Tips for how to successfully use Boric Acid (or other) vaginal suppositories for thrush, BV or CV when you have vulvovaginal inflammation.
We are here to tell you HOW to use a Boric Acid or other type of suppository when your starting point is that of vaginal pain and discomfort. Most of the time we are given no instructions on how to go forward. Or worse, we are told to avoid Boric Acid entirely, despite it being a wonderful (and sometimes the only) treatment option for our particular condition. Eg C. Glabrata - thrush resistant to fluconazole.
Boric Acid works to treat both thrush and Bacterial Vaginosis, plus it destroys biofilm. It also helps to balance our pH all while not entering our bloodstream. It never expires and is an affordable option that makes sense to have on hand.
We strongly recommend Vegan capsules for women with sensitivity issues as they dissolve much faster and users report that they tolerate them better than the gelatine ones which take longer to dissolve.
This is a list of helpful tips compiled from my own experience dealing with vulva pain and from helping many thousands of women plus listening to feedback from women posting online.
It is challenging to treat thrush and BV when we have discomfort, burning & inflammation. It can take a mental and physical toll. We know that you might feel scared, and stressed and that things are hopeless and overwhelming. But don't worry we know that you will get through this with the right help & support.
Our approach recognises that we must address the physical and mental health aspects involved in going forward. First, we know that Boric Acid will eventually work its magic by treating the active thrush and BV infection. But for many women, the hardest part is starting this treatment, especially due to dealing with degraded and highly sensitive tissues. We are going to explain how to get through this initial stage. It is worth it and you will get there.
1) Use a barrier cream.
Unfortunately, it's often the women who need to use Boric Acid the most, who present with a really poor starting point. In our opinion, the most important step is to use a skin barrier cream on your vulva eg nappy rash cream with zinc, to protect the vulva tissues and in effect create a shield.
This helps a lot in preventing the BA from burning because as you know, when we have inflammation, even our own discharge, urine and period tend to burn. So it makes sense to use a thick skin barrier against everything.
We highly recommend using Desitin's maximum strength 40% zinc (the purple one) as a brilliant skin barrier. I can personally vouch for this myself. It is soothing due to the oils & zinc plus creates a shield against moisture and fluids plus rubbing. It creates a shield which is what we need. https://www.serenityph.com/product-page/zinc-paste-40-maximum-strength
Wearing period undies can also help by drawing our discharge and the Boric Acid morning exit fluid away from our membranes. Period undies are also better than disposable products as they are less likely to cause thrush or irritation and feel fresher. IMO they also cause much less odour when worn for periods.
Another tip is to insert the Boric acid suppository as high as possible into the vagina. When it's placed (comfortably) high it tends to be less irritating. Many users report that an applicator is ideal for this purpose.
(2) Use a lubricant to insert
Boric acid is great but if you are experiencing vaginal dryness or atrophy e.g. due to menopause, chemo, LS or even inflammation from the actual thrush and BV itself, it can be helpful to use a vaginal balm or a pH-balanced intimate lube to help with inserting the capsule. You might want to try our Vbalm by Dr Nat B
Boric Acid needs a moist environment to fully dissolve, disperse, do its thing and then exit! Never insert a Boric Acid suppository if you feel any type of resistance. If we are too dry the BA powder and capsule can get stuck and cause irritation. Finding the capsule still there the next morning can also be stressful. This won’t hurt you but indicates that you need more moisture.
We recommend applying an emollient daily to help with dryness. eg V Balm by Dr Nat B, a Carson Vitamin E Suppository, coconut oil or anything designed to restore and help the skin barrier.
If you are experiencing atrophy and persistent dryness due to a hormonal imbalance or Menopause you will benefit from using a prescribed Estrogen cream and most likely HRT. Ask your doctor if this is appropriate for your situation. If your dr isn't up to date with the latest evidence-based studies on dealing with a hormone deficit it's worth finding a better one. Vaginal atrophy, dryness, UTI's and urgency are all commonly seen with estrogen deprivation and can be treated and reversed in most cases.
Estrogen cream helps with dryness and also helps to thicken our vaginal walls. It can help with lots of other things too eg pain, itching, urgency and micro tears in some cases also reduces thrush, BV and UTIs. If you can't tollerate the cream you can try using Estrogen pellets.
