Povidone-iodine is an antiseptic liquid that has been used in wound care and hospitals for over 170 years. This formulation is now available as a Betadine vaginal douche and vaginal suppositories.
Betadine douches and suppositories are used to treat bacterial vaginosis (BV), aerobic vaginitis (AV) and yeast infections (vulvovaginal candidiasis, VVC).
The Betadine douche is the only povidone-iodine formulation available as a douche, but any diluted povidone-iodine liquid works just as well. You just need to ensure it’s a 10% dilution (which you can dilute yourself at home with water), and you’ll need a douching device.
The Betadine vaginal pessaries (suppositories) are also available and help reduce iodine absorption into the bloodstream via the slow-release formulation.
What is povidone-iodine?
Povidone-iodine is one of the most potent antiseptics available over the counter, with broad-spectrum antimicrobial action against bacteria, fungi, protozoa and viruses. This preparation is on the World Health Organisation’s list of essential medicines.1
Betadine is a well-known brand of antimicrobial formulations, and most people know povidone-iodine as Betadine; it’s been around for a long time.
Why don’t we just use pure iodine?
Water or alcohol solutions of iodine alone are toxic and cause skin discolouration, pain, irritation and inflammation. New carriers for the iodine (the effective ingredient) were therefore developed, with povidone-iodine as one such mixture.
The povidone-iodine solution reduces the side effects caused by elemental iodine by itself.
The antimicrobial effect of povidone-iodine
Povidone-iodine (Betadine) neutralises many major groups of bacteria, fungi and protozoa and can do so in the vagina as well as many other areas of the body (skin, mouth and wounds in particular).
The concentration of free iodine continuously released is above the level required to kill microorganisms but below the level that would cause skin irritation.
Betadine is commonly used vaginally and on the skin without irritating and is believed safe and effective as a topical and vaginal antiseptic.
Understanding the Betadine vaginal douche and suppository
Povidone-iodine vaginal douches and suppositories may be used to kill certain species of bacteria (gram-positive and gram-negative), some yeasts and fungi and thus may relieve symptoms of BV, AV and yeast infections.
Studies show that the Betadine douche and pessaries inhibit many disruptive vaginal bacteria and yeasts and have a positive effect on protective vaginal flora. Betadine is not a cure-all; results over the longer term have been mixed, and some bacteria are resistant.
Treating yeast infections with vaginal Betadine
The research2 found that a combination of povidone-iodine vaginally and oral drug antifungal fluconazole had superior and much longer-lasting impacts on recurrent vaginal yeast infections compared with vaginal povidone-iodine alone, or a combination of vaginal and oral drug antifungals.
Betadine vaginally in this study was found to be about as effective as other treatment methods but is not resistance-forming and therefore offers an alternative to drug treatments.
All the treatment groups had similar rates of clinical cure, but the group who used the Betadine vaginal swab and oral fluconazole had slightly superior results across all categories. This group had more complete clinical cures, more people saw improvements, and far fewer (just 3%) saw no improvement at all, versus 10% in the Betadine-only group and 12% in the drug antifungal group.
Importantly, when the groups were assessed for vaginal candida recurrence rates six months after their study treatment, the vaginal Betadine and oral fluconazole group had a recurrence rate of just 1.5%, whereas the Betadine-alone group had 8% recurrence rate, and the oral and vaginal drug antifungal group had 3% recurrence. This is a significant result, and shows that Betadine combined with an oral antifungal treatment has better long-term results than the other options.
Non-drug oral antifungal alternatives to combine with Betadine vaginal treatments
We recommend using non-drug oral antifungal options where possible, such as the Kolorex Oral Supplement or getting a personalised prescription from a My Vagina holistic naturopath.
Our practitioners have very effective anti-yeast strategies, with excellent success rates using 100% natural yeast treatments (no Betadine staining!).
Support recovery from vaginal yeast infections/thrush and restore a protective vaginal microbiome.
