Objective: The objective of this study was to identify douching patterns and their relation to sexually transmitted disease (STD) among black women seeking an STD evaluation. Study Design: This study was a cross-sectional survey with biologic testing for chlamydia and gonorrhea infection. Results: Of 891 participants, 46.1% were current douchers. Commonly identified reasons for douching were to cleanse after menses (65.4%) and to feel fresh (42.2%). Frequent douching was associated with douching after sex (P <0.001), to alleviate an itch (P <0.001), and to feel fresh (P <0.001). Women who douched during menses (adjusted odds ratio [AOR] = 4.78; 95% confidence interval [CI] = 1.13-20.13) and to alleviate an itch (AOR = 3.66; 95% CI = 1.00-13.41) were more likely to have a current chlamydial infection. Conclusions: Douching was common among this high-risk population of black women. Prospective studies are needed to determine the consequences of douching and any mediating effects of women's motivation for the behavior on reproductive health. Copyright © 2006, American Sexually Transmitted Diseases Association All rights reserved.