Research and clinical experience indicate that women commonly seek OTC and alternative therapies for the treatment of vaginal infections and vulvovaginitis (Table Botanical Treatment Strategies for Vulvovaginitis). In one study, 105 patients, with a mean age of 36 years, and 50% with college degrees, referred by their gynecologists for evaluation of chronic vaginal symptoms, were interviewed about their OTC and alternative medicine use in the preceding year, it was found that 73% of patients had self-treated with OTC antifungal medications or povidone-iodine douching and 42% had tried alternative therapies including acidophilus pills orally (50%) or vaginally (11.4%), yogurt orally (20.5%) or vaginally (18.2%), vinegar douches (13.6%), and boric acid (13.6%).
Botanical Treatment Strategies for Vulvovaginitis
|Therapeutic Goal||Therapeutic Activity||Botanical Name||Common Name|
|Eliminate / reduce infection||Antimicrobial||Allium sativum||Garlic|
|Arctostaphylos uva ursi||Uva ursi|
|Berberis aquifolium||Oregon grape|
|Melaleuca alternifolia||Tea tree|
|Reduce swelling and irritation||Anti-inflammatory||Althea officinalis||Marshmallow|
|Reduce swelling and irritation||Demulcent||Althea officinalis||Marshmallow|
|Ulmus rubra||Slippery elm|
|Heal and repair tissue||Vulnerary||Althea officinalis||Marshmallow|
|Ulmus rubra||Slippery elm|
|Reduce vaginal discharge Improve vaginal lubrication and treat vaginal atrophy||Astringent||Arctostaphylos uva ursi||Uva ursi|
|Demulcent / emollient|
|Improve vaginal lubrication and treat vaginal atrophy||Phytoestrogen|
|Improve immunity and resistance||Adaptogens|
Vulvovaginitis may simply be an acute response to a temporary period of imbalance or recent exposure to precipitating factors, such as a period of stress at school or work, excessive consumption of sugar or alcohol at holiday time, or increased sexual activity with condom and spermicide use, affecting proper balance in local flora. In such cases, simple lifestyle modifications combined with topical applications are often adequate treatments. Recurrent vulvovaginitis may be part of a larger picture of chronic lifestyle imbalance, underlying conditions that disrupt the vaginal flora (e.g., bowel dysbiosis or hormonal dysregulation) or exposure to any of the many instigating causes mentioned earlier in this post. Complicated, recurrent vulvovaginitis can be more difficult to treat but can often be effectively addressed with a combination of local and systemic strategies and removal of underlying causes. Patients with intractable vulvovaginitis should be evaluated for serious underlying conditions such as immunosuppression or diabetes mellitus, and any botanical treatment should occur in conjunction with appropriate medical care. Although there is evidence in the medical literature to suggest that, with the exception of trichomoniasis, it is not necessary to treat sexual partners; empirical evidence from botanical clinical practice suggests that recurrence is less likely when all partners are treated. This should not be surprising, as with most vaginal infections, it has been found that men do harbor organisms in the urethra.
The goal of the botanical practitioner is to reduce or eliminate factors that encourage infection or overgrowth of pathogenic organisms, restore the normal vaginal environment and its flora, and relieve symptoms associated with infection. This chapter does not address hormonal dysregulation that may be associated with vulvovaginitis.
Why Douching Is Not Recommended
Women commonly douche because of the misperception that it “cleans out” the vaginal canal and can thus cure vaginal infections. A systematic review found that although douching may provide some symptomatic relief and initial reduction in infection, it may lead to rebound effects and other complications in the long run. Povidone iodine preparations, a common OTC choice for self-treatment, have been demonstrated to cause a “rebound effect” in which a higher than normal bacterial colonization is seen within weeks of last douching, which could actually increase the risk of bacterial vaginosis. Routine douching for hygiene has been shown to double the risk of acquiring vaginitis. Douching of all types can lead to increased risks of PID, endometritis, salpingitis, and ectopic pregnancy.