Vaginal Pinworms: Symptoms & Treatment

Parasitic pinworms and threadworms normally try to make themselves at home in the digestive tract; however, sometimes these worms can wriggle their way into the vagina, becoming vaginal pinworms. Pinworms can also live in the urinary tract¹.

These worms don’t like living in the vagina or urinary tract much, as it’s not their natural habitat. They aren’t seeking out the vagina specifically; vaginal pinworms end up there by mistake because they are hungry, blind and clumsy.

Names of worms and how they differ globally

Pinworms may also be called worms, threadworms, roundworms or seatworms.

In the USA, pinworms are the species Enterobius vermicularis, while in the rest of the world, pinworms are the species Strongylyoides stercoralis.

In the USA, S. sterocralis is known as threadworm. In the UK and Australia, threadworm can also refer to Enterobius species and S. sterocralis both. For simplicity’s sake, here we’ll use the terms pinworm and threadworm interchangeably.

The name matters only a little, if you are trying to treat a specific species. Most species of pinworm and threadworm are susceptible to the same treatments.

Understanding pinworms/threadworms in the intestine

Pinworms are contagious, with their eggs passed from surface to surface – sheets, towels, toilets, underwear, food, cups, plates, etc. We inadvertently eat the eggs, and then they hatch once inside our small intestine.

Once hatched, the larvae enter the large intestine, where they attach to the walls of the intestine. After a month or two, the females head to the rectum to lay their eggs in a jelly-like substance – this substance is likely the cause of the itching that ensues.

When we scratch the itch, the tiny little eggs get onto fingers or clothing, where they then go on their adventure to a new destination.

Pinworm eggs can survive 2-3 weeks on a surface but do not come from animals. You can usually see pinworms if you or your child are infected because they are about as big as a staple and white. They tend to appear in the toilet or underwear.

However, adult pinworms can dissolve, so you may not actually see any worms coming out, dead or alive.

Helminths – these types of parasitic worms, also known as nematodes – feed on the blood of the host, and can be a cause of iron-deficiency anaemia.

Understanding vaginal and urinary tract pinworms

Pinworms or threadworms can also colonise the mucous membranes of the vagina and urinary tract. These worms are much harder to get to and kill, since most worming treatments are designed to work in the digestive tract, not the vagina.

In fact, most antiparasitic drugs are not well absorbed into the bloodstream, so can’t get to the mucous membranes of the vagina or urinary tract. This poses a huge problem when trying to treat vaginal or urethral worms.

A combination of gut treatments, systemic treatments, and vaginal treatments might be the best approach.

Symptoms of digestive tract pinworm infection

Itchy anus, particularly at night
Restless sleep
Digestive tract symptoms, though the itch typically comes first

Symptoms of vaginal and urinary tract pinworm infection

Feeling of wriggling worms, especially at night
Stinging sensation when eggs are laid
Vaginal discharge
Vaginal and vulvar itching, especially at night
Urethral itching or soreness
Urinary tract infection
Inflammation of vulvar and vaginal area – vaginitis
Worms may migrate to ovaries, fallopian tubes, and uterus causing inflammation and pain
Scratching can cause cuts or broken skin, leading to secondary infection

Treating gut pinworm infections²

Treating pinworms in the digestive tract tends to be pretty straightforward with worming medicine, taken once and then two weeks later, repeated. Other people you live closely with may need to be treated too.

Itching may take some time to resolve after treatment, which can be helped with a cream. Ask your doctor.

Lifestyle modifications

Wash hands frequently, including carefully after the toilet
Clean under fingernails with a nail brush
Avoid biting your nails
Shower regularly
Don’t share bathwater
Wash pyjamas/sleepwear often and in hot water
Wash underwear in hot water
Wash all bedding in hot water
Keep surfaces clean in living areas

Treating vaginal pinworms

Vaginal treatment tends to be the same as digestive tract treatment, but you will need medicines that are absorbed into the bloodstream. Not all worming medications are well-absorbed, so speak to your healthcare practitioner for specifics.

Since the pinworms are primarily found in the digestive tract, taking medicine that has direct contact with the worms works very well there. This isn’t always so in the vagina; follow-up checks should be arranged to check for eggs and worms microscopically after treatment.

