The way that we think douching might relate to PID is not that it forces the bugs up into the upper genital tract because in terms of the mechanics of it that wouldn’t make sense, but that douching may actually alter the PH of the vaginal flora thereby creating condition where you get bacterial vaginosis, which is a replacement of the normal vaginal flora, which is called Lactobacillus, with a mixture of bad bugs. Literally a good guys versus the bad guys situation. The good guys are residing in the vaginal flora normally, keeping away all the bad bugs, such as Gonorrhea and Chlamydia, being protective. When you put soap up in your vagina or through douching you may actually wipe out the good guys and allow the bad guys to grow, which would allow Gonorrhea and Chlamydia to get into the cervix and to ascend the upper genital tract. There’s been a huge question in the literature as to whether these bugs, BV, even if there wasn’t Gonorrhea and Chlamydia, may cause PID if they ascend into the upper genital tract.