Dermatitis

10-Undecenoic Acid (undecylenic acid) is a naturally occurring antifungal fatty acid from castor oil with documented in vitro activity against Candida albicans biofilm formation, directly relevant to vulvovaginal candidiasis (VVC). It inhibits fungal cell growth and biofilm formation in laboratory studies. It is used in antifungal topical preparations relevant to vaginal yeast infections.

A clinical study of B. coagulans SNZ 1969 combined with metronidazole in 120 women with bacterial vaginosis showed an 86.6% success rate in treating and minimizing recurrence. B. coagulans LMG S-24828 has been shown to impair Candida virulence and protect vaginal epithelial cells against infection in vitro. Clinical evidence for bacterial vaginosis treatment is documented.

Ointments containing barberry and metronidazole have been used clinically for vaginal infections (bacterial vaginosis), with evidence that this combination reduces recurrence. Berberine has been proposed as a topical antiseptic for vaginal infections, with preliminary clinical support.

Bifidobacterium bifidum W28 was a component of a multi-strain vaginal capsule that restored Lactobacillus-dominated vaginal microbiota and significantly reduced BV incidence in a clinical study. B. bifidum is listed among well-studied probiotic species for BV and vaginitis treatment, and it has antimicrobial properties against urogenital pathogens.

Bifidobacterium longum is listed among well-studied commercially available probiotics for BV and vaginitis treatment, and oral probiotic formulations including B. longum alongside vaginal lactobacilli have demonstrated vaginal microbiome restoration in clinical studies. It modulates mucosal immunity and has antimicrobial properties relevant to vaginal health.

Black cohosh has been studied for effects on vaginal mucosa in postmenopausal women. A clinical trial found beneficial changes including increased superficial cells and improvement in vaginal atrophy-related symptoms. However, the HALT Study RCT found no effect on vaginal epithelium or reproductive hormones.

Intravaginal boric acid restores acidic vaginal pH, disrupts pathogenic biofilms, and supports Lactobacillus-dominant flora. Clinical evidence shows efficacy in recurrent vulvovaginal candidiasis and adjunctive benefit in BV, with a large RCT ongoing. The mechanism includes antimicrobial, anti-biofilm, and pH-acidifying properties independent of systemic boron supplementation.

Calendula is recognised in the ESCOP monograph for clinical use in vaginal candidiasis. A clinical trial in women with vaginitis and a randomised study in bacterial vaginosis have been conducted. Its antifungal, antibacterial, and mucosal-healing properties support its use for vaginal flora balance.

Intravaginal DHEA (prasterone) is FDA-approved for dyspareunia due to menopause and has been demonstrated in multiple RCTs to improve vaginal dryness, pH, epithelial cell maturation, and overall vaginal health markers. It acts locally via intracrine conversion to estradiol and androgens in vaginal tissue without significantly raising systemic hormone levels.

Fructooligosaccharides (FOS) are prebiotics that selectively stimulate the growth of beneficial bacteria including Lactobacillus species in the vaginal environment. Prebiotics including FOS are included in validated vaginal health formulations and systematic reviews recognize their ability to restore and maintain vaginal acidic pH and ecosystem. FOS-containing products are used commercially in vaginal washes, suppositories, and oral supplements for feminine health.

Clinical studies show that vaginally applied HA reduces elevated vaginal pH and improves vaginal maturation index, supporting a more favorable mucosal environment for Lactobacillus-dominated flora. These effects have been demonstrated in postmenopausal women, postpartum women, and endometrial cancer survivors. HA's water-binding properties restore epithelial health, indirectly supporting normal vaginal ecology.

Inulin is a well-established prebiotic fiber that selectively promotes the growth of beneficial Lactobacillus and Bifidobacterium species relevant to vaginal health. It is used in vaginal probiotic formulations to enhance Lactobacillus colonization and support an acidic vaginal environment. Prebiotic oligosaccharides including inulin are recognized in BV literature for their ability to restore vaginal microbiota.

