have brought on an inflammation of an originally healthy vagina.

If the vagina is already inflamed, and the woman troubled with leucorrhea, douching with a caustic substance such as Lysol is apt to aggravate the condition. Dr. James E. King in the New York State Journal of Medicine for February 11, 1933, said that even doctors sometimes err in this direction in their treatment of leucorrhea. “He [the physician] fails to visualize the irritated vaginal walls and the denuded areas, and prescribes a douche that is irritating. Iodine, Lysol, or some douche powder is often his choice.” Dr. King points out that the use of such agents on inflamed surfaces is so irritating that it actually increases the amount of discharge.

“It is used in delicate childbirth when feminine membranes are most sensitive. Then surely it is safe for normal everyday use.” This, or a similar statement, has appeared in many Lysol advertisements in an attempt to reassure women regarding the safety of the product. A truer statement would be that it has been used in childbirth, but that this use is now largely discredited. Dr. Lawrence P. Garrod, Lecturer in Biology at the St. Bartholomew’s Hospital in England says: “To those familiar with the properties of germicides the use of Lysol in obstetrics has always appeared mistaken. It is the most caustic of all antiseptics in clinical use, with the single exception of phenol, and the limitations imposed by this property on the strengths of solutions employable bring them dangerously near a point at which they are ineffective.” Dr. Garrod, in a study which he made of the efficiency of antiseptics used in midwifery, found that a dye known as brilliant green proved to be over fifty times as effective in killing germs as Lysol. Dr. J.M. Munro Kerr reports that when St. Mary’s Hospital in Manchester, England, substituted Lysol for another antiseptic at childbirth, the fever rate became very much higher.

Many doctors have abandoned the use of antiseptics in the vaginal canal during childbirth, for they have found that frequently the damage to the delicate cells of the vagina and cervix is greater than the damage to the bacteria which may be present. Too often the antiseptics cause the very infection they are supposed to prevent.

Every reader of the popular women’s magazines probably remembers the long series of ads which the Lysol makers ran a year or two ago called “frank talks by eminent women physicians,” which were all based on the inference that women could free themselves of the fear of unwanted pregnancies by using Lysol douches. These advertisements were strikingly similar in some respects. For instance, in all that we have seen the doctors quoted were from foreign countries: Dr. Anne Marie Durand-Wever, “distinguished German gynecologist;” Dr. Anna Baltischurler, “leading gynecologist of Switzerland;” Dr. Clotilde Delaunay, “leading gynecologist of Paris;” Dr. Paul Karniol-Shubert, “one of the most distinguished gynecologists of Austria;” Dr. Louise Foucart-Fassin, “leading gynecologist of Brussels;” Dr. Amparo Monmeneu, “famous gynecologist of Madrid, Spain.” One would think that America had no gynecologists of distinction; or perhaps American names are not sufficiently bizarre to embellish a Lysol advertisement.

Another marked similarity is the sameness of the testimonials from these doctors, even in the phrases they use. Thus the Austrian, Dr. Paula Karniol-Shubert, says of one of her patients: “Sound advice on marriage hygiene was all she needed. And that was all I gave her. In two little words: Use ‘Lysol.’” And Dr. Clotilde Delaunay of Paris says that her advice to her scores of patients “is given in two short words – use ‘Lysol.’” That two doctors of different countries should express themselves in such nearly identical language should certainly be investigated by the Society for Psychical Research as a striking illustration of thought transference.

“The Lysol advertising, playing up the testimonials of foreign physicians, is reminiscent,” says the Bureau of Investigation of the American Medical Association, “of what the Fleischmann people were doing in recent years, and some others long before them. It seems likely that ‘patent medicine’ concerns have to resort to testimonials from foreign physicians because reputable ones in America will not sell themselves out to such schemes. It appears, also, that the foreign physicians’ testimonials are not often found in publications issued in their own countries. Possibly they hope that their fellow countrymen will not see their testimonials in American periodicals.”

In these, and many other advertisements, it is implied that Lysol is a safe contraceptive measure. The same inference is made in the leaflet in the Lysol package when it says: “The douche should follow married relations as a cleansing and antiseptic agent.” We have already pointed out in the chapter on douching that no douche, no matter what it contains, is an effective contraceptive, for frequently the spermatozoa have entered the uterus, made their way into the Fallopian tubes and impregnated the ovum before any douche can reach them. Or they may have found their way into some of the innumerable folds of the vagina. No douche can be depended upon to penetrate all of these folds, despite the very brash and positive assertion that “Lysol has that rare quality of penetrating into ever crevice and furrow of the membranes, destroying germ-life even in the presence of organic matter.”

Even putting aside the fact that the douche is an unreliable contraceptive, Lysol is less effective than many other chemicals. In a study of the spermicidal powers of a group of chemicals, Dr. John R. Baker has found that seventeen are more efficient than cresol in killing spermatozoa. (As said before, Lysol and cresol are essentially the same.) Such a harmless substance as the citric acid of lemons ranks ahead of cresol. Yet the manufacturers of Lysol advertise:

Women are sensitive – shy. Down deep in their hearts they know what’s the matter. But something keeps them from telling – even their doctor – and from listening to her advice when she has guessed the truth. Such a case came to my notice recently. I could see my patient thought it ‘wasn’t nice’ to face the problem of marriage hygiene frankly. So I sent for her husband. ‘I’m sorry I had to send for you,’ I told him. ‘But your wife won’t listen. Now you must teach her what to do.’ I explained about ‘Lysol’ – the antiseptic that can always be trusted. I told him how safe it is – how gentle. I told him that the whole medical world approves, uses, recommends it. He went away comforted. And when I next saw his wife, her fears had vanished like dew in the sun. They had both grown young again.

Such sentimental trash would be laughable were it not for the tragedy of the many women who have become pregnant because they have relied upon antiseptic douches.

