Use of complementary and alternative medicine in recurrent vulvovaginal candidiasis—Results of a practitioner survey

doi:10.1016/j.ctim.2012.01.004

Complementary Therapies in Medicine

Volume 20, Issue 4, August 2012, Pages 218-221

https://doi.org/10.1016/j.ctim.2012.01.004 Get rights and content

Summary

Background

The mainstream long term management of recurrent vulvovaginal candidiasis (RVVC) often results in poor outcomes. It is expensive and unacceptable for many women who therefore have incorporated complementary and alternative medicine (CAM) into their personal care plan.

Objective

To ascertain clinicians’ knowledge of CAM and their recommendations for the use of CAM and non-pharmacological management in women with RVVC.

Design and setting

Anonymous, single page, self completed survey using convenience sampling at a vulval disorders meeting in New South Wales, Australia in 2009.

Participants

Sixty six health professionals (medical practitioners, dermatologists, nurses and allied health professionals).

Results

Most clinicians reported asking about their patients’ use of CAM and non-pharmacological management of RVVC, although only around half reported recommending it. CAM management included lactobacillus, oral and vaginal yoghurt, vinegar, garlic, Chinese medicine and tea-tree oil. Non-pharmacological management included dietary changes and use of cotton undergarments. Lactobacillus was the most commonly recommended CAM.

Conclusion

CAM is popular with patients and many clinicians actively recommend its use in RVVC despite limited supporting evidence. Further research in the area of CAM and RVVC is long overdue.

Introduction

Recurrent vulvovaginal candidiasis, or vaginal thrush (RVVC), is defined as four or more episodes of VVC in 12 months and affects 5–8% of women of reproductive age.¹ Symptoms women experience include itch and vaginal discharge and the condition can have a major impact on both the sufferers and their partners. The current recommended conventional treatment consists of high doses of oral or vaginal anti-fungal pharmaceuticals to induce clinical remission, followed by long term maintenance therapy of weekly or monthly treatment.² Despite its expense, many women obtain little long term relief from this treatment, with 50% experiencing recurrences of RVVC within months of completing long term therapy.² Some women experience side effects from the treatment including headaches and gastrointestinal disturbance.²

The lack of effective treatment results in many women turning to complementary and alternative medicines (CAM), which includes treatment such as oral or vaginal yoghurt, lactobacillus supplements and tea tree oil. Conventional health professionals need to be familiar with CAM, as its community use in developed countries is so widespread.³ However, there is a building body of literature that demonstrates that many women do not inform their medical doctor of their CAM use.⁴ Although there are two papers investigating patients’ use of CAM in RVVC,5, 6 there are no papers reporting clinicians’ self reported knowledge of their patients’ use of CAM, nor their personal recommendations. This paper explores use of CAM in RVVC from clinicians’ perspectives.

Section snippets

Methods

A brief self-complete survey with closed and open-ended questions regarding RVVC and CAM use was conducted in June 2009 using a convenience sample of health professionals at a vulvovaginal disorders scientific meeting. Participating multidisciplinary clinicians were asked to document which CAM they thought their patients used for RVVC, as well as whether they themselves recommend these therapies. Ethics approval was obtained through University of Melbourne's Human Ethics Advisory Group.

Results

The vulvovaginal disorders conference was attended by 160 health professionals. The survey was completed by 66, giving a response rate of 41%. The respondents included obstetricians/gynaecologists (n = 37), general (family) practitioners (n = 13), dermatologists (n = 8), sexual health physicians (n = 4), and a single nurse, physiotherapist, acupuncturist, and obstetrics and gynaecology trainee. The majority (n = 55; 86%) reported that they had more than two years experience in managing RVVC.