Lactic acid produced by vaginal lactobacilli is the primary mechanism maintaining vaginal pH below 4.5, creating an antimicrobial environment. Clinical trials with topical lactic acid gels have demonstrated significant reductions in vaginal pH and Nugent scores in women with bacterial vaginosis. OTC vaginal gels containing lactic acid are used clinically to treat and prevent BV recurrence.

Lactobacillus acidophilus strains (W70, KS400, DDS-1) are among the clinically validated probiotics for bacterial vaginosis treatment and vaginal flora restoration. Multiple RCTs demonstrate acidophilus-containing vaginal capsules restore Lactobacillus-dominated microbiota and reduce BV recurrence. Its mechanisms include lactic acid and hydrogen peroxide production, pathogen adhesion inhibition, and immune modulation.

Lactobacillus brevis (strains W63, CV8LAC) is a native vaginal Lactobacillus species with documented antimicrobial effects against vaginal pathogens. L. brevis W63 was included in a multi-strain vaginal capsule formulation that restored Lactobacillus-dominated microbiota and significantly reduced BV incidence in a clinical study. Strain CV8LAC has been specifically studied for its inhibitory effects on vaginal pathogens.

Lactobacillus species including L. bulgaricus have been studied for vaginal health via lactic acid production and pathogen inhibition. The WGO and PMC-indexed reviews confirm that lactobacilli (with GRAS status) are widely used as alternatives to antimicrobial treatment for vaginal infections and flora restoration. L. bulgaricus specifically has been noted for antiviral, antioxidant, anti-biofilm, and immunomodulatory effects relevant to vaginal health.

L. casei Shirota has demonstrated in vitro inhibitory activity against Candida species causing vulvovaginal candidiasis, including antifungal-resistant isolates. It has also been studied in the context of antibiotic-therapy-induced vaginal dysbacteriosis alongside H. pylori treatment. The genus Lactobacillus is the dominant healthy vaginal flora, and strains like L. casei can acidify the vaginal environment.

Lactobacillus crispatus is the dominant species in the most protective and stable vaginal microbiome community state type (CST I), producing lactic acid and hydrogen peroxide to maintain vaginal pH below 4.5. Clinical strain CTV-05 has been evaluated in randomized trials demonstrating effective vaginal colonization and prevention/treatment of recurrent bacterial vaginosis. A systematic review confirmed strains DSM and LMG S-29995 reduce BV symptoms and prevent recurrence.

Lactobacillus delbrueckii is listed among the native vaginal Lactobacillus species found in healthy women and is included among well-studied, commercially available probiotics for BV and vaginitis treatment. It is part of the broader lactic acid bacteria group whose acidifying and antimicrobial activities maintain vaginal health.

Lactobacillus fermentum (strain LF15) has clinical evidence for vaginal health; a vaginal tablet combining L. fermentum LF15 with L. plantarum LP01 restored vaginal pH acidity and reduced Nugent scores in BV patients. L. fermentum is a native vaginal isolate from healthy women and is included among lactobacilli with antimicrobial properties against urogenital infections. It is found in the healthy vaginal microbiome alongside other key lactobacilli.

Lactobacillus gasseri (CST II) is one of four Lactobacillus species that naturally dominate the healthy vaginal microbiome and is associated with microbiota stability and protection from BV, VVC, and STIs. Clinical studies confirm oral L. gasseri CECT 30648 colonizes the vagina after oral administration. Combinations including L. gasseri strains (DSM 14869, CECT 30648) with other lactobacilli have been tested in BV RCTs.

Lactobacillus helveticus is a native vaginal isolate found in healthy women and has been shown in vitro to reduce viability of G. vaginalis and Prevotella bivia (BV-associated bacteria) and to interfere with pathogen adhesion to the urovaginal surface. It was a component of a multi-strain vaginal capsule (W74 strain) that restored Lactobacillus-dominated vaginal microbiota in a clinical study. L. helveticus was the dominant species observed during lactoferrin treatment in a BV RCT.

Lactobacillus jensenii is one of four species defining the healthy vaginal microbiome (CST V), associated with pH modulation and protection against BV and STIs. Combinations of L. jensenii with other vaginal lactobacilli have been tested in clinical formulations for BV treatment. In vitro, L. jensenii growth is specifically promoted by cranberry oil at concentrations as low as 0.1%.