If your doctor won’t take you seriously, find one who will.

Typical medical treatments for intestinal worms are mebendazole, albendazole, or pyrantel pamoate. Mebendazole is poorly absorbed into the bloodstream, so it should be avoided in vaginal worm infections; however, albendazole is reported to have successfully eradicated vaginal pinworm infestations.

Mebendazole and albendazole block the worms’ ability to absorb glucose, which starves them of their energy source within days.

Piperazine or pyrantel pamoate paralyses the worms, so they are passed through the intestine in faeces, so a combination of treatments, especially in heavy infestations, may be used.

These medicines do not kill the eggs, just larvae and adult worms, which is why repeat treatment is required. Hygiene will need to be modified for a short time to get rid of the eggs on surfaces and from under fingernails.

Treating vaginal pinworms with natural medicine and home remedies

Any treatment needs to treat worms in the digestive tract as well as the vagina with vaginal pinworms, which can present some tricky treatment pickles.

Being thorough is important since any leftovers will set the system up to repeat itself until all the worms die. This can be extremely tiring because killing the worms is only half the puzzle – cleaning all your bedding and clothing and being diligent about not passing the eggs around is very time-consuming.

Individual treatments will vary, but herbal medicine can effectively eradicate parasitic worms in the digestive tract. You may need to get a special treatment designed for the vagina; however, it will depend on the type of herbal medicine chosen.

It is a bit of a gamble using home remedies for your pinworms, not because they don’t work, but because you need to make sure you are getting the right dose of an effective treatment.

There are plenty of home remedies pinworms won’t like, but whether it is enough to kill them and prevent re-infestation is the real question.

Using garlic orally and vaginally to kill vaginal pinworms

A common remedy to treat pinworms is raw garlic. Garlic is not going to be appropriate for everyone, but can be effective.

Vaginal application – cut slices into the side of a peeled, washed clove of garlic, and tie a thread around it, and insert deep vaginally. Remove after 2-4 hours or when you wake up. Repeat three times daily for five days or when you have symptoms.
Eat raw garlic before meals, not after – contact and surface area of intestines matter.
Garlic can cause digestive upset if taken orally, especially in anyone who is FODMAP-sensitive
How to use garlic vaginally.

Using clove oil vaginal suppository to kill pinworms and eggs

Clove is a very useful herbal treatment for worms, supporting destruction of both eggs and worms. Clove pessaries or suppositories can be made from clove essential oil and a solid carrier oil such as coconut oil or cocoa butter. Never use undiluted essential oils on skin or mucous membranes.

Use a 1-2% formula of essential oil with the rest your melted oil. Don’t overheat. Use a pessary/suppository mould to refrigerate pessaries (don’t freeze, they’ll crack).

Other vaginal treatments for vaginal pinworms

Vaginal irrigation with Albendazole suspension

Use Valbazen (Albendazole) Oral Suspension for Cattle & Sheep. This treatment contains 11.36% or 113.6mg/mL of Albendazole. Measure exactly 3.5ml, which is the same dose as a 400mg tablet.

Mix 1 tablespoon of Valbazen with 2 tablespoons of warm water and syringe into the vagina, allowing liquid to drain right out. Do not hold it in. Repeat for three consecutive days.

Hydrogen peroxide vaginal flush

Fill and then flush the vagina with 6% hydrogen peroxide three times daily, holding in for one minute, for five consecutive days.
Use a 2-3oz/60-100mL syringe of 6% hydrogen peroxide (found at pharmacies or supermarkets, or buy higher dilutions like 9, 123 or 35% food grade, and dilute – dilution instructions here, do not use greater than 6% H²O² vaginally).
Sterilise the syringe in boiling water for 10 minutes before use or use sterile single-use syringes.
Lay on the floor or in a bath with hips high in the air and insert syringe gently into the vagina.
Syringe hydrogen peroxide into the vagina, repeating twice so the vagina is full.
Wait one minute, then in a bath or shower, stand up and let the liquid drain out (remember to rinse shower or bath).
Immediately rinse vulva in shower with fresh water to clear away any expelled eggs or worms.
Repeat three three times daily for five consecutive days.
How to douche with hydrogen peroxide

Flushing urethral worms with ivermectin suspension

Mix 1 tablespoon of liquid oral Ivermectin with three tablespoons of clean water and inject into the urethra a couple of times a week with hips held up. Urinate immediately after to flush out worms.