Some users report that inserting the Boric Acid capsule with an applicator helps to minimise pain when there is inflammation. (Our applicators are made in the UK and have very soft edges to minimise scratching). However, using just your clean hands is perfectly fine for most users.
(3) Don't use too many BA capsules in a row
This is one of the biggest mistakes we see with women using Boric Acid. It's so important not to use more Boric Acid than needed to resolve your issues due to it being potentially irritating and just wasteful.
No one should be using Boric Acid for 14 days unless they have a complex infection resistant to Azoles. E.g. Candida Glabrata etc. And even then we have to go slow. This is a journey, not a race. (Boric Acid is not a course like antibiotics).
We should always use the least amount necessary to get results. When we use too many BA suppositories they can irritate and this then sets us back physically and mentally. Sadly so many women swear off from using BA because their Dr advised them to use too many.
If you genuinely need a longer course of BA make sure that you take some time off while using them until you develop some tolerance. Start gently and don’t overuse it to the point where it starts hurting. We recommend using from 1 to 3 days maximum and during this time monitor your symptoms. Most users shouldn't need more than this. But if you do, take a day or two off to allow yourself to better tolerate the Boric Acid. Remember that when we have inflammation our goal is to desensitise and heal the surrounding tissues. This requires a gentle approach and recognising that doing too much can cause us to go backwards.
(4) Don't ignore the dermal issues involved
Be mindful that you are treating two separate conditions at the same time. The Boric Acid will help with the vaginal infection, but the vaginal walls and vulvar tissues also need a targeted approach. To help with inflammation you might benefit from applying some hydrocortisone cream sparingly on the outside tissues. It will help to reduce inflammation and swelling.
Topical OTC products can also be extremely effective. We recommend VBalm by Dr Natalie, Carlson Vit E suppositories . These topical treatments help to add moisture & elasticity to our vulva tissues and also help to protect and restore the skin barrier and aid in skin integrity. You might find other emollients that work for you e.g. olive oil or coconut oil...etc. Aloe Vera can also be very soothing.
Many find it helpful to reduce inflammation by soaking in a bath with a small amount of baking soda. Please take extra care to be gentle with drying or wiping etc. Just pat down gently never rub.
As mentioned at the start, our own urine can cause painful burning. It's worth having a plan of attack for this activity.
One lady online mentioned that her trick was to urinate into a funnel to direct the stream away from her skin. It's worth a try. Especially for anyone dealing with a genital herpes outbreak! Peeing in a bath of water can also help by diluting our urine and keeping it away from our membranes. For those without a bath, you can still make use of this method by using a portable sitz bath for peeing/ or soaking with a tiny bit of baking soda in warm water afterwards.
And although we can dream about having a fancy Japanese warm spraying and air-drying toilet, which I hear is lifesaving for those of us with vulva pain, you can get a similar effect with a portable on-the-go travel bidet. It's perfect when filled with warm water for instant relief after peeing.
You can also use a spray bottle with warm water to both use while urinating to help dilute the stream, and afterwards to help clean the urine. Some women report that not using toilet paper but instead using a new clean small towel to gently dab each time helps with skin integrity.
For women with Lichen sclerosis (LS) and thrush, treating the thrush is vital in order to manage this autoimmune progressive dermal condition. Thrush discharge tends to cause vulva LS to flair up and it can be hard to apply the steroids and or estrogen needed. However by using boric acid to treat the thrush, its much easier to look after the dermal side of things.
For women with hormonal imbalances, perimenopause or menopause, a lack of estrogen causes a vulva urinary syndrome that typically involves dryness, atrophy, urgency, BV and thrush infections, UTI's and more. In these cases the lack of estrogen must be addressed because it is causing these issues.
Estrogen cream and HRT are important for our vaginal and overall health. Having the correct hormones enable our body to function, it is protective to our joints and organs and anti-inflammatory. And needed for our brain, bones, heart health and more. Estrogen is protective and when applied vaginally it thickens the walls and adds elasticity.
There are many forms of Estrogen and its worth working with a Menopause specialist to find the right HRT treatment that works for you.
Self-care instructions from the MSCS
Sensations like an itch or burning are pain responses and can be caused by a pelvic floor dysfunction issue. Some women benefit from seeing a pelvic floor therapist which can help to relieve these nerve responses. I also highly recommend Honey Pot anti-itch cream and Gold Bond medicated anti-itch powder. These offer welcome relief even if short lived.
