The short answer is infrastructure, history, and habit. Most Western countries built their modern plumbing systems around flush toilets and dry paper, not water-based cleaning. By the time commercial toilet paper became cheap and widely available in the late 1800s, it was already baked into the culture. Countries in South Asia, the Middle East, Southeast Asia, and parts of Africa developed their sanitation customs around water instead, often reinforced by religious practice. Neither approach is random. Both reflect centuries of infrastructure decisions, climate, economics, and cultural values that became self-reinforcing over time.
How Toilet Paper Became the Western Default
Commercial toilet paper didn’t exist until 1857, when a New York entrepreneur named Joseph Gayetty started selling packages of 500 medicated sheets for 50 cents. Before that, people in Europe and North America used whatever was available: corn cobs, leaves, rags, newspaper, catalog pages. The first perforated rolls appeared in 1890, and manufacturers didn’t manage to produce reliably “splinter-free” paper until 1930.
Once indoor plumbing spread across Europe and North America in the early 20th century, bathrooms were designed with a toilet and a paper holder. There was no bidet fixture, no water hose, no spray nozzle built into the system. Toilet paper fit neatly into this setup: it was cheap to manufacture at scale, required no extra plumbing, and could be sold as a disposable consumer product. Entire supply chains, grocery store aisles, and household budgets formed around it. That momentum made it extremely difficult for any alternative to displace paper, even when better options existed.
Why Water-Based Cleaning Is the Norm Elsewhere
In much of Asia, the Arab world, and parts of Africa, water has been the primary cleaning method for centuries. This isn’t a matter of lacking access to paper. It reflects deeply held beliefs about what “clean” actually means. In Islamic hygiene practice, washing with water after using the toilet is a religious expectation, not just a preference. Hindu traditions similarly emphasize water for purification. These practices predate commercial toilet paper by many centuries, so when modern plumbing arrived in these regions, it was designed to accommodate water-based cleaning: handheld sprayers, built-in bidet nozzles, or a simple water vessel kept next to the toilet.
Japan offers an interesting case. Despite being a highly industrialized country, Japanese toilet culture embraced water cleaning enthusiastically. High-tech toilet seats with built-in warm water sprays are standard in most Japanese homes and public restrooms. The technology caught on because the underlying cultural attitude already valued water-based hygiene.
In countries like Thailand, Turkey, and Egypt, travelers from the West are often surprised to find a spray hose next to every toilet. The reverse is equally true. Visitors from these regions arriving in Europe or the United States for the first time are often puzzled to find nothing but a roll of dry paper.
What Doctors Say About the Difference
Proctologists have long acknowledged that water cleaning is gentler and more thorough than paper. Wiping with dry paper can cause chafing, micro-tears in the skin, and irritation, especially with repeated use throughout the day. For people who already have hemorrhoids or anal fissures, paper makes the problem worse. Water avoids all of this.
The Cleveland Clinic notes that bidets eliminate the friction that causes those small cuts, making them more comfortable for anyone with existing skin sensitivity in that area. From a pure hygiene standpoint, water removes residue more completely than dry wiping. The comparison doctors sometimes use: if you got something on your hands, you wouldn’t just wipe it off with a dry tissue and consider them clean.
None of this means toilet paper is dangerous. Billions of people use it without serious problems. But the medical consensus is clear that water is the superior cleaning method for skin health and thoroughness.
The Role of Cost and Infrastructure
An average person in the United States spends roughly $60 to $90 per year on toilet paper. A basic bidet attachment that connects to an existing toilet costs $30 to $50 and uses about one-sixth of a gallon per use, adding almost nothing to a water bill. The math favors the bidet: cutting out even 75% of toilet paper use saves $45 to $67 per person annually. For a household of four, that adds up quickly.
So why don’t more Western households switch? Partly because the upfront cultural barrier is real. Many Americans and Europeans feel squeamish about the idea of a water spray, having never used one. Bathrooms in older Western homes have no outlet or hookup designed for a bidet. And perhaps most powerfully, people tend to replicate whatever they grew up with. If your parents used toilet paper, you use toilet paper. The habit passes through generations without anyone stopping to question whether it’s the best option.
In water-washing cultures, the economics work differently. A plastic water vessel or a simple spray hose costs very little, requires minimal plumbing, and lasts for years. In parts of South Asia and Africa where toilet paper would need to be purchased repeatedly, water is simply the more practical and affordable choice, especially in rural areas.
Why the Gap Is Slowly Narrowing
Bidet sales in the United States and Europe have climbed significantly in recent years. The toilet paper shortages during 2020 pushed many Western consumers to try bidet attachments for the first time, and a large percentage kept using them. Japanese-style washlet seats are now sold at mainstream Western retailers. The environmental cost of toilet paper production, which involves cutting down tens of millions of trees annually and using enormous amounts of water in manufacturing, has also pushed some consumers to reconsider.
Still, cultural habits shift slowly. Toilet paper remains deeply embedded in Western daily life, stocked in every public restroom, hotel, and office building. For most people in Europe and North America, it’s not a conscious choice so much as the only option they’ve ever been presented with. The infrastructure was built around it, and changing infrastructure is far harder than changing minds.