The Truth about Douching, Boric Acid, and D-Mannose
I still remember my third day as an attending. It was the first time I had more than 2 people on my schedule. I also remember that a significant number of these women were add on patients for vaginal discharge. Throughout the last few years, complaints of vaginal itching, irritation, discharge, discomfort, burning, etc etc etc, has become a mainstay as a general gynecologist. Although there is some overlap, for the most part, there are different reasons for external complaints vs internal complaints.
This article will focus on some of the internal remedies that are out there: vaginal douching, boric acid, and D-Mannose.
To be clear, natural remedies can be very effective and a good way to avoid taking medicine. We recently had written an article on some of the health benefits of turmeric. I often joke that I have to be very sick to take any sort of prescription medicine. However, just because something is natural or over the counter does absolutely NOT mean it is without risk, nor does it mean it is effective.
One of the worst things to do for the vagina is to douche.
I have had women tell me they use a variety of things as suppositories, including vinegar, yogurt, peroxide (yes. I know), soap, garlic and tea bags.
I’m going to say it again. DO NOT DOUCHE.
The vagina is virtually a self-cleaning oven. If you feel the need to clean the inside or want some relief, take a plastic cup into the shower- not glass, #safetyfirst – and use it to rinse the area with warm water while gently spreading the external lips. That’s it!
Boric acid can be used to treat both yeast infections of the vagina and bacterial vaginosis. It is administered in a capsule placed in the VAGINA overnight. Even though I really don’t feel like I need an explanation to capitalize the word VAGINA, I capitalized VAGINA (okay, that one was unnecessary) to highlight the fact that this treatment is NOT oral. If an adult, or child swallows boric acid, it can be toxic, and even possibly fatal. This treatment is not ever to be used orally- don’t swallow it, chew it, or sniff it (too far?). When used vaginally, it is safe for adults who are not pregnant. It is not to be used in pregnant women or children.
The regimen for treatment of yeast and/or bacterial vaginosis is a nightly vaginal dose for 7-14 days. Then it can be used as a maintenance regimen two times per week. I like because it is an alternative to oral therapy for women who experience multiple episodes of vaginitis per year. There is also data to suggest that there are more and more evolving fungi that won’t die as easily in response to the little pink pill or other classic treatment. This resets the vaginal pH and makes it a conducive environment for normal bacteria to grow.
If used as a maintenance, or therapy, please abstain from intercourse for at least 2-3 days from the final suppository used just to let the remaining medication come out of the vagina. That is not a recommendation based on evidence, but it just makes sense to me. It can be purchased online or your doctor can prescribed it to a compounding pharmacy. Disclaimer: External skin irritation around the vagina can occur during use. Think of it like a facial that is uncomfortable during, but makes you feel rejuvenated afterward.
Boric acid is like a vag-acial.
A little A&D ointment or Aquaphor can help keep that under control. Apply to clean, dry skin and the barrier for when the boric acid starts coming out. One more time: Do NOT, eat, drink or otherwise ingest Boric Acid. It ONLY belongs in your vagina, and is NOT to be used in pregnant women or children.
D-Mannose is a supplement used to prevent and treat urinary tract infections. I don’t recommend this to treat a UTI, primarily because if it doesn’t work, a kidney infection could develop and kidney infections are real. By real, I mean REAL DANGEROUS. Anyway, D-mannose was brought to my attention by one of my patients because she suffered from recurrent UTIs. She wiped from front to back, urinated after sex, drank a lot of water, and still had to deal with UTIs every 1-2 months. Since trying D-mannose, she said the frequency dropped substantially.
D-mannose is a natural molecule that is found in cranberries, apples and some other fruits. It is the active ingredient in cranberries, minus the sugar that usually accompanies cranberry products like juice. Sugar is the not an infection’s best friend, so being able to consume the active ingredient without the sugar is best. Drinking water is also very important. The molecule has been found to reduce the ability of bacteria to adhere to the urinary tract, which is why I think that it is most useful for prevention rather than treatment. The bacteria don’t even make it in the door, let alone have an opportunity to trash the place. Risks are relatively low with this product, especially if used as directed.
A Quick Fun Fact
Another fun fact to remember when considering self-treating vaginal irritation: ACOG states that only 5% of women can accurately tell when they have bacterial infection and 30% can tell when they have a yeast infection. And this stat is only true if a woman has had this problem before. So you potentially could be treating the wrong problem with a natural treatment that may not even work. Not an ideal situation.
Your Takeaway on Natural Remedies for Vaginal Health
Vaginal health is greatly influenced by overall and general health. Drinking plenty of water, maintaining a good weight, eating a well-balanced diet, taking a daily probiotic to keep the vaginal environment healthy, using condoms, all of these things can be extremely important to reducing the number of infections in a year. Although natural remedies in general are not harmful, they are not routinely tested or regulated by the FDA. It may take some trial and error to find one that works well for your lady bits.
Also, if you try something that has worked in the past and it isn’t working anymore then it is a good idea to have a doc check it out. Remember these are just guidelines and it’s always best to review all questions with your physician.