#1. Why don’t My Vagina practitioners recommend boric acid for BV?
My Vagina practitioners don’t use boric acid in bacterial vaginosis (BV) (or any other) treatments because we consider it to be a management tool that can be used between treatments to manage symptoms, rather than it being a treatment by itself.
My Vagina’s clinical naturopaths don’t advise not to use boric acid specifically – use whatever works to manage symptoms – but we don’t use it with our treatments.
The point of My Vagina’s BV treatments is to selectively dislodge disruptive flora and support recolonisation with protective flora. Boric acid doesn’t really fit into this strategy, as it doesn’t kill disruptive flora very well compared to My Vagina treatments, and it doesn’t help recolonise with protective bacteria.
Most of the studies done on boric acid so far have been in combination with antibiotics, and the success rate is just as poor. Boric acid can work on easy-to-fix BV or a simple yeast infection, so it is worth a try if you’re not sure, but in our experience, it is not a reliable treatment for BV.
#2. Can I use boric acid with a vaginal probiotic bacteria at the same time?
Using boric acid with probiotics is not advised, as we’re still not clear on what boric acid kills and what it spares – and My Vagina has much more effective options.
To acidify the vagina, a small dose of vitamin C can be used instead of boric acid. Boric acid isn’t very acidic, despite the name, and vitamin C is better as an acidifier with a treatment. No damage will be done with the combination of probiotics and boric acid, so if you want to try it, absolutely feel free!
But, it’s better to use lactulose and a probiotic for a much greater impact. The lactulose and probiotics work together to strongly boost lactobacilli populations. The lactobacilli target disruptive bacteria and are much better biofilm busters than boric acid could ever hope to be.
#3. Many people are using boric and getting great results for BV on Amazon reviews. Why?
Boric acid can work very well for some people. But, if you look a little closer, you’ll see in the reviews that many people are using it off and on, or for long periods of time, to manage BV not to cure BV.
Boric acid can work quickly to reduce odours and discharge, but over time – i.e. the minimum of three months without treatments or symptoms that we use as a benchmark for a total cure – the results are simply not good enough.
Boric acid is the darling of the internet for all things bad vag, and for a good reason: it’s cheap, it’s easy to buy and use, and it’s generally inoffensive. Importantly, boric acid is bacteriostatic, which means it retards microbes’ ability to reproduce and may have some antimicrobial qualities. Bacteriostatic means it interrupts the life cycle of microbes, and eventually, they’ll have no more bacterial babies and the colony will die off. In theory.
The reason boric acid doesn’t work that well in most cases of recurrent BV (or yeast for that matter) is that the microbes embed themselves in their biofilms, like a sleeper cell. The minute the outer cells are sloughed off, and the old dead bugs with them, the dying bacteria send out an SOS.
The microbes send signals to each other in the biofilm sleeper cells to jumpstart the next colony. And out they come, completing the delightful cycle of life of a vaginal bacteria, colonising the fresh layer of cells while creating a new planktonic (free-floating) infection with symptoms once the antibiotic or boric acid wears off.
Certain bacteria also have the ability to immobilise the immunity of the cell so they can attach to it or invade it, and have tactics so that the cell doesn’t recognise an intruder.
If a vagina is affected by BV just once, with the milder strains of bacteria, and the treatment is applied fast enough, boric acid can work. Boric acid is a good management strategy for symptoms, but not a reliable or total cure in many. But, still worth a try – just not our favourite by any means.
#4. So, boric acid is more of a band-aid for BV, not a cure, and BV will usually will come back?
Boric acid is more like a first-aid attempt at a treatment. If it works, great. It can and does sometimes for some people. But here at My Vagina, we’re into much more advanced, effective treatments for recurrent, BV that last the distance.
#5. What about boric acid with a FOS prebiotic?
Great, and yes, prebiotics are a useful strategy and why we use the vaginal prebiotic, lactulose. The main issue with boric acid and prebiotics is that you also need the species you want to rebuild at the
#6. Can I use lactulose and lacto probiotics as a first-line treatment against BV?
Absolutely. The lactobacilli are excellent warriors, especially Lactobacillus crispatus. That microbe is a fantastic little murderer and coloniser.
Your protective vaginal flora are the best weapons against BV, because they are the OG biofilm busters and colonisers. They are strong and robust and have vaginal domination on their mind, which is just how we like it. You don’t want weak colonisers as probiotics, because you need them to really fight hard to take over.
Some lactobacilli are weak in certain key colonising and fighting areas (hydrogen peroxide producing, bacteriocins producing, biofilm building) or are weak all round, and they piggyback on the stronger strains.
L. crispatus is a very strong coloniser, even to the point where it can be responsible for cytolytic vaginosis (CV), which can cause very unpleasant symptoms too.
L. crispatus can overcolonise and start to cause damage, which is why in our lactulose treatment we use it week by week, to avoid this swing in the “right” wrong direction. It’s a complicated business!
#7. Why do you use lactulose as a vaginal prebiotic?
Lactulose is a prebiotic, but better than just any old prebiotic, there is evidence1 that lactulose selectively feeds lactobacilli and not pathogens. So you’re ONLY building up your lactobacilli counts, and not feeding anything else.
Then, the lactobacilli – especially our top three, being L. crispatus, L. gasseri and L. jensensii) – take over the environment and build a strong colony. This wipes out the pathogens and their infrastructure, being replaced with lactobacilli and colony.
Thus, you recolonise with lactobacillus, and they form a strong foothold and then pathogens can’t re-enter without some effort.
References
- 1.Collins SL, McMillan A, Seney S, et al. Promising Prebiotic Candidate Established by Evaluation of Lactitol, Lactulose, Raffinose, and Oligofructose for Maintenance of a Lactobacillus-Dominated Vaginal Microbiota. Elkins CA, ed. Appl Environ Microbiol. Published online March 2018. doi:10.1128/aem.02200-17
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