Short reportUse of complementary and alternative medicine in recurrent vulvovaginal candidiasis—Results of a practitioner survey☆
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.
References (17)
Vulvovaginal candidosis
Lancet
(2007)- et al.
Over-the-counter and alternative medicines in the treatment of chronic vaginal symptoms
Obstetrics and Gynecology
(1997) - et al.
Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis
New England Journal of Medicine
(2004) - et al.
Comprehensive review of conventional and non-conventional methods of management of recurrent vulvovaginal candidiasis
Australian Journal of Obstetrics and Gynaecology
(2007) - et al.
Complementary and alternative medicine use in Australia: a national population-based survey
Journal of Alternative and Complementary Medicine
(2007) - et al.
Alternative therapies with chronic vaginitis
Obstetrics and Gynecology
(2011) - et al.
Physician and patient attitudes towards complementary and alternative medicine in obstetrics and gynecology
BMC Complementary and Alternative Medicine
(2008) - et al.
The effect of lactobacillus in preventing post-antibiotic vulvovaginal candidiasis: a randomised controlled trial
British Medical Journal
(2004)
Cited by (16)
Managing recurrent vulvovaginal thrush from patient and healthcare professional perspectives: A systematic review and thematic synthesis
2024, Patient Education and CounselingWomen-specific routes of administration for drugs: A critical overview
2021, Advanced Drug Delivery ReviewsCitation Excerpt :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.
Garlic clove applied as vaginal suppository – A case report
2018, Complementary Therapies in MedicineCitation 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.
Recurrent vulvovaginal candidiasis
2016, American Journal of Obstetrics and GynecologyCitation 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.
- ☆
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.