So why does a gynecologic oncologist / pelvic surgeon write about yeast infections and bacterial vaginosis? Well, women with cancer and those women who are post menopausal and cannot use estrogens, may have difficult to treat vaginal infections which may become immune to repeated use of antibiotics and antifungals. Thus, natural therapies may be helpful for these difficult problems. The below information is not meant to be a medical recommendation, but should be reviewed with your physician.

Natural Therapies for Bacterial Vaginosis

Bacterial vaginosis (also called BV) is caused by a change in the balance in the bacteria of the vagina. Normally, Lactobacillus bacteria predominate in the vagina, however in bacterial vaginosis other organisms such as Gardnerella and Bacteroides may be over represented. Symptoms of vaginal discharge, itching and pain may ensue when these other organisms overgrow and result in a shift the balance of the vaginal flora. The delicate ecosystem can be knocked out of balance by antibiotics, spermicides, birth control pills, and shift in vaginal ph. Normally, the dominant organism of the vagina, Lactobacillus, also makes the vagina too acidic for other organisms to grow and survive. For some women, probiotic treatments with Lactobacillus may be helpful for common genitourinary problems such as bacterial vaginosis, yeast infections, and recurrent urinary tract infections.

Bacterial vaginosis can be difficult to treat, and many times the infection may return after the standard antibiotic treatments, due to the development of antibiotic resistance and persistence of instigators.  These standard antibiotic treatments include: oral Flagyl, Metrogel (topical Flagyl), clindamycin cream, and tinidazole. For some women who: have failed antibiotic treatments, are not pregnant, not planning to get pregnant in the near future, or do not demonstrate signs of pelvic inflammatory disease, natural therapies may be attractive. Indeed, studies are being conducted in order to determine and isolate the active agents in Lactobacillus and other natural therapies that help hold other organisms in check. Studies are also being performed with thymol and eugonal, natural antibacterial and antimycotic active ingredients extracted from plants. These treatments have been found in clinical studies to decrease exposure to antibiotics in the treatment of bacterial vaginosis. Eugenol is a liquid extracted from essential oils such as clove oil, nutmeg, cinnamon, basil and bay leaf. Thymol is a naturally occurring anti microbial (including anti-bacterial and anti-fungal) and is found the essential oil of oregano.

Basic steps in the treatment of bacterial vaginosis include:

1. Attention to lifestyle:

Avoid: synthetic and tight fitting undergarments and thongs. Undyed, white cotton underwear is the best (not so sexy – but functional).

Avoid: harsh soaps, perfumes

Avoid: poorly managed stress

Abstain: from intercourse during treatment

Avoid: caffeine, alcohol, sugars, processed foods, vinegar, and soy sauce

2. Treat the symptoms:

Aloe Vera gel may help with itching. Echinacea tincture may decrease inflammation

3. Treat the bacteria:

Essential oils and tinctures may be helpful

Tea tree oil

Lavender oil

Oil of oregano

Neem oil

Goldenseal tincture

Garlic tincture

Grapefruit seed extract

All of these compounds are natural, but that does not mean that they cannot have side effects. For example: neem oil has been reported to cause hepatotoxicity (liver toxicity), oil of oregano can cause allergic reactions and can interact with lithium. Goldenseal and garlic may have multiple drug interactions. None of these agents should be used in pregnant or breast-feeding women, women who are planning to get pregnant in the near future, very young women and adolescents. Echinacea should not be used in women with autoimmune conditions. Some has advocated black walnut, however it contains a compound, which may a carcinogen and thus should be avoided.

For most of these oils or tinctures, a few drops may be placed on a tampon and then placed in vagina for 1 to 3 hours, or applied directly with fingers. Vaginal suppositories may be also compounded with these agents. Any of the anti bacterial treatments may be caustic or allergenic, and a small test area should be treated first to see how you react.

A douche may also be used such as: 24 oz. distilled water, 2 chamomile tea bags, 6 drops of tea tree oil, 5 drops of lavender oil and 1 drop of thyme oil. Brew the chamomile tea first and then place the oil in the tea and disperse. This can be used after cooling as a douche two times a day. Alternatively, one tablespoon of tea tree oil can be mixed with 2 cups of water as used as a douche. Another douche reported to be helpful is: one teaspoon of grapefruit seed extract with 2 cups of water.

A vaginal ointment may also be compounded with tea tree oil such as: 6 drops of tea tree oil, 1 tablespoon of aloe Vera gel (vitamin E oil or cocoa butter can also be substituted). This ointment can directly be applied to the vagina or placed on a tampon and inserted into the vagina.

Some women report that hydrogen peroxide may be helpful, but must always be diluted. For example ¼ cup of 3% medical hydrogen peroxide can be mixed with 2 cups of water and used as a douche.

