Until recently, vaginal douching has been considered a relatively benign procedure. However, in recent years, a number of papers have reported an association between current vaginal douching and pelvic inflammatory disease or ectopic pregnancy. Although it is biologically plausible that the act of vaginal douching could be associated with introduction of bacteria into the upper genital tract thus causing salpingitis and its sequelae, the epidemiologic data are far from compelling, yet it is clear that douching is a voluntary act and not a necessity. The data suggesting a causative role are too strong to ignore. There is an urgent need for further studies to help define any possible causative role for vaginal douching in pelvic inflammatory disease or ectopic pregnancy. It is likely that intervention programs could be more successfully aimed at modifying douching behaviors than at reducing infection rates with the sexually transmitted disease agents that cause acute salpingitis. In the meantime, without a medical indication for vaginal douching, together with the possible risks, one must ask, why douche?