Oral herbal supplement for cyclic or recurrent vaginal yeast infections.
Lactobacilli return quickly after Betadine – if they can
Protective lactobacilli species are often the first to recover after the Betadine douche and pessaries/suppositories3. Lactobacilli recovery usually takes about two hours. After this two-hour mark, whatever microbes were present before the Betadine douche usually reappear.
What this looks like in real life will differ between you, there are a lot of variables, so you’ll need to figure out if a Betadine douche or pessary is only temporary symptom relief or is truly an effective treatment for your vaginal infection.
Results might depend heavily on what other treatments you’re using at the same time, including effective oral antifungal or antimicrobial options.
Betadine-soaked tampon vs douche
One of the issues with a rinse or douche is that the povidone-iodine liquid leaves the vagina quickly, possibly reducing its effectiveness as an otherwise sound treatment. Using a Betadine-soaked tampon for a short time each day, possibly several times per day, may have a more beneficial, long-lasting effect.
Warning about Betadine-soaked tampons!
Do not use Betadine tampons (or douches) for more than a few days at a time, as the iodine content can affect thyroid function. If you have thyroid dysfunction, do not use Betadine tampons. There are slow-release pessaries available that are more suitable.
Can Betadine cure my vaginal infection?
Povidone-iodine is not commonly thought of as a cure for aerobic vaginitis, bacterial vaginosis, yeast infections, or other vaginal infections, despite its long-term use for all kinds of infections.
Betadine may be a helpful (and cheap!) management strategy while you work on other elements of your health, or it could completely resolve uncomfortable symptoms.
Which bacteria are affected by Betadine?
You need to know what bacteria or fungi you are treating, so get a test. An at-home vaginal microbiome test can be very useful to avoid wasting time and money on ineffective treatments.
The comprehensive vaginal microbiome tests report on microbial DNA, so tell you exactly what is in your vagina down to 0.0001% – they don’t leave room for guessing games the way cultures and limited PCR tests do.
Povidone-iodine doesn’t work on all bacteria and is more effective against some versus others, so check your vaginal microbiome test result with what povidone-iodine is known to be effective against to see if it’s the best option for you.
Using Betadine to treat bacterial vaginosis
A study3 into Betadine’s vaginal suppositories impact on BV compared with lactobacilli found that Betadine had better efficacy than lactobacilli suppositories, with an increase in lactobacilli in the second week.
Note on Betadine’s largely useless research into their own suppositories
The comparison with a vaginal lactobacilli treatment alone is a very weak research premise since there is no established treatment for BV using lactobacilli probiotics alone.
Here at My Vagina’s specialist clinic, we have treated thousands upon thousands of people with BV and found vaginal probiotics alone to be largely ineffective without the addition of a prebiotic (we use lactulose) or other targeted treatments (like BV Rescue).
Racing a snail and a hare
Thus, comparing a Betadine suppository with a vaginal probiotic is like putting a snail and a hare in a running race and acting like they are equal. The hare can not be proud of its win, as it has an innate advantage.
Comparing Betadine suppositories to the accepted gold standard antibiotic therapy would have been a more useful study. Alas, capitalism and scientific advancements collide.
On the bright side, the study had some useful tidbits that support the fact that vaginal probiotics are fairly useless on their own! After week one, the lactobacilli group had increased vaginal lactobacilli counts, but this dropped in week two.
More disruptive bacteria (Gardnerella, Bacteroides, Enterobacteria) were eradicated with the Betadine treatment than the probiotic treatment, and this effect lasted longer.
How to douche using povidone-iodine
You can use multiple douches per day for several days while also using high-quality vaginal probiotics immediately afterwards.
You are responsible for your own iodine intake, and if you are sensitive, you should avoid this treatment. You may wish to try to find some povidone-iodine pessaries instead, which slow-release the iodine.
- Fill up a 50-100ml syringe, douche or turkey baster with your povidone-iodine solution – either the 7-10% Betadine douche (which comes with a douche apparatus) or a dilution you make yourself.