Ivermectin cream

People have been using Ivermectin cream topically for pinworms in the vagina. The cream can kill pinworms on contact.

Use one notch of cream mixed with diaper/nappy rash cream with 40% zinc spread on affected areas.

Herbal medicine for pinworms (anthelmintic)

Anthelmintics destroy or expel worms from the digestive system. Many can be quite toxic in high doses and may no longer accessible to medical herbalism.

Anthelmintics may also be called vermifuge or anti-parasitic, but the term anthelmintic is specific to worms, while antiparasitic may apply to other types of parasites.

Name	Biological sources	Mechanism of action	Chemical constituents
Myrrh	Commiphora myrrha or Commiphora molmol, Family-Burseraceae	Reduces activities of Alanine transminase (ALT) and Aspartate transminase (AST)	Limonene, Eugenol, a-Pinene, Cadinene, Acetic acid, Formic acid etc.
Tulsi, Holy basil	Ocimum sanctum Linn. Family-Lamiaceae	Causing paralysis of infected parasitic worms or death.	Carvacrol, Caryophyllene, Eugenol, Linalool, Urosolic acid, etc.
Chinaberry tree	Melia azedarach, Family- Meliaceae	Reacting with free proteins reduces the nutrients availability, thus larval death occurs due to starvation, or React with glycoproteins in the larval cuticle, causing death.	Spathulenol, Quercetin, Astragalin, 1,7,8-Trihydroxy-2-naphtaldehyde etc.
Papaya	Carica papaya, Family-Caricaceae	Killing the parasite worms by eosinophils, attack on structural protein of parasite nematodes.	Papain, Cystatin, Chymopapain, Ascorbic acid, Tocopherol.
Black caraway, Black seed, Nigella	Nigella sativa, Family-Ranunculaceae	Inhibiting the antioxidant enzymes thus produces a defense mechanism towards the oxidants generated by the parasitic nematode.	Linoleic acid, Oleic acid, Palmitic acid, p-cymene, Carvacrol, Thymol, α-Pinene.
Sohphlang	Flemingia vestita, Family-Leguminosae	Causing paralysis of infected parasitic worms or death.	Formononetin, Genistein, Daidzein, Pseudobaptigenin.
Walnut	Juglans regia, Family-Juglandaceae	It binds with the free protein of GIT of the host or interferes in energy generation of helminths, causing death of parasites.	Stearic acid, Palmitic acid, alpha Linolenic acid, Oleic acid, Catechin, Tannins.
Mimusops	Mimusops elengi, Family-Sapotaceae	Denaturation of proteins, produce defense mechanism, damages reactive oxygen species (ROS) properties.	Ursolic acid, Spinasterol, Taraxerol etc.
Pomegranate	Punica granatum Family-Punicaceae.	Inhibit transformation of larvae from egg, produce inflammation of epithelial cells by peroxisome proliferator-activated receptors-γ and δ-dependent mechanisms	Ellagic acid, Cyanidin-3-glucose, Pelargonidin-3-glucose etc.
Embelia	Embelia ribes, Family-Primulaceae	Paralysis of worms and reduces fecal eggs per gram (EPG).	Vanillic acid, Christembine, Cinnamic acid, O-cumaric acid, Embelin
Epazote, Jesuit’s tea, Mexican-tea, Payqu, Epazote, Mastruz, Herba sanctæ Mariæ	Chenopodium ambrosioides, Family-Amaranthaceae.	Paralysis of the parasitic worms.	Limonene, α-Terpinene p-Cymene, Camphor Thymol.
Piliostigma	Piliostigma thonningii, Family-Fabaceae.	It stimulates the neuromuscular junction of the parasite mostly and sometimes its effects to the ganglion and cause larval paralysis.	Alepterolic acid, Anticopalic acid, Clovane-2β,9α-diol etc.