(5) Pain needs to be managed or it can become its own illness
Pain management is essential. You deserve to have your pain minimised as much as possible. Use whatever is in your power and appropriate to treat your pain, be it prescribed pain medications eg Gabapentin or nortriptyline, OTC ones, using a tens machine, sleeping pills to help you sleep, numbing cream, electric heat pack, ice pack, baths etc. Manage that pain because this is part of self-care.
Sometimes we need to think outside the square when treating thrush and for some women taking an antihistamine can help by reducing itch and inflammation. We believe that an antihistamine can work in cases where the body is experiencing an allergic response to the thrush. This can occur even in cases of the thrush being subclinical.
Finally, we have worked with many complex cases where the user couldn’t handle the BA initially due to pain but it’s our experience that when used in a way that respects the idea of prepping the area and going slow most users will develop a tolerance and see a benefit with using BA. We have yet to meet anyone who didn’t get results in treating their thrush or BV from using BA following these guidelines.
BA is an important part of most long-term complex cases of thrush and BV so it’s worth persevering. Plus there are no other treatments that exist that work as well and don’t have other major side effects.
However, if you have any other reactions Eg non-period bleeding then please stop and seek medical advice. This indicates internal inflammation and should be checked by your doctor. Period spotting is rarely a concern. Boric acid doesn't cause bleeding from healthy tissues and it can't trigger your period.
Our tips here are designed for women with vulva inflammation or pain due to thrush, BV or menopausal dryness where it is envisioned that the vulva will improve with appropriate treatment. If your issue involves Lichen Planus please show this fact sheet to your doctor and work out what applies to you and what doesn't. You don't want to flair up your condition and BA might not be the best treatment for you.
For women using compounded creams be sure to ask for a different base if you experience irritation. You can even ask to try samples of the available bases beforehand to be sure. There are lots of options so don't despair if one isn't right for you!
And lastly, we can't talk about vaginal & vulva health without giving some attention to our gut health and diet. Some women have reported great success with eliminating certain food and beverage groups. Coffee, tea and alcohol are known bladder irritants. Sugar is also implicated in flaring up inflammation. Our gut health including being constipated often directly affects what goes on with our vaginal health. One woman in our group reported a complete turn around with her vaginal pain after she tried a low oxylate diet. Another reported that her deep and continuous vaginal burning stopped within 2 weeks of ingesting Evening Primrose Oil capsules. Ask your dr if any of these might be appropriate for you before trying.
(6) What if the Boric Acid isn't working?
If the BA is not working for your thrush or BV as it should eg your symptoms bounce back straight away, please get tested for other things going on. E.g. STI's including Mycoplasma, Ureaplasma and co-infections etc.
Ureaplasma and Mycoplasma need to be tested by a PCR test as they can't grow in a culture. We have a fact sheet on the Plasmas https://www.serenityph.com/post/guide-to-dealing-with-ureaplasma There are 4 strains that all need to be requested. We can help you to navigate the hurdles involved in getting tested correctly.
Cytolytic Vaginosis presents as thrush but isn't. Boric Acid will not help if you are dealing with CV. This requires a different approach and we have a few fact sheets on dealing with CV.
Boric Acid is considered to be diagnostic so please never think it's just not working and ignore your symptoms. We know of too many women who were told that this was their new normal when in fact they were just not tested properly.
(7) Mental Health (last but definitely not least)
Our mental health is important in getting through this. Consider seeing a therapist if you need to. It's important to take care of yourself and to find ways to ground yourself. You aren’t alone and this isn't your fault. We highly recommend taking part in an online support group. Many can be found on Facebook and Reddit. Be kind to yourself, you deserve lots of TLC. It's not surprising that many of us might feel depressed and need to make ourselves as comfortable and happy as possible. This is also a time to have boundaries against people wanting you to do things that make your pain worse. Sometimes we have to learn how to say no.
As a sufferer of BV and thrush since the age of 14, with genital psoriasis, and now menopause, using BA is a necessary part of my own vaginal healthcare. It helped me to not see it as a medical treatment but as an act of self-love and care. So, if you want to follow my lead....make yourself comfy in bed, light a scented candle, play some music, favourite snacks or beverages on the side table and know that while you sleep these will be doing their magic!
Good luck and please reach out for more help and advice if needed.
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