Two doors from the home of the hypothetical Mrs. Robert Smith who bought Lysol lived Mrs. David Jones – also a typical American wife. Her attention was caught by the picture of a beautiful and radiant woman proclaiming, “Now I’m so much happier.” Mrs. Jones, who had four children, was also struck by the caption, “It’s never too late for a wife to learn.” She read the advertisement and found that Zonite is both “safe and powerful.” And so she bought a bottle.

What is Zonite which the Mrs. Joneses of the country have been told provides the “ideal combination of strength and safety” needed for the purpose of feminine hygiene? It is essentially sodium hypochlorite in water, a very cheap solution. For many years hypochlorite solutions have been known to be of value in the treatment of infections, but they were also known to have decided drawbacks – they were unstable and deteriorated rapidly, and they contained free alkali, which is irritating to body tissue. During the war two surgeons evolved a hypochlorite solution which has been named after them – the Dakin-Carrel solution, and it was used with success on wounds. Zonite is essentially a double-strength Dakin-Carrel solution.

The Zonite Corporation claims that Zonite “keeps its strength indefinitely.” William H. Zabel has reported the experience of St. Luke’s Hospital in Chicago with hypochlorite solutions. St. Luke’s Hospital has tried various processes for making Dakin’s solution, and has also investigated the “concentrated stabilized solutions that are available to be diluted for use.” The judgment formed as the result of this investigation was that “Dakin’s solution, regardless of the method of preparation, loses its efficiency after forty-eight hours, and on longer standing, secondary products form which irritate the wound. Adding chemicals to stabilize the solution interferes with the reaction on micro-organisms.” It is difficult to see in the face of such evidence (confirmed by reports from other scientists) how the claim that Zonite keeps its strength indefinitely can be substantiated. And the chance that a woman can get a fresh bottle of Zonite is extremely small. Quite possibly the bottle has stood on the druggist’s shelf for several weeks, or even longer. At the best it is as old as the time it has taken it to pass through the hands of the manufacturer, the wholesaler, and the druggist.

Zabel reports that Dakin’s solution can be made with an electrolytic cell for about four cents a gallon. Zonite, also manufactured by an electrolytic process, sells for 30 cents for a two and one-half ounce bottle and 60 cents for the six-ounce size. According to Zabel’s cost estimate, and allowing for Zonite’s double strength, the bottle retailing at 60 cents contains about one-half cent’s worth of the solution.

All doctors know that if Dakin’s solution is to be used successfully it must not contain caustic alkali, and its strength must be maintained within a very narrow range. If it is too weak, it is ineffective; if too strong, it seriously irritates the tissues. Many doctors do not use Dakin’s solution because it is difficult to get just the right strength. It seems almost unnecessary to say that the woman who measures her Zonite with a tablespoon and who makes a rough estimate of the water by merely filling up her douche bag is not able to improve on the doctor’s technique.

What about the claims of Zonite that it is non-irritating? In treating wounds with Dakin’s solution it is necessary to cover the surrounding normal tissue with gauze soaked in Vaseline in order to protect it. Any antiseptic that may injure the skin may certainly irritate the mucous membranes of the vagina. Dr. Robert A. Lambert has reported in the Journal of Experimental Medicine that Dakin’s solution is among the antiseptics which are more injurious to tissue cells than to bacteria. Any woman who douches often with Zonite is running a risk because douching frequently with any antiseptic may be harmful. By killing or injuring the protective Doderlein bacilli, and by possibly irritating the mucous membranes, she is inviting an attack of vaginitis. When the Zonite Products Corporation states that “the douche has become a fixed part of the feminine toilet, recognized as a wholesome, healthful routine;” when they claim that Zonite when used as indicated in the vaginal douche is “non-irritating” and “exercises no harmful effect on the delicate membranes and tissues of the vaginal tract,” they are guilty either of ignorance or a callous indifference to the health of the countless women whom they are trying to enlist as steady buyers.

“Nearly every woman at one time or another is afflicted by leucorrhea (‘whites’), characterized by a whitish, viscous discharge. A Zonite douche will help to relieve the inflammation and to disinfect and cleanse the affected parts. When convenient, a tampon of absorbent cotton may be used. This should be moistened well with the solution…” says “Facts for Women,” the booklet put out by the Zonite Corporation. We have already pointed out the dangers of self-treatment of leucorrhea. Use of the tampon, which would keep Zonite in prolonged contact with the mucous membranes, is particularly unwise. “Caution,” read the Zonite leaflets. “Do not let Zonite come in contact with dyed fabrics; the active principle is a powerful bleaching agent.” Yet no caution is given regarding the possible injury resulting from the introduction into the vagina of a tampon saturated with a solution of the same powerful bleaching agent.

The Zonite people at the present time are basing their appeal to women on the inference that Zonite is a good contraceptive. “Many a home is peaceful and happy … when fear and doubt no longer cloud the young wife’s outlook.” The continuous barrage of such statements justifies a final reminder that the douche is not a reliable contraceptive measure. One advertisement reads: “There are sensitive women everywhere who do not trust the superficial information that is going around about feminine hygiene. These deep-natured women want the whole truth from the scientific standpoint. They must depend on themselves to sift out the read facts.” It is to be hoped that enough has been said to make women, deep-natured or otherwise, realize that for the facts they must go elsewhere than to the Zonite Products Corporation.

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Part 1 of 2

Vaginal Douching: Evidence for Risks or Benefits to Women's Health
by Jenny L. Martino and Sten H. Vermund
Epidemiol Rev. 2002; 24(2): 109–124.

INTRODUCTION

Vaginal douching is the process of intravaginal cleansing with a liquid solution. Douching is used for personal hygiene or aesthetic reasons, for preventing or treating an infection(1), to cleanse after menstruation or sex, and to prevent pregnancy (2). For at least 100 years, there have been conflicting views on the benefits or harm in douching. Although there is a broad consensus that douching should be avoided during pregnancy, there is less agreement regarding douching for hygiene and relief of vaginitis symptoms. Two earlier reviews of douching data in women (3) and adolescents (4) have concluded that douching is harmful and should be discouraged because of its association with pelvic inflammatory disease, ectopic pregnancy, and perhaps other conditions. Nonetheless, douching continues to be a common practice. We seek to review the evidence of the impact of douching on women's health.