Lactobacillus paracasei is a native vaginal isolate identified in healthy women's vaginal microbiome and is listed among lactobacilli with probiotic potential for vaginal health. It has been isolated from healthy vaginal swabs and screened as a probiotic candidate with antimicrobial properties against vaginal pathogens. Evidence is primarily from in vitro and microbiome profiling studies.

Lactobacillus pentosus KCA1 was studied in a clinical investigation showing it decreased vaginal and gut microbiota associated with bacterial vaginosis and down-regulated the pro-inflammatory cytokine IL-1β in women of childbearing age. The strain modulated bacterial genes related to metabolic functions and reduced BV-associated dysbiosis.

Lactobacillus plantarum strains (57B, MG989, PBS067, LP01) have clinical evidence for vaginal flora restoration and BV treatment, including a vaginal tablet formulation (LF15+LP01) that restored acidic vaginal pH and reduced Nugent scores. L. plantarum enhances vaginal epithelial barrier integrity and modulates immune responses via anti-inflammatory cytokines. It is among the six most efficacious probiotic species across BV trials per systematic review.

Lactobacillus reuteri RC-14 is among the best-documented oral probiotic strains for vaginal flora restoration, particularly in combination with L. rhamnosus GR-1. Multiple randomized controlled trials show oral RC-14 increases vaginal Lactobacillus colonization and reduces BV-associated pathogens. Species-specific PCR confirms oral administration results in vaginal colonization.

Lactobacillus rhamnosus strains GR-1 and BMX 54 are among the most extensively studied oral and vaginal probiotics for bacterial vaginosis treatment and prevention. Oral GR-1 (combined with L. reuteri RC-14) restores vaginal Lactobacillus dominance and reduces BV-associated bacteria via lactic acid and bacteriocin production. A systematic review of multiple RCTs confirmed efficacy of GR-1 for restoring vaginal pH and flora.

Lactobacillus salivarius is a native vaginal isolate (found in ~20% of healthy vaginal isolates) and has been used as a component of vaginal probiotic capsules that restored Lactobacillus-dominated microbiota and reduced BV incidence in clinical studies. It is listed among lactobacilli with antimicrobial properties against urogenital pathogens.

Lactoferrin (LF) is a multifunctional iron-binding glycoprotein with documented antimicrobial, anti-inflammatory, and prebiotic activity in the female reproductive tract. An open prospective randomized trial demonstrated that intravaginal lactoferrin treatment for BV increased Lactobacillus colonization, with L. helveticus emerging as the dominant species. Lactoferrin inhibits BV-associated pathogens including G. vaginalis and Candida species.

Intravaginal GML has been tested in a randomized placebo-controlled pilot study (n=36 women) for bacterial vaginosis treatment; the 5% gel increased Lactobacillus counts compared to placebo, though it did not achieve statistically superior clinical cure rates. Animal studies and macaque SIV models also inform the vaginal GML evidence base.

Sea buckthorn oil (rich in omega-7 palmitoleic acid) was tested in a randomized, double-blind, placebo-controlled trial (Larmo et al., Maturitas 2014, n=116 postmenopausal women) and found to improve vaginal epithelial integrity and show a beneficial trend on the vaginal health index. The study also found omega-7 improved vaginal epithelium integrity by 50% and vaginal hydration/elasticity by 33% in a subset analysis.

Berberine from P. amurense inhibits Candida albicans adhesion to vaginal epithelial cells and modulates inflammatory cytokines relevant to vulvovaginal candidiasis. TCM uses P. amurense for 'leukorrhea with vaginal itching'—directly relevant to vaginal pH dysregulation and infection. Anti-Candida and anti-inflammatory effects support vaginal flora balance.

Progesterone influences vaginal epithelium and pH, and vaginal progesterone preparations may transiently alter the vaginal microbiome. Some studies suggest prolonged vaginal progesterone use can reduce Lactobacillus species abundance, while systemic hormonal effects may help maintain vaginal trophism indirectly.

