Which of the following is an important risk factor for vaginal infections?

• A. High estrogen levels
• B. Frequent douching
• C. Late menarche
• D. Caucasian ethnicity

Answer: (B)

Vaginal infections often arise when the protective vaginal flora is disrupted and the environment becomes less hostile to overgrowth. Normally, lactobacilli keep the area acidic by producing lactic acid, which helps prevent pathogenic organisms from taking hold. Frequent douching disrupts this balance by washing away the beneficial bacteria and raising the vaginal pH, creating favorable conditions for bacteria that cause bacterial vaginosis or yeast infections to proliferate. This makes douching a modifiable behavior with a clear, well-established link to increased infection risk, so it stands out as the important risk factor. The other options don’t have as consistent or broad a association: high estrogen can predispose to yeast overgrowth in certain situations, but it isn’t a universal risk factor for vaginal infections; late menarche and ethnicity don’t inherently raise infection risk.