METHODS

Studies included in this review were identified via a search of the computerized MEDLINE database from 1965 through March 2002. Only English-language articles were included, as were a few relevant articles published before 1965. Major medical and nursing organizations were contacted for their policy and educational documents. Via a Freedom of Information request, we secured a summary of the Nonprescription Drug Advisory Committee meeting held on April 15, 1997, from the US Food and Drug Administration.

EPIDEMIOLOGY OF DOUCHING

Douching products (table 1), methods, frequency, motivation, and timing can vary considerably among women who douche. The prevalence of douching has decreased since 1988, but it is still a common practice among American women, especially adolescents, African-American women, and Hispanic women (table 2) (1, 5). In 1995, 55 percent of non-Hispanic Black women, 33 percent of Hispanic women, and 21 percent of non-Hispanic White women reported “regular” douching (5). In the United States, there have been reports of 52-69 percent of adolescents douching at least once and one study documenting 56 percent reporting douching one or more times a week (2, 6-8). In addition, douching is prevalent in some African countries, such as Côte d'Ivoire, where the douching rate among women has been reported to exceed 97 percent (9). It is uncommon for women to douche daily; sporadic douching is more common (1, 8). A dose-response relation between douching and its adverse effects has been found by some, highlighting the importance of assessing douching frequency in any related research (10-14). The intensity and method of douching, especially douching with pressure, have been associated with adverse outcomes (15).

TABLE 1

Some vaginal douching products*

Ingredients / Function / Commercial / Home preparation

5% acetic acid (vinegar) / Acidifying agent / X / X
Benzoic acid, citric acid, lactic acid, sorbic acid / Acidifying agents / X / --
Bleach (sodium hypochlorite and sodium hydroxide) / Cleanser / X/ --
Cetylpyridinium chloride / Antimicrobial, antiseptic, germicidal, surfactant / X / --
Decyl glucoside / Nonionic detergent, mild surfactant, solubilizes water-insoluble materials / X / --
Diazolidinyl urea / Acidifying agent / X / --
Disodium EDTA,† edetate† disodium / Preservative, antibacterial agent, metal chelator (binds magnesium and calcium) / X / --
Lysol (alkyl 50% C14, 40% C12, 10% C16, dimethylbenzyl-ammonium chloride 2.7%; Reckitt & Coleman, Wayne, NJ) / Cleanser / -- / X
Octoxynol-9 / Surfactant, produces a mucolytic or proteolytic effect, spermicide / X / --
Povidone-iodine‡ / Antimicrobial / X / --
SD Alcohol 40† / Liquid vehicle / X / --
Sodium benzoate / Preservative (prevents bacteria from growing in solution that contains citrate and lactate) / X / --
Sodium bicarbonate (baking soda) / Alkalizing agent / X / X
Sodium citrate / Acidifying agent / X / --
Sodium lactate / Acidifying agent / X / --
Water / Liquid vehicle, cleansing / X / X
Yogurt / Potential source of nonhuman strain of lactobacillus / -- / X

*Sources: Handbook of Nonprescription Drugs. Washington, DC: American Pharmaceutical Association and the National Professional Society of Pharmacists, 1982; and Dr. Dennis Pillion, Pharmacology Department, University of Alabama at Birmingham, personal communication, 2001.
†EDTA, ethylenediaminetetraacetic acid; edetate, ethylenediaminetetraacetate; SD Alcohol 40, specially denatured alcohol, followed by a number or a number-letter combination that indicates how the alcohol was denatured, according to the formulary of the US Bureau of Alcohol, Tobacco, and Firearms.
‡Medicated douches.

TABLE 2
Percentage of women who douche regularly, by age and race/ethnicity, according to the National Survey of Family Growth, United States

Year and reference / Sample size(no.) / Age (years) / Total (%) / Non-Hispanic Black (%) / Non-Hispanic White (%) / Hispanic (%)

NSFG,*1995(5) / 10,847 / 15-44 / 26.9 / 55.3 / 20.8 / 33.4
NSFG,*1995(5) / 10,847 / 15-19 / 15.5 / 36.8 / 10.8 / 16.4
NSFG,*1995(5) / 10,847 / 20-24 / 27.8 / 60.4 / 20.4 / 32.5
NSFG,*1995(5) / 10,847 / 25-29 / 30.0 / 58.7 / 23.9 / 38.0
NSFG,*1995(5) / 10,847 / 30-34 / 30.6 / 60.4 / 24.5 / 35.1
NSFG,*1995(5) / 10,847 / 35-39 / 28.9 / 62.5 / 21.9 / 41.2
NSFG,*1995(5) / 10,847 / 40-44 / 26.9 / 53.1 / 21.1 / 38.5

Year and reference / Sample size(no.) / Age (years) / All races (%) / Black (%) / White (%)

NSFG, 1988(1) / 8,450 / 15-44 / 36.7 / 66.5 / 32.0
NSFG, 1988(1) / 8,450 / 15-19 / 31.0 / 53.5 / 25.4
NSFG, 1988(1) / 8,450 / 20-24 / 41.1 / 63.1 / 35.7
NSFG, 1988(1) / 8,450 / 25-29 / 37.6 /67.6 / 32.9
NSFG, 1988(1) / 8,450 / 30-34 / 36.0 / 64.8 / 31.5
NSFG, 1988(1) / 8,450 / 35-39 / 35.1 / 70.2 / 30.2
NSFG, 1988(1) / 8,450 / 40-44 / 37.0 / 65.8 / 33.8

*NSFG, National Survey of Family Growth.

The timing of douching may impact on adverse sequelae, such as the temporal use of douching in relation to sexual activity, pregnancy, symptoms, and the menstrual cycle (4, 11, 16, 17). During ovulation, the levels of circulating estrogens increase, the cervical os opens, and the cervical mucus becomes clearer and more profuse (3, 18). Therefore, the risk of ascending infection from the pressure of douching may be greatest around the time of ovulation when the cervical os is gaping and the mucus is thin (3).