4. Creation of healthy vaginal environment (pH):

Vinegar douche: mix in a ½ vinegar and ½ water solution

5. Introduction of beneficial bacteria:

Lactobacillus suppositories and oral probiotics

A probiotic is a live micro-organism (bacteria) that is administered to confer a health benefit to a host (person). Lactobacillus is a type of bacteria that helps keep the vaginal ecosystem healthy by production of substances that keep other bacteria in check. There is evidence that the beneficial bacteria, L. rhamnosus GR-1 and L. reuteri RC-14, provide significant safeguards against vaginal disorders. Lactobacillus acidophilus suppositories (Vivag, Pharma Vinci A/S, Denmark) and vaginal tablets (Gynoflor, Medinova, Switzerland) may be effective. Researchers also found that vaginal capsules Lactobacillus gasseri and Lactobacillus rhamnosus, seem to lengthen the time between vaginal infections. Lactobacilli products require refrigeration for optimal potency. The label should always state the strain names and the amounts (cfu, or colony forming units – should be in the 1-10 billion range). Supplementing with 5-10 billion colony-forming units (cfu) of the Lactobacilli strains GR-1 and RC-14 each day may also be recommended.

Probiotic-rich foods include the following: kefir, yogurt with live cultures, dark chocolate, miso, pickles. Sourdough bread, fruits such as bananas and tomatoes, vegetables such as artichokes, green beans and leeks, whole grain breads.

Caution: women with a weakened immune system should always review with their physician if the use of probiotics is safe. Individuals who are using steroids or other immunosuppressants should be careful with these types of medications. There may be some concern that Lactobacillus may cause problems in these individuals.

Notes on interactions for reviewed remedies: The safety of these topical remedies for you should always be reviewed with your physician, who knows and understands your health conditions. These remedies should not be used in pregnant or breast-feeding women; those who are planning to become pregnant, young girls or adolescents.

Aloe Vera Topical

The aloe plant produces two substances, gel and latex, which are used for medicines. Aloe gel (many times referred to as aloe Vera) is the clear, jelly-like substance found in the inner part of the aloe plant leaf and aloe latex comes from just under the plant’s skin. Aloe gel has properties that are harmful to certain types of bacteria and fungi. Allergic reactions may occur with aloe gel and dermatitis may develop after prolonged usage. In order to ensure a lack of sensitivity to the gel, women should always use a small test patch of skin for application prior to more intensive applications. Individuals who have diabetes or are on medications for diabetes should be cautious, as aloe gel might decrease blood sugar.

Echinacea Topical

Echinacea is an herb that is native to North America and was used in traditional herbal remedies by the Great Plains Indian tribes. From 1916-1950 Echinacea was listed on the United Sates national Formulary, however its use fell out of favor due to the development of antibiotics and lack of proven benefit. Echinacea may help to decrease inflammation and may also directly attack yeast directly. It can be used as a topical cream to fight yeast and bacterial infections.  Echinacea may cause allergic reactions, and is most likely to cause allergic those who are allergic to ragweed, mums, marigolds, or daisies. Applying Echinacea to the skin can cause redness, itchiness, or a rash. Women with autoimmune disorders such as: multiple sclerosis (MS), lupus (SLE) or rheumatoid arthritis (RA), should not use Echinacea.

Tea Tree Oil Topical

Tea tree oil is an extract from a plant native to Australia and has been used traditionally as a topical antiseptic and antifungal treatment. This oil may cause allergic reactions, blistering, redness, and itching. It may aggravate eczema.

Lavender

Lavender is an herb, and the flower and the oil of lavender are used to make medicine.

Oil of Oregano Topical

Oregano is a plant and the leaf is used to make medicine. Oil of oregano may cause allergic reactions, especially in those who have an allergy to plants in the Lamiaceae family (basil, hyssop, lavender, marjoram, mint and sage).

Neem Oil Topical

Neem is a tree and the bark, leaves, and seeds are used to make medicine. It may help to kill bacteria. Women with autoimmune disorders such as: multiple sclerosis (MS), lupus (SLE) or rheumatoid arthritis (RA), should not use neem oil as it cause these diseases to become more active. It should also not be used in women with a history of an organ transplant. There is some evidence that neem can decrease blood sugar levels and should be used with caution in women who have diabetes. Medications that interact with neem include: lithium, diabetes medications, immunosuppressants and transplant medications,

Goldenseal

Goldenseal is an herb found in North America, and the dried root is used to make medicine. Goldenseal contains the chemical berberine, which may have effects against bacteria and fungi. For example, it can prevent the bacteria from binding to urinary tract walls, and help to prevent urinary tract infections). Goldenseal interacts with cyclosporine, digoxin, and medications that are metabolized in the liver and P-Glycoprotein substrates.

Garlic Tincture

Garlic is an herb and has been used to prevent or treat a wide range of diseases and conditions. Garlic oil may be applied to the skin to treat fungal infections,

Allicin is the active ingredient and the source of garlic’s distinctive odor. Manufacturing processes that remove the odor, also remove the active agent, limiting its effectiveness. It may be used topically in concentrations of 1%. Garlic may burn the skin. It may also increase clotting times and should be discontinued before surgery. Garlic can interact with TB medications, HIV medications, birth control pills, cyclosporine, medications changed by the liver, and anticoagulants.

Grapefruit Seed Extract

The fruit, oil from the peel, and extracts from the seed can all be used to create medicine from grapefruit. Grapefruit seed extract can be used as a douche for the treatment of yeast and bacterial vaginosis. Grapefruit interacts with a number of medications and as always, its use should be reviewed with your physician.