Symptomatic Relief and Tissue Repair

Irritation and superficial damage from vulvovaginitis can lead to significant discomfort as well as fissures and rawness of the vaginal tissue. The use of herbs as topical agents for reducing inflammation, irritation, and for promoting healing are an important part of any herbal protocol for this condition. Tissue repair is also especially important because inflamed and fissured vaginal tissue increases a woman’s susceptibility to secondary infection, notably, with HIV. Herbs commonly used to promote local tissue repair and reduce discomfort fall into several categories including anti-inflammatories, vulneraries, demulcents, and astringents. Anti-inflammatories relieve local swelling, irritation, and pain; vulneraries work to heal wounds and irritated tissue, demulcents cool and soothe irritated tissue, and astringents tonify tissue and create a protective barrier on the surface, reducing further insult. Astringents can also be effective in drying up excessive secretions. Some of the many herbs with topical anti-inflammatory effects to consider using include licorice, marshmallow root, and lavender, all of which may be used in various combinations and preparations with other herbs to treat vaginitis.

Calendula

Calendula has demonstrated efficacy in the treatment of wounds, promoting tissue regeneration and re-epithelialization, and has also shown some antimicrobial activity (see the preceding). It is soothing as a tea, oil, or diluted tincture (1 tbs tincture to ΒΌ cup of water), and is an important ingredient in topical vulvovaginitis preparations. ESCOP recommends calendula for the treatment of skin and mucosal inflammation and to aid wound healing.

Comfrey Root

Comfrey root has a very long history of folk use for healing damaged skin, tissue, and broken bones. It is highly mucilaginous. It is thought that allantoin and ros-marinic acid are the constituents mainly responsible for comfrey’s healing and anti-inflammatory actions. Comfrey is indicated for topical use only. Use on broken skin or mucosa should be minimized but is reasonable for short durations (1 to 2 weeks at a time), and should not exceed 100 \ig of pyrrolizidine alkaloids with 1,2 unsaturated necine structure daily for a maximum of to 4 to 6 weeks annually. Comfrey infusion may be added to a peri-rinse or sitz-bath blend, or comfrey oil or finely powdered herb may be added to a suppository blend.

Lavender

Lavender has a folk tradition of use for topical treatment of mild wounds, for which it is still included by herbalists and midwives in topical preparations for vulvovaginitis. Additionally, its fragrance imparts a pleasant scent to herbal preparations. It may be used as a rinse or sitz bath in tea form or using diluted tincture, or several drops of essential oil may be added to rinses, sitz baths, or suppositories.

Marshmallow Root

Marshmallow is demulcent and vulnerary. Marshmallow root contains a mucilage that covers the mucosa, protecting it from local irritation. Topical application is soothing in sitz baths and peri-rinses, and the powdered herb, finely ground, helps give herbal suppositories firmness.

Slippery elm bark powder can be substituted for marshmallow root powder in suppository blends.