Women who douche consider it to be a healthy practice and often state that hygiene is their primary reason for douching (2, 6, 8, 15, 19). Some women state that douching is “necessary for good hygiene” (19). Motives for douching are many: to cleanse the vagina after menses or before or after sexual intercourse, to prevent or ameliorate an odor, to prevent or treat vaginal symptoms such as itching and discharge, and, less commonly, to prevent pregnancy or sexually transmitted diseases (2). Most women report douching for hygienic reasons, while douching due to symptoms may be comparatively uncommon (20, 21). Outside influences such as physicians, mothers, girlfriends, boyfriends, and the media affect a woman's decision to douche (19). The motivation for douching is a complicated issue imbued with both psychologic and social features that need to be addressed if vaginal douching behavior is likely to be modified on any large scale.

HEALTH EFFECTS OF DOUCHING

Douching has been associated with many adverse outcomes including pelvic inflammatory disease, bacterial vaginosis, cervical cancer, low birth weight, preterm birth, human immunodeficiency virus transmission, sexually transmitted diseases, ectopic pregnancy, recurrent vulvovaginal candidiasis, and infertility. Studies conflict, however, and the strength of association varies enormously between studies. Many potentially confounding factors blur the epidemiologic assessment of the consequences of douching. Douching in the United States is more common among African-American women (1, 3, 5, 19). Independently of race, associations between douching and poverty, less than a high school education, a history of pelvic inflammatory disease, and having between two and nine lifetime sexual partners are reported (1). A lower educational level, many sexual partners, and poverty are also risk factors for sexually transmitted diseases and bacterial vaginosis, making it especially complicated to assess causality since women might douche secondary to infection-related symptoms rather than for routine purposes.

Conflicting results are reported regarding sexually transmitted infections and douching. Some studies suggest that adolescents who douche are more likely to have a history of a sexually transmitted disease (1, 15), while other studies have found that women who have a history of a sexually transmitted disease were less likely to douche (1, 10, 22). Prospective studies are needed to assess whether douching is causally related to sexually transmitted diseases or if douching is most commonly a response to symptomatic vaginitis. Whether complications like pelvic inflammatory disease might have occurred even without douching can be answered with prospective studies (1, 23, 24).

PHYSIOLOGY

There are several ways by which douching may contribute to disease. Douching may remove normal vaginal flora, permitting the overgrowth of pathogens. It may also provide a pressurized fluid vehicle for pathogen transport, helping lower genital tract infections ascend above the cervix into the uterus, fallopian tubes, or abdominal cavity (3, 16). These microbiologic and physical mechanisms may work in concert. Ness et al. (25) found that, among a group of women with clinical pelvic inflammatory disease, frequent and recent douching was associated with endometritis and upper genital tract infection in women with normal or intermediate vaginal flora, although this was not noted in women with bacterial vaginosis.

An added concern is that, if douching reduces the density of normal vaginal flora, bacterial vaginosis might develop or there may be a predisposition to colonization by such sexually transmitted pathogens as Neisseria gonorrhoeae or Chlamydia trachomatis, filling the “ecologic niche” (16). Pathogenic bacteria may then ascend into the upper reproductive tract, leading to inflammatory scarring (endometritis, salpingitis, or peritonitis), the principal cause of ectopic pregnancy, early miscarriage, and infertility (16).

Physiologic risk for sexually transmitted diseases is greater among adolescent women, since they typically have ectopic columnar epithelial cells in the exocervix with a large transformation zone that is vulnerable to bacterial and viral sexually transmitted infections (26). Some argue that it is especially important to caution adolescents about the potential adverse effects of douching, as they may be even more susceptible to its adverse consequences (4).

DOUCHING AND VAGINAL ECOLOGY

A healthy menarcheal vaginal environment is composed primarily of lactobacilli (27). Hydrogen peroxide (H2O2)-producing lactobacilli may protect the vagina against the overgrowth of potentially pathogenic indigenous flora and exogenous pathogens. Selected human strains of lactobacilli produce lactic acid that helps keep the vaginal pH low, usually less than 4.5, which is inhospitable to many pathogenic organisms (28). In addition to H2O2 production, lactobacilli adhere to epithelial cells, block pathogen adhesion, and stimulate the mucosal immune system (28).

Newton et al. (29) found that douching more than once per month was associated with the presence of Trichomonas vaginalis (odds ratio (OR) = 3.5, p = 0.02) and that douching one or more times a month was associated with Gardnerella vaginalis (OR = 2.4, p = 0.05). They examined Mexican-American and African-American women and concluded that race (specifically, being African American) had a more consistent association with the presence or absence of a cervical-vaginal organism than other factors, including behavioral variables.

Different types of douching liquids have various antimicrobial effects. Pavlova and Tao (30) used in vitro studies to show that four antiseptic douches were inhibitory against all vaginal microorganisms, including lactobacilli. Three vinegar-containing douches selectively inhibited vaginal pathogens associated with bacterial vaginosis, group B streptococcal vaginitis, and candidiasis, but not lactobacilli, suggesting to the investigators that vinegar (5 percent acetic acid) douches may be less harmful or may be beneficial. Juliano et al. (31) tested seven commercial vaginal antiseptic douche solutions against vaginal lactobacilli and found marked in vitro antibacterial activity, often after very short exposure times. Thus, some douche preparations may cause substantial changes in vaginal flora.

Onderdonk et al. (32) found that healthy women who douched with a 4 percent acetic acid solution experienced a transient reduction of total bacteria that they attributed to the physical washing of the vaginal vault alone. However, when they used povidone-iodine, a bactericidal agent, it caused a significant reduction in total bacterial counts that suggested an antiseptic effect in addition to the washing effect. They concluded that, in some individuals, douching may decrease the vaginal bacteria that are present, allowing a rapid proliferation of potential pathogens, increasing the risk of associated infections. In contrast, Monif et al. (33) found that, while in vivo douching with povidone-iodine caused a dramatic decrease in the total number of vaginal bacteria, baseline counts were reestablished within 120 minutes. They also found that lactobacilli were the first bacteria to recover. As a consequence, Monif (34) has argued for the potential benefits of douching. However, these experiments do not reflect that some women may participate in a behavior that alters the vaginal ecology before it has a chance to return to normal, such as repeated douching or vaginal or receptive vaginal, oral, or anal sex]. The weight of the epidemiologic evidence suggests that repeated douching with its attendant washing and antibacterial effects will diminish lactobacilli predominance and risk reproductive tract infections.

