Habitual use of warm-water cleaning toilets is related to the aggravation of vaginal microflora

Aim:  Warm-water cleaning toilets, or ‘bidet toilets’, are one of the most popular household goods in Japan. However, a recent large-scale survey raised questions about the relationship between bidet toilet use and bacterial vaginitis as reflecting bacterial vaginosis with inflammation. Recently, gynecologists have expressed concerns about the increase in aggravated vaginal microflora in habitual bidet users. Therefore, the present study was designed to clarify the possible relevancy of bidet usage to changes in vaginal microflora. Methods:  Two hundred and sixty-eight non-pregnant women of reproductive age, with an increase in vaginal discharge, consented to enter the study. On outpatient visit, an aliquot of cervicovaginal secretion was obtained by a sterilized cotton swab and cultured using standard culture systems. Results:  Normal microflora (Lactobacillus species) was not present in 42.86% of bidet toilet users, compared to 8.77% of non-users. Fecal bacteria were detected in 50 of the 268 cases (18.66%), 46 cases in users (92%) and only 4 cases in non-users (8%). Contamination by other pathogens was 4 to 6 times higher in users than in non-users. Conclusion:  Habitual use of bidet toilets aggravates vaginal microflora, either by depriving normal microflora or facilitating opportunistic infection of fecal bacteria and other microorganisms.