- To apply the douche vaginally, lie down on old towels or in a bath (the liquid is brown and stains!), tilt your hips upwards (feet on a wall to relax the pelvic floor and stabilise yourself) and try to hold the solution in your vagina for no more than 30 seconds, then relax and let it drain out.
- Or, sit on the toilet and insert the douche apparatus vaginally, squirt, and let it run into the toilet. This method suits many people very well, particularly if mobility or mess is a concern. You’ll need to figure out the best way for you, with your facilities and abilities. There is no better or worse way; just getting the treatment applied is the goal!
Using vaginal probiotics immediately after Betadine douche
After using povidone-iodine vaginally, you should immediately use vaginal probiotics to recolonise with protective vaginal bacteria, since lactobacilli are often the first to recover after a povidone-iodine douche.
You have an opportunity here to jump in there with probiotic vaginal bacteria, to put up a fight against the disruptive bacteria when they try to come back.
We love Life-Space Women’s Microflora Probiotic or the V-Spot Vaginal Probiotic for the follow-up vaginal probiotic. Add prebiotic lactulose to supercharge your probiotics. Prebiotics are food for the probiotic bacteria and help them thrive and fight off invaders.
For odour, discharge, BV, 'mystery bad vag' and to restore a protective vaginal microbiome with specialised vaginal prebiotic and probiotic.
Promote and support a protective vaginal microbiome with tailored probiotic species.
Specially formulated probiotic for vaginal application to promote a healthy vaginal microbiome.
Warnings for vaginal use of povidone-iodine
- Povidone-iodine is brown and stains! Keep away from nice underwear by rinsing your vulva (not vagina!) with water and using a panty liner after use.
- Do not eat betadine.
- Betadine douches are understood to be safe for use during pregnancy.
- Do not constantly douche vaginally without addressing the underlying cause of your infection or symptoms – you are upsetting the ecology of your vagina further while not getting long-lasting results. Book with a My Vagina practitioner or another healthcare provider if symptoms persist.
- Frequent douching is known to be an unhealthy practice – if you don’t have symptoms, don’t douche.
- Do not mix povidone-iodine with hydrogen peroxide, silver, taurolidine or proteins – it makes the Betadine ineffective.
- Beware those with thyroid conditions – don’t be alarmed, but do your homework. Betadine contains iodine, which may be problematic in some thyroid conditions. Iodine may be absorbed vaginally.
References4,5
- 1.Eggers M. Infectious Disease Management and Control with Povidone Iodine. Infect Dis Ther. Published online August 14, 2019:581-593. doi:10.1007/s40121-019-00260-x
- 2.Younis S, Mahmoud M, Elshorbagy A. Use of Povidone Iodine Vaginal Swabbing in Treatment of Recurrent Vulvovaginal Candidiasis. International Journal of Medical Arts. Published online October 1, 2023:3763-3768. doi:10.21608/ijma.2023.219025.1713
- 3.Wewalka G, Stary A, Bosse B, Duerr HE, Reimer K. Efficacy of Povidone-Iodine Vaginal Suppositories in the Treatment of Bacterial Vaginosis. Dermatology. Published online 2002:79-85. doi:10.1159/000057731
- 4.Martino JL. Vaginal Douching: Evidence for Risks or Benefits to Women’s Health. Epidemiologic Reviews. Published online December 1, 2002:109-124. doi:10.1093/epirev/mxf004
- 5.Donders GGG, Ruban K, Bellen G. Selecting Anti-Microbial Treatment of Aerobic Vaginitis. Curr Infect Dis Rep. Published online April 22, 2015. doi:10.1007/s11908-015-0477-6
A personalised, expert-guided program to effectrively treat vaginal and other issues in perimenopause.
Support recovery from vaginal yeast infections/thrush and restore a protective vaginal microbiome.
Replenish healthy lactobacilli species the easy way - feed them their favourite food, lactulose! Comes with capsules.