BACTERIAL VAGINOSIS

Bacterial vaginosis is a common cause of malodorous vaginal discharge in women (35). Three million symptomatic cases are reported annually in the United States, but millions more remain unreported or unrecognized (28, 36). A clinical diagnosis of bacterial vaginosis requires three of the following “Amsel criteria”: vaginal pH of greater than 4.5, a positive “whiff” test for amines, presence of clue cells, and a thin homogenous discharge (37). In women with bacterial vaginosis, lactobacilli, especially H2O2-producing lactobacilli, are greatly decreased and the vagina becomes overgrown with anaerobic and facultatively anaerobic bacteria that are often present in small numbers in the normal vagina. These include G. vaginalis, Mycoplasma hominis, Prevotella spp., Peptostreptococcus spp., Mobiluncus spp., and Bacteroides spp. (28, 38-40). Bacterial vaginosis has been reported to be twice as common among African-American and Afro-Caribbean women than among White women (35, 41-44). Vaginal douching is also twice as common among African-American women. It has been proposed that bacterial vaginosis is sometimes sexually transmitted; however, no male factor has been identified, and bacterial vaginosis can occur in adolescent women who have never had sexual intercourse (45).

Bacterial vaginosis is common, and many factors reminiscent of sexually transmitted disease risk are associated with bacterial vaginosis. Schwebke et al. (46) found that 78 percent of women without evidence of genital tract infection had significant, although transient, changes in their vaginal flora. Day-to-day variability was defined as less than 85 percent of a given woman's normal vaginal flora, which was calculated on data from self-obtained vaginal smears from each woman. In a multivariable analysis, more frequent episodes of receptive oral sex were associated with unstable flora. Day-to-day variability in vaginal flora was associated with the use of vaginal medication, menses, greater number of sexual partners, spermicide use, more frequent vaginal intercourse, and less frequent use of condoms. Many of these factors are also associated epidemiologically with bacterial vaginosis and sexually transmitted diseases. It has also been reported that intrauterine device users are more likely to be diagnosed with bacterial vaginosis than are nonusers (47).

Bacterial vaginosis has been linked with several adverse reproductive outcomes, including endometritis (48-51), spontaneous preterm delivery (52-61), preterm delivery of low birth weight infants (62), low birth weight (13), premature rupture of the membranes (52, 55), histologic chorioamnionitis (63), and infection of amniotic fluid (64-66). In a randomized clinical trial, Hauth et al. (67) studied pregnant women with bacterial vaginosis who also had a high risk for preterm delivery. Antepartum metronidazole and erythromycin lowered the frequency of prematurity. However, two other studies found that vaginal clindamycin for treatment of bacterial vaginosis did not decrease the rate of preterm deliveries (68, 69). The frequency of vaginal douching was shown by Fiscella et al. (13) to have a dose-response relation with the likelihood of low birth weight. If a pregnant woman has bacterial vaginosis and douches, chronic bacterial colonization of the endometrium and/or chorioamnion may cause preterm rupture of the membranes and/or preterm labor (70). Meis et al. (60) found that the presence of bacterial vaginosis at 28 weeks' gestation is associated with an increased risk of spontaneous preterm birth, defined as birth at less than 35 weeks. This association is strongest for early preterm birth and may be mediated by subclinical chorioamnionitis (71).

Douching is associated with bacterial vaginosis, although the direction of causation is uncertain: Does douching predispose to bacterial vaginosis, or do women douche in response to bacterial vaginosis symptoms? In a cross-sectional study, Holzman et al. (72) found that vaginal douching within the past 2 months was associated with an increased prevalence of bacterial vaginosis (OR = 2.9, 95 percent confidence interval (CI): 1.5, 5.6). Fonck et al. (73) found that, in female sex workers in Nairobi, Kenya, douching in general and douching with soap and water were both significantly associated with bacterial vaginosis, with a significant trend for increased frequency of douching and higher prevalence of bacterial vaginosis. In an important recent prospective cohort study, Royce et al. (74) found that douching was associated with bacterial vaginosis (risk ratio (RR) = 1.8, 95 percent CI: 1.7, 2.0) and preterm birth (RR =1.6, 95 percent CI: 1.1, 2.1). Rajamanoharan et al. (35) found that bacterial vaginosis was strongly associated with the use of commercial antiseptic products applied to the vulval mucosa or as a vaginal douche. After controlling for genital hygiene behaviors (such as douching and vulval antiseptics) and history of previous bacterial vaginosis episodes, they found that there were no ethnic differences between women with bacterial vaginosis and women without bacterial vaginosis. Hawes et al. (44) found that lack of vaginal H2O2-producing lactobacilli was independently associated with bacterial vaginosis but not with vulvovaginal candidiasis. They also reported that acquisition of bacterial vaginosis was associated with having a new sexual partner and douching for hygiene. Stevens-Simon et al. (75) found that Black adolescents had a more alkaline vaginal pH than did White adolescents, possibly decreasing their resistance to common vaginal infections, such as trichomoniasis and bacterial vaginosis.

Given the frequency of bacterial vaginosis among American women and its associations with adverse reproductive outcomes, the largest attributable risk for which douching may be responsible may be increased bacterial vaginosis frequency. However, the temporal relation has not been well established given the paucity of large, prospective studies.

