Background:
Douching has been linked to numerous reproductive health consequences including sexually transmitted infections (STIs). Why some women douche and others never initiate the behavior is unclear.

Objective:
To identify current douchers' reasons for starting to douche and other women's reasons for never starting the practice.

Method:
A random-digit-dial computer-assisted telephone interviewing (CATI) survey was conducted among U.S. women between the ages of 18 and 44. Current douchers were asked open-ended questions regarding their reasons for starting to douche, and never douchers were asked their reasons for never experimenting with the behavior.

Result:
Of the 2,603 women surveyed, 46.2% were White, 41.3% were Black, and 12.5% were Hispanic. The mean age of the sample was 31.2 years and 464 (17.8%) were current douchers, while 1,043 (40.1%) had never douched. Three main themes were found regarding women's reasons for starting to douche: for cleanliness (n=187; 41.1%); to alleviate gynecologic issues (n=112; 24.6%); and, upon the recommendation of others (n=98; 21.5%). Major themes that emerged for women who never douched included: unnecessary for the body (n=351; 34.0%); upon the recommendation of others (n=177; 17.1%); and the behavior's link to negative health outcomes (n=119; 11.5%).

Conclusion:
The influence of trusted others and concerns for health are popular rationales identified by both douchers and non-douchers for either starting to douche or never douching. Efforts to prevent women from douching or reducing the practice among regular douchers should use these reasons as an opportunity to focus intervention efforts to lower STI acquisition and transmission.

Implications:
STI prevention efforts should consider women who douche (and others who could be influenced to douche) as a potential high risk group. Thus, the most effective intervention programs should be based on douchers' motivations for engaging in the behavior and should also consider the arguments that have kept non-douchers from initiating the behavior.