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Julius Schachter, PhD; Joan M. Chow, DrPH; Richard L. Sweet, MD
University of California San Francisco General Hospital

JAMA. 1991;265(20):2670-2671.

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In Reply. —

We appreciate the interest of Meyer et al in our study, which found previous exposure to Chlamydia trachomatis and current douching behavior to be risk factors for ectopic pregnancy. Our article and another study¹ have come to the same conclusions. That C trachomatis infection can damage fallopian tubes and thus impair fertility and increase the risk of ectopic pregnancy is clear. However, the role of douching in causing infertility or ectopic pregnancy is less certain. In our study, the increased risk of ectopic pregnancy associated with douching was independent of the risk associated with increased chlamydial antibody rates. Others have found douching and exposure to chlamydiae to be correlated.¹

We agree with Meyer et al that douching activity is culture related and varies among racial and/or ethnic groups. However, the matched-pair, case-control analysis that we did should have controlled for that type of confounding. We . . . [Full Text PDF of this Article]

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