GONORRHEA, CHLAMYDIA, AND OTHER SEXUALLY TRANSMITTED DISEASES

Many sexually transmitted diseases are asymptomatic and therefore go undiagnosed, particularly in women. Two bacterial sexually transmitted diseases, gonorrhea and chlamydia, are especially important causes of pelvic inflammatory disease. Chlamydia has been associated with tubal infertility due to fallopian tube scarring and obstruction (76-80), ectopic pregnancy (81), and pelvic inflammatory disease (82). In addition, both chlamydia and gonorrhea have been reported to facilitate human immunodeficiency virus transmission (26). Several studies have found an association between douching and chlamydial infection (9, 14, 25, 83-85). However, cross-sectional studies cannot determine reliably whether the douching preceded the disease or if the symptoms led to the douching.

Scholes et al. (14) found that women who reported douching 12 months prior to their clinic visit were twice as likely to have cervical chlamydial infection and that, as the frequency of douching increased, the likelihood of chlamydial infection also increased. Peters et al. (83) found that douching at least monthly was significantly associated with chlamydia in adolescents. Beck-Sague et al. (84) found that, in adolescents who douched monthly or more frequently, there was a higher prevalence of chlamydia. Stergachis et al. (85) found that douching within the last year was independently predictive of chlamydial infection.

Other studies have examined sexually transmitted diseases in general. Foch et al. (7) found that, in adolescents attending a family planning clinic, those who reported douching were more likely to have a history of a sexually transmitted disease. Joesoef et al. (17) found that, among Indonesian pregnant women, douching with water and soap, betel leaf, or a commercial agent after sex was associated with having a sexually transmitted disease and that the association was strengthened among women who douched before sex or both before and after sex. Compared with women who never douched, those who always douched with betel leaf or a commercial agent had a substantially increased risk for sexually transmitted diseases (OR = 9.4, 95 percent CI: 1.8, 50.3). Douching with irritating substances may make the vaginal mucosa more susceptible to sexually transmitted diseases, analogous to the use of intravaginal herbs as drying agents (86). Critchlow et al. found that cervical ectopy, which has been associated with acquisition of certain sexually transmitted diseases, including chlamydia (87, 88) and human immunodeficiency virus (89), was less common among women with sexually transmitted diseases who douched recently (90). Douching and sexual activity both may accelerate squamous metaplasia and cervical maturation (91, 92). Cervical ectopy is common in adolescents and has been associated with increased risk of sexually transmitted disease acquisition, suggesting the importance of measuring all these factors together in studies of douching and health risk (87, 88, 91). Jacobson et al. (91) found that both douching and sexual activity may decrease ectopy in adolescents. If women who douche have less ectopy, they might eventually have a theoretically lower chance to acquire sexually transmitted diseases, although there are no data that suggest this. In contrast to the above studies, Fonck et al. (73) found that, in female sex workers in Nairobi, Kenya, there was no direct relation between douching and the risk for human immunodeficiency virus infection or other sexually transmitted infections. Similarly, Moscicki et al. (92) found no ectopy association with human immunodeficiency virus among US adolescents.

Given the severity of the reproductive consequences of gonorrhea and chlamydia, the associations with douching are worrisome, particularly for chlamydia. As with bacterial vaginosis, the temporal relation is clouded by the paucity of prospective data, hindering clarification of whether douching is a cause or a consequence.

PELVIC INFLAMMATORY DISEASE

Pelvic inflammatory disease is a polymicrobial infection primarily initiated by ascending infection to the upper reproductive tract by N. gonorrhoeae, C. trachomatis, or anaerobic and/or facultative bacteria also occurring with bacterial vaginosis (93-96). It is virtually certain that the physical pressure of douching can facilitate ascension of pathogens (23). Infection, inflammation, and scarring of the fallopian tubes, ovaries, and/or the uterine lining can result in tubal infertility, tuboovarian abscess, endometritis, chronic pelvic pain, recurrent pelvic inflammatory disease, and ectopic pregnancy. Pelvic inflammatory disease affects over 1 million American women and adolescents annually at an estimated cost of $4.2 billion in 1990 (94, 97). The total cost of pelvic inflammatory disease, including both direct and indirect costs, was projected to be more than $9 billion in 2000 (97). It was estimated that 20-30 percent of women with pelvic inflammatory disease would be hospitalized (24) and that at least 25 percent would suffer one or more serious long-term sequelae (97). Guidelines for diagnosis from the Centers for Disease Control and Prevention include complaint of abdominal pain and clinical findings of lower abdominal, cervical motion, and adnexal tenderness (98). Silent pelvic inflammatory disease that goes unreported may account for 50 percent or more of all the cases of pelvic inflammatory disease (99).

About 70 percent of the women diagnosed with pelvic inflammatory disease in the United States are under 25 years of age (100). Risk factors for pelvic inflammatory disease have been found to include being of lower socioeconomic status, non-White, less than 25 years of age, being exposed to a sexually transmitted disease or having a history of pelvic inflammatory disease, use of an intrauterine device, failure to use contraception, multiple sexual partners, and earlier sexual initiation (100, 101). Some of these same characteristics are prevalent among women who douche, and vaginal douching has been associated with pelvic inflammatory disease in most studies (3, 12, 22, 26, 102-107).

Vaginal douching may potentially increase the risk of pelvic inflammatory disease by promoting the ascension of lower genital tract infections to the upper genital tract, by changing the vaginal environment to increase susceptibility to reproductive tract infections that precede pelvic inflammatory disease, or by introducing nonpathogenic vaginal bacteria into the typically sterile upper genital tract (24). The weight of the evidence suggests a causal association of douching and pelvic inflammatory disease, but the lack of prospective studies continues to plague efforts to clarify the causal relation.

