To prevent pelvic inflammatory disease (PID) and its consequences, risk factors must be identified. A review of the literature supports the possibility that vaginal douching may affect the risk factor of PID, and new data are presented on douching practices of women hospitalized with PID. Individual case reports and controlled studies support associations between vaginal douching and both PID and ectopic pregnancy. The prevalence and distribution of douching are also compatible with a possible association. The temporal pattern of PID symptoms may be linked to douching and menses. The nature of the douche solution and the douching technique may be important variables with regard to douching as a PID risk factor. A case-control epidemiologic study is recommended to clarify the relationships between PID and douching.