Clinical trials show that red clover isoflavones improve vaginal cytology indices in postmenopausal women, reflecting a local estrogenic effect on vaginal epithelium. A randomized crossover RCT (n=60) showed significantly improved karyopyknotic, cornification, and basal cell maturation indices. A ScienceDirect monograph confirms positive effects on vaginal cytology as a documented trial outcome.

Clinical trials and a systematic review of RCTs indicate that soy isoflavones improve vaginal dryness in menopausal women, with a 2025 meta-analysis (13 RCTs, n=1325) finding significant improvement in vaginal dryness (SMD=−1.88, p=0.006) and urogenital symptoms. Effects on vaginal tissue histology and epithelial maturation are documented though inconsistent.

Clinical trials show soy isoflavones modestly improve vaginal dryness symptoms in postmenopausal women via estrogenic effects on vaginal epithelium. A systematic review found a significant reduction in vaginal dryness, though improvements in the vaginal maturation index were statistically non-significant.

A decoction of annatto leaves is traditionally used as a vaginal antiseptic douche in Peruvian and Latin American herbal medicine. The use is documented in multiple ethnobotanical sources and attributed to the antimicrobial properties of annatto extracts. Human clinical trial evidence is absent.

ACV sitz baths and topical rinses are a traditional remedy for vaginal pH imbalance and yeast-related discomfort, based on ACV's acidic pH and in vitro antifungal activity. No human RCTs have validated topical or internal ACV for vaginal pH maintenance or bacterial vaginosis. Gynecological sources note potential for irritation with misuse.

Bayberry has a documented traditional use as a douche for vaginal discharge (leukorrhea), mentioned in multiple pharmacological references and folk herbal texts. The astringent tannins are proposed to reduce excess discharge and tone vaginal mucosa. No clinical evidence exists.

Caprylic acid's antifungal properties against Candida albicans—the primary cause of vulvovaginal candidiasis—have been established in vitro. Traditional and integrative practitioners use it for vaginal yeast management. Controlled human clinical trials assessing intravaginal caprylic acid are not published; the relationship is grounded in its documented antifungal mechanism and traditional use.

Cranberry has been used traditionally to support urogenital health, and in vitro evidence shows cranberry PACs inhibit adhesion of uropathogens to urogenital epithelium. Preliminary in vitro evidence also indicates cranberry oil may inhibit Candida albicans and Gardnerella vaginalis while supporting Lactobacillus growth. Dedicated human RCTs on vaginal pH or flora modulation by oral cranberry supplementation are lacking.

Goldenseal is traditionally used as a vaginal douche for infections and flora imbalance, recorded in historical herbal practice. A clinical trial device (Cerviron ovules) containing goldenseal has been evaluated for vaginitis. Traditional use is well documented, though evidence from human trials is very limited.

In TCM, Lablab Semen Album is a recognized treatment for excessive leucorrhoea (abnormal vaginal discharge), documented in classical and contemporary Chinese pharmacopeias. This is a consistent and well-codified traditional use, though no clinical trials on vaginal flora or pH have been conducted.

Evidence for TTO in vaginal health is limited to a single published case report of successful self-treatment of bacterial vaginosis with TTO pessaries, and an animal model (rat) supporting use for vaginal candidiasis. No controlled human clinical trials have been published.

P. umbellatus is recorded in both the Chinese Pharmacopoeia and classical TCM texts for the treatment of vaginal discharge. This use is framed as clearing 'damp-heat' from the lower jiao. No modern clinical trials specifically addressing vaginal pH or microbiome have been conducted.

Solomon's seal is used in Western and Ayurvedic herbal traditions to address vaginal dryness, leukorrhea, and general vaginal mucosal health. Herbal Reality (2026) documents its demulcent action on vaginal mucosa. The herb's moistening and antimicrobial properties underpin this use.

Squawvine has a documented traditional use for leukorrhea (pathological vaginal discharge) in both Eclectic medicine and naturopathic herbalism, attributed to its astringent tannin content acting on vaginal mucosa. RxList also records use for vaginal discharges. No clinical evidence exists.