OTC and Alternative Medicines for Vaginal Symptoms
Source: Nyirjesy P, et al. Obstet Gynecol 1997;90:50-53.
Temple university established a "vaginitis Referral Center" in 1991. All patients seen at that center must be referred by their health care provider. The current report reports the results of this study conducted during four months of 1994 and includes 105 patients.
During the study period, each evaluation included a patient-administered questionnaire that had been developed to determine the types of over-the-counter (OTC) and alternative medical remedies each patient had used during the previous calendar year.
A thorough history and physical examination followed completion of the questionnaire. The evaluation included microscopic examination of any vaginal discharge, appropriate cultures (always including fungal cultures), and a pelvic examination. At the end of the evaluation, each patient was assigned a diagnosis if one could be made.
Seventy-three percent of the patients had used over-the-counter medications during the previous year. As expected, the most common medications were antifungal preparations. Thirteen percent used iodine-containing preparations, and 9% used topical hydrocortisone. Nyirjesy and colleagues estimate that the average patient spent $50 during the year to purchase these medications; at least one patient spent an estimated $1000.
Nearly 42% of the patients used one or more alternative medications. Most commonly, these included oral and vaginal acidophilus and yogurt. Vaginal vinegar douches and boric acid were also commonly used. The average expense during the year for these medications was $35, and at least one patient spent $1200. More than 70% of the women had reported the use of these alternative medicines to their health care provider.
At the completion of the evaluation at the Vaginitis Referral Center, 28% of the patients were found to have vulvovaginal yeast infections, and 17% had vulvar vestibulitis. The source of the patient's problem was irritant dermatitis 15% of the time and bacterial vaginosis 11% of the time. Seven percent had a physiologic discharge, and 10% had no symptoms at the time of the examination. Nyirjesy et al conclude that the use of over-the-counter and alternative medications considerably adds to the cost of medical care, and these medications often involve therapies that have no chance of providing relief.
Comment by Kenneth l. Noller, MD
Anyone who has a referral practice for patients with chronic lower genital tract problems have all had a similar experience to that of Nyirjesy et al. Very often, the patients with the most protracted vulvovaginal symptoms have failed to obtain relief primarily because they have been treated or self-treated with inappropriate medications. Day after day, I see patients who have had "yeast infections" multiple times per year with some other disease. Most commonly, the patients have an infection with a resistant yeast, vulvar vestibulitis, or irritation to the multiple medications they have used. They are often frustrated, annoyed, and angry. In most cases, an accurate diagnosis results in rather quick resolution of the problem.
As pointed out by Nyirjesy et al, many of these patients turn to alternative remedies in an attempt to find relief. Although quite a large number of "home remedies" have been found to be medically effective in prospective randomized trials, very few studies have been performed on the usefulness of these medications for the treatment of vulvovaginal symptoms. Indeed, the most common therapies-acidophilus and yogurt-have virtually no basis to support their use. Indeed, many health care providers do not discourage patients from using these because they are relatively "cheap." But, as was shown in this article, even "natural" therapies can become quite expensive. I am reminded of a patient I saw less than one month ago who had recently seen a naturopath. He prescribed various herbs to treat her condition, which turned out to be lichen sclerosis, and only charged her $20 for the herbs. He also charged her $200 for his consultation. I wish Nyirjesy et al had questioned the patients about their use of alternative care providers and the charges they may have paid for such consultations.
Finally, we should not conclude that the availability of antimycotics as over-the-counter preparations is necessarily bad. Although Nyirjesy et al reported a series of patients for whom these medications were inappropriate, they cannot comment on the many patients (perhaps thousands) from their community who had a yeast infection and were appropriately treated and cured by one of the over-the-counter medications. Perhaps physicians who see patients with brain tumors are distressed that so many of these individuals took aspirin for their headaches for some period of time before the proper diagnosis was made. Every coin has two sides.
Dr. Noller is Professor and Chairman, Department of OB/GYN, University of Massachusetts Medical Center, Worcester.