As early as 1952, an association between douching and pelvic inflammatory disease was suspected (108). Jossens et al. (106) found that douching after menses was a significant risk factor for pelvic inflammatory disease. Others report uncertainty (109) in the relation between douching and pelvic inflammatory disease or have found vaginal douching to be associated with pelvic inflammatory disease (107, 110) (figure 1) (3, 10, 95, 104, 106, 110, 111). Mueller et al. (111) found that women who douched had moderately elevated risks for overt and silent pelvic inflammatory disease-associated infertility. Scholes et al. (104) found that women who douched during the previous 3 months had an elevated odds ratio for pelvic inflammatory disease of 2.1 after controlling for other risk factors. They also found that there was a dose-response relation as women who douched more frequently had a higher pelvic inflammatory disease risk. In a case-control study, Wolner-Hanssen et al. (10) found that current douching was more common among women with pelvic inflammatory disease and that pelvic inflammatory disease was significantly related to frequency of douching. Neumann and DeCherney (102) found an association between pelvic inflammatory disease and vigorous and frequent (more than once a week) douching. Miller et al. (26) reported douching to have a significant impact on the risk of pelvic inflammatory disease. Forrest et al. (22) reviewed the literature through 1989 and concluded that the weight of published evidence supported an association between vaginal douching and both pelvic inflammatory disease and ectopic pregnancy. Zhang et al. (3) reported in a 1997 meta-analysis that douching increased the risk of pelvic inflammatory disease by 73 percent. Miller et al. (26) found that, from the 1995 National Survey of Family Growth, douching was significantly associated with having pelvic inflammatory disease. Aral et al. (103) analyzed data from the 1988 National Survey of Family Growth and found that almost 11 percent of American women had a history of treatment for pelvic inflammatory disease. They suggested that vaginal douching increased the risk of pelvic inflammatory disease by 50 percent among White and by 30 percent among African-American women.

FIGURE 1
Pelvic inflammatory disease and douching. Top: This figure represents the odds ratio and 95% confidence interval from several studies that looked at pelvic inflammatory disease and douching. Bottom: This figure represents the odds ratio and 95% confidence interval from several studies that looked at pelvic inflammatory disease and various frequencies of douching. *, estimated n = 231 based on two studies (10, 104).

Pelvic inflammatory disease is a prevalent problem worldwide as well as in the United States. Its serious reproductive outcomes and financial burdens are a major factor motivating sexually transmitted disease control and prevention. The weight of the evidence suggests strongly an association between pelvic inflammatory disease and douching. This association may represent the strongest incentive for policies to discourage women from douching.

REDUCED FERTILITY, INFERTILITY, AND ECTOPIC PREGNANCY

Pelvic inflammatory disease is a common cause of reduced fecundity (fertility) and sterility (112, 113). In an analysis of the 1995 National Survey of Family Growth, it was found that women with a history of pelvic inflammatory disease were less likely to be fecund compared with women with no such history (26). The likelihood of infertility increases as the number and severity of pelvic inflammatory disease episodes increase (26). It has been reported that 20 percent of women who have one episode of pelvic inflammatory disease will be infertile (114) and that 50 percent of women who have three or more episodes of pelvic inflammatory disease will be infertile (115). Vaginal douching may reduce fecundity by increasing susceptibility to infection (11). Baird et al. (11) found that women who douched were 30 percent less likely to become pregnant each month compared with women who did not douche. This risk was greater for younger women than it was for older women.

Ectopic pregnancy is defined as implantation of a fertilized egg outside the uterine cavity (116). Women with a history of pelvic inflammatory disease were twice as likely to have had an ectopic pregnancy compared with sexually active women who had no history of pelvic inflammatory disease (26). Vaginal douching has been associated with ectopic pregnancy (117-119). Several studies reported that vaginal douching increased the risk for ectopic pregnancy (figure 2) (3, 84, 120-123). Daling et al. (121) found that there was a small increase in risk of tubal pregnancy among women who douched more than two times per year in the past year (RR = 1.3, 95 percent CI: 0.9, 1.8). This risk was found to increase further if, in addition to douching more than two times per year, the women also had more than one sexual partner during their lifetime (RR = 1.6, 95 percent CI: 1.1, 2.3) or had previous exposure to chlamydia (RR = 2.4, 95 percent CI: 0.8, 7.3). Kendrick et al. (123) found that ectopic pregnancy risk among African-American women correlated with the number of years of douching at least once per month. They found that any douching carried some risk and that different douching strategies were associated with different levels of risk. In a case-control study that controlled for chlamydial exposure, J. M. Chow et al. (81) found that current douching was an independent risk factor for ectopic pregnancy. In a different study, W. H. Chow et al. (120) reported that the risk of tubal ectopic pregnancy for women who douched at least weekly was twice that of women who never douched. In a meta-analysis, Zhang et al. (3) found that frequent douching increased risk of ectopic pregnancy by 76 percent. In a meta-analysis of case-control and cohort studies done between 1978 and 1994, Ankum et al. (118) found only a slightly increased risk for ectopic pregnancy due to douching. However, in a case-control study of ectopic pregnancy with 69 cases and 101 controls, Phillips et al. (122) found that there was not a significant increase in the risk of ectopic pregnancy due to vaginal douching once or more per month (OR = 0.8, 95 percent CI: 0.3, 2.2).

FIGURE 2
Ectopic pregnancy and douching. Top: This figure represents the odds ratio and 95% confidence interval from several studies that looked at ectopic pregnancy and douching. Bottom: This figure represents the odds ratio and 95% confidence interval from several studies that looked at ectopic pregnancy and various frequencies of douching. *, estimated n = 1,000 based on five studies (81, 120-123).

Bacterial infections of the lower and upper genital tracts can result in pelvic inflammatory disease, which can, in turn, result in reduced fertility, infertility, and ectopic pregnancy. Many studies have looked at ectopic pregnancy risk and douching, with the majority of evidence finding an association. The temporal relation here remains problematic with the dearth of prospective studies.

CERVICAL CANCER

Cervical cancer is among the most common cancers in women worldwide (124). The American Cancer Society estimates that, during 2001, about 12,900 cases of invasive cervical cancer would be diagnosed in the United States and that about 4,400 American women would die from cervical cancer (125). Cervical cancer was once one of the most common causes of cancer death for American women but now, due to early detection and treatment, it is far less so (125). Worldwide, cervical cancer is the second or third most common cancer among women and, in some developing countries, it is the most common women's cancer (126). Nearly all squamous cell cervical cancer cases are related to human papillomavirus, a sexually transmitted infection. The cause of cervical cancer has been postulated to be multifactorial, with other cofactors being required to cause cancer. Haverkos et al. (127) proposed that tar exposure through tar-based vaginal douching products may be one such cofactor, increasing the risk of invasive cervical cancer. Cervical cancer is twice as high among African-American women as among White women, as are douching rates.