Clinicians’

Discussion

Clinicians with an interest in vulval disorders report a high awareness of CAM use by their patients. Overall we found that female clinicians were more likely than male clinicians to be aware of their patients’ use of CAM, as well as being more likely to recommend CAM. This finding concurs with previous studies.⁷

Probiotics such as lactobacillus were the most commonly recommended CAM in this survey. The presumed mechanism is that increasing the ‘good bacteria’ will reduce pathogenic effects of

Conclusions

CAM remains a popular addition or alternative for women with RVVC, most likely due to poor response to conventional medical treatments. Although some CAM modalities such as probiotics are not supported by research, they are widely recommended and used by patients, and are considered unlikely to do harm. Clinicians should ascertain what CAM modalities are used by their patients, and where available ensure that they are aware of supporting evidence. Further research in the use of CAM in RVVC from

Conflict of interest statement

This work has not been commissioned, sponsored, or funded by a pharmaceutical company. There are no financial and personal relationships with other people that could inappropriately influence this work.

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There are more references available in the full text version of this article.

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Managing recurrent vulvovaginal thrush from patient and healthcare professional perspectives: A systematic review and thematic synthesis
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This systematic review aims to identify what is known about patient and healthcare professional experiences of managing recurrent vulvovaginal thrush by synthesising published findings.
Five databases were searched for studies on patient and healthcare professional experiences managing recurrent thrush. Two reviewers independently screened and quality assessed qualitative, quantitative, and mixed-methods studies. Findings from eligible studies were thematically synthesised.
720 papers were identified, and 29 were included. Four descriptive themes were developed to depict the repeated management of recurrent thrush. These themes were: (re)experiencing impacts, (re)identifying recurrent thrush, (re)considering consultations, and (re)trying treatments. An analytic high-order frame of ‘interwoven and reoccurring uncertainties’ was used to understand these themes.
Patients and healthcare providers face uncertainties when managing recurrent thrush. The inconsistencies raised across papers suggests an unaddressed gap in knowledge about patient experiences and their informational and support needs; this includes insights about this condition’s diagnosis, management, treatment, impacts, and meaning.
This review has implications for patient education, health promotion, and communication between patients and providers. Our interpretations suggest the need for more research and resources to help support patients and clinicians in managing this condition to promote more understanding, communication, and collaborative care.
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Topical treatment of bacterial and Candida spp. infection appears to be as effective as oral regimens and causing limited systemic adverse effects. Alternative topical treatments have been studied and even routinely used in clinical practice (e.g., probiotics for BV or plant extracts for VVC), but efficacy remains unclear [71,72]. Still, research on new agents and treatment approaches is deemed urgent because of the emergence of drug resistance across pathogens causing vaginal infections.
The woman’s body presents a number of unique anatomical features that can constitute valuable routes for the administration of drugs, either for local or systemic action. These are associated with genitalia (vaginal, endocervical, intrauterine, intrafallopian and intraovarian routes), changes occurring during pregnancy (extra-amniotic, intra-amniotic and intraplacental routes) and the female breast (breast intraductal route). While the vaginal administration of drug products is common, other routes have limited clinical application and are fairly unknown even for scientists involved in drug delivery science. Understanding the possibilities and limitations of women-specific routes is of key importance for the development of new preventative, diagnostic and therapeutic strategies that will ultimately contribute to the advancement of women’s health. This article provides an overview on women-specific routes for the administration of drugs, focusing on aspects such as biological features pertaining to drug delivery, relevance in current clinical practice, available drug dosage forms/delivery systems and administration techniques, as well as recent trends in the field.
Garlic clove applied as vaginal suppository – A case report
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Citation Excerpt :
These are conventionally treated with antibiotics and other anti-infectious drugs, but there is a rise in use of complementary and alternative medicine (CAM) in cases of infections and other types of genital disorders.1 Some of the CAMs used for treatment of vaginal complaints include Lactobacillus sp. vagitoriae, yogurt (used both orally and vaginally), vinegar, lemon juice, bleach, tea tree (Melaleuca alternifolia) oil, acidi borici and many other.2,3 Use of garlic, onion and other different species of genus Allium dates to ancient cultures, where these plants were used for treatment of many diseases of eyes, skin and kidney.
Besides conventional drugs, various vaginal disorders are often treated with complementary and alternative medicines. Different natural products are often used in treatment of genital infections. The aim is to present a case of treatment of vaginal infection with a garlic clove.
A detailed interview was conducted with the subject whose condition was described in this case.
Young woman was diagnosed with vaginal Ureaplasma sp. infection. After failed local treatment with antibiotics and antifungals, subject obtained advice to treat the disorder with incised clove of garlic. Control examination by her gynecologist confirmed that infection was successfully cured. Subject experienced no adverse effects.
Garlic clove successfully cured vaginal infection presented in this case. However, application to genital organs should be reserved for dosage forms, in order to prevent potential toxicity and to obtain reproducibility of active compounds concentrations.
Recurrent vulvovaginal candidiasis
2016, American Journal of Obstetrics and Gynecology
Citation Excerpt :
In this context induction and long-term therapy can be considered utilizing either vaginal nystatin or boric acid, with little published data of efficacy.54,56 In layman literature, probiotic use to treat and prevent VVC is a long-standing tradition.59,60 Scientific justification for exogenous Lactobacillus replacement is based on the premise that Lactobacillus species exert a significant protective effect in vivo in reducing the virulence expression of Candida organisms colonizing the vagina as well as enhancing the vaginal epithelial cell immune defense mechanisms.
Recurrent vulvovaginal candidiasis (RVVC) is a common cause of significant morbidity in women in all strata of society affecting millions of women worldwide. Previously, RVVC occurrence was limited by onset of menopause but the widespread use of hormone replacement therapy has extended the at-risk period. Candida albicans remains the dominant species responsible for RVVC, however optimal management of RVVC requires species determination and effective treatment measures are best if species-specific. Considerable progress has been made in understanding risk factors that determine susceptibility to RVVC, particularly genetic factors, as well as new insights into normal vaginal defense immune mechanisms and their aberrations in RVVC. While effective control of RVVC is achievable with the use of fluconazole maintenance suppressive therapy, cure of RVVC remains elusive especially in this era of fluconazole drug resistance. Vaccine development remains a critical challenge and need.
Lived experience of medical management in recurrent vulvovaginal candidiasis: a qualitative study of an uncertain journey
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Garlic alters the expression of putative virulence factor genes SIR2 and ECE1 in vulvovaginal C. albicans isolates
2020, Scientific Reports