A positive relation between the frequency of douching and cervical cancer risk was found in several studies (figure 3)(3, 128-134). Graham and Schotz (128) found that, as the frequency of douching increased, so did the risk of invasive cervical cancer and carcinoma in situ. Peters et al. (129) found that the “frequency-years” of douching contributed independently and significantly to the risk of invasive cervical cancer. In a meta-analysis, Zhang et al. (3) found that douching was modestly associated with cervical cancer, when they aggregated studies that looked at both invasive cervical cancer and carcinoma in situ together or at invasive cervical cancer alone (RR = 1.25, 95 percent CI: 0.99, 1.59). However, it is unclear whether this risk ratio refers to invasive cervical cancer or both carcinoma in situ and invasive cervical cancer combined. Zhang et al. reported that, among women who douched at least once a week, the pooled adjusted risk ratio was 1.86 (95 percent CI: 1.29, 2.68). In a population-based case-control study in Utah, Gardner et al. (132) looked at a combined study group of invasive cervical cancer (13 percent of the study group) and carcinoma in situ (87 percent of the study group) and found no association between cervical cancer and douching in women who douched once per week or less. However, in women who douched more than once a week, a positive association was found (OR = 4.7, 95 percent CI: 1.9, 11). They hypothesized that douching alters the vaginal chemical environment, making the cervix more susceptible to pathologic changes and subsequent cervical cancer.

FIGURE 3
Cervical cancer and douching. Top: This figure represents the odds ratio and 95% confidence interval from several studies that looked at cervical cancer and douching. Middle: This figure represents the odds ratio and 95% confidence interval from several studies that looked at cervical cancer and various frequencies of douching. Bottom: This figure represents the odds ratio and 95% confidence interval from several studies that looked at cervical cancer and long durations of douching. CIS, carcinoma in situ; ICC, invasive cervical cancer. *, estimated n = 2,081 based on six studies (128-132, 134); †, error in original paper as to lower bound of 95% confidence interval: 0.8; our estimate of likely correct lower bound: 0.3.

In contrast, in a population-based case-control study in Costa Rica, Stone et al. (134) found that douching was not associated with carcinoma in situ or invasive cervical cancer. Herrero et al. (131), in a case-control study in Latin America, found no consistent association between vaginal douching and invasive cervical cancer. In a case-control study, Brinton et al. (130) found inconsistent results related to the risk of vaginal douching and invasive cervical cancer. They found 30-40 percent nonsignificant elevations in invasive cervical cancer risk associated with regular douching of five or more times per month, but they also found that nonregular douchers were at a higher risk than were regular douchers and that there was no clear relation to the age of first douching or total months of use. They therefore hypothesized that the association they observed may just represent chance.

Cervical cancer is a common cancer in women. Studies on cervical cancer and douching do not show a clear association, with some studies showing a positive association, some a negative association, and some no association. Although cervical cancer would not generate symptoms that might motivate a woman to douche, it is more common among women with other sexually transmitted disease risk factors. For a definitive assessment of causality, a prospective determination would be needed, a difficult task for a chronic disease with a long latency period.

HUMAN IMMUNODEFICIENCY VIRUS

Sexually transmitted diseases and other genital tract infections have been implicated in the acquisition and transmission of human immunodeficiency virus (135-137). Vaginal flora abnormalities, including bacterial vaginosis and sexually transmitted diseases, have been found to be associated with human immunodeficiency virus infection (138-140). Normal vaginal acidity can partly inactivate human immunodeficiency virus, so if bacterial vaginosis raises the pH of vaginal fluid and recruits target inflammatory cells, women with bacterial vaginosis may be more susceptible to human immunodeficiency virus. H2O2-producing lactobacilli have been shown to have viricidal effects on human immunodeficiency virus type 1 (141), and a low vaginal pH may reduce the number of human immunodeficiency virus type 1 target cells in the vagina (142). Helfgott et al. (143) found significant associations between human immunodeficiency virus and bacterial vaginosis, vulvovaginal candidiasis, and trichomonal vaginitis. In a study in Côte d'Ivoire, human immunodeficiency virus was found to be two times more frequent in women using intravaginal antiseptics (9). These cross-sectional studies could be confounded in that bacterial vaginosis, sexually transmitted diseases, and human immunodeficiency virus can be consequences of high risk sexual behavior, although several studies used logistic regression modeling to try to control for sexual behavior.

Not all douching products would be expected to carry comparable risks. Gresenguet et al. (86), in Bangui, Central African Republic, found that vaginal douching with noncommercial preparations was associated with an increased prevalence of human immunodeficiency virus, whereas douching with commercial antiseptic preparations was associated with a lower prevalence of this virus. However, the median years of education for women using commercial antiseptics was 8 years, compared with only 2 years for women using noncommercial preparations, so the results may be confounded by socioeconomic status. Tevi-Benissan et al. (144) reported that vaginal douching reduces semen load substantially after sexual intercourse, and they suggested douching as a supplementary means for prevention of heterosexual human immunodeficiency virus transmission. Given the associations of douching with bacterial vaginosis/sexually transmitted diseases, such a policy suggestion should be studied carefully as other data suggest douching to be harmful.

The relation among human immunodeficiency virus, bacterial vaginosis, and sexually transmitted diseases is complex, as all may be contributed to by high risk sexual behavior. Only a few cross-sectional studies have looked at human immunodeficiency virus and douching, suggesting concern that douching might be associated with risk for human immunodeficiency virus. Given the vast pool of women infected worldwide with human immunodeficiency virus, other sexually transmitted diseases, and bacterial vaginosis and the increased risk attributable to douching, education to discourage douching by women may have a huge impact on the risks of infections and reproductive health consequences.