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^☆: Women's Health Nurse Association of Victoria provided financial support for the corresponding author to attend the scientific meeting. Marie Pirotta is supported by a Primary Health Care Research Evaluation and Development fellowship, and Cathy Watson is supported by a Melbourne University Research Scholarship.

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Short reportUse of complementary and alternative medicine in recurrent vulvovaginal candidiasis—Results of a practitioner survey☆

Summary

Background

Objective

Design and setting

Participants

Results

Conclusion

Introduction

Section snippets

Methods

Results

Discussion

Conclusions

Conflict of interest statement

Lancet

Obstetrics and Gynecology

Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis

New England Journal of Medicine

Comprehensive review of conventional and non-conventional methods of management of recurrent vulvovaginal candidiasis

Australian Journal of Obstetrics and Gynaecology

Complementary and alternative medicine use in Australia: a national population-based survey

Journal of Alternative and Complementary Medicine

Alternative therapies with chronic vaginitis

Obstetrics and Gynecology

Physician and patient attitudes towards complementary and alternative medicine in obstetrics and gynecology

BMC Complementary and Alternative Medicine

The effect of lactobacillus in preventing post-antibiotic vulvovaginal candidiasis: a randomised controlled trial

British Medical Journal

Short report
Use of complementary and alternative medicine in recurrent vulvovaginal candidiasis—Results of a practitioner survey☆