Asparagus, Shatavari	Asparagus officinalis, Asparagus racemosus, Family-Asparagaceae.	Causing paralysis of infected parasitic worms or death.	Racemosol, Asparagamine, Folic acid.
White clover	Trifolium repens, Family-Fabaceae.	Paralysis of worms and reduces EPG.	Rutin, Quercetin, Myricetin Kaempferol.
Fig	Ficus insipida, Family-Moraceae.	Causing paralysis of infected parasitic worms or death.	Vomifoliol, Dihydrophaseic acid, Dehydrovomifoliol etc.
Squash	Cucurbita maxima, Family-Cucurbitaceae.	Inhibit transformation of larvae from egg, reduces EPG.	Palmitic acid, Oleic acid, Linoleic acid, β-sitosterol.
Ajwain, Ajowan caraway, Omam, Thymol seeds, Bishop’s weed, Carom	Trachyspermum ammi, Family-Apiaceae or Umbelliferae.	Causing paralysis of infected parasitic worms or death.	Thymol, α-Pinene, α-Terpinene, β-Pinene, γ-terpinene, p-cymene.
Cinnamon	Cinnamomum zylanicum, Family – Lauraceae.	Inhibition of the parasitic egg hatching inhibits the fourth stage of larvae motility.	Eugenol, Cinnamic acid Cymene, Cinnamate.
Nutmeg	Myristica fragrans, Family -Myristicaceae.	Causing paralysis by inhibiting acetyl cholinesterase.	Myristicin, Eugenol, Safrole, Terpinene, Myristic acid.
Elecampane, Horse-heal, Elfdock	Inula helenium, Family-Asteraceae.	Inhibitory effects on process of embryo development, paralysis by inhibiting acetylcholinesterase.	Alantolactone, Inulin, Helenin Stearoptene.
Clausena anisata	Clausena anisata, Family-Rutaceae.	Causing paralysis by inhibiting acetylcholinesterase.	Coumarins, Linalool, Myrcene, Anethole, Lomonene etc.
Zanthoxylum, Senegal prickly-ash, Artar root	Zanthoxylum zanthoxyloides, Family-Rutaceae.	Inhibition of the parasitic egg hatching prevents larvae from migrating.	Lomonine, Citronellal, Myrcene, α-pinene.
Annona	Annona squamosa, Family-Annonaceae.	Inhibition of the parasitic egg hatching inhibits cell division.	Anonain, OxophoebineIsocorydine, Reticulin.
False daisy	Eclipta prostrata, Family-Asteraceae.	Causing paralysis of infected parasitic worms or death.	Quercetin, β-Sitosterol, Luteoloside, Apigenin, Luteolin.
Turkey berry	Solanum torvum, Family-Solanaceae.	Causing paralysis of infected parasitic worms, or reduces EPG.	Quercetin, Isoquarecetin Kaempferol, Rutin etc.
Myrobalan	Terminalia chebula, Family -Combretaceae.	Interrupts in energy production by binds free protein from GI tract or oxidative phosphorylation.	Arjungenin, Chebulin, Ellagic acid, Chebulic acid, Gallic acid.
Vinca, Periwinkle	Catharanthus roseus, Family-Apocynaceae	Prevents polymerization of tubulin into microtubules.	Vincristine, Vinblastine Catharanthine etc.
Celandine	Chelidonium majus, Family-Papaveraceae	Reduce ROS generation, paralysis the parasitic worms.	Chelidonine, Sanguinarine, Caffeic acid, Protopine.
Mentha, Mint	Mentha cordifolia, Family-Lamiaceae	Causing paralysis of infected parasitic worms or death.	Carvone, Limonene, Menthol.
Sainfoin	Onobrychis viciifolia, Family-Fabaceae.	Reduce nematode excretion from GI tract, delay in egg maturation.	Tannin, Rutin, Nicotiflorin.
Ashwagandha, Withania	Withania somnifera, Family -Solanaceae	Causing paralysis of infected parasitic worms or death.	Withanolides, Anaferine, Sitoindoside.
Coriander	Coriandrum sativum, Family – Apiaceae	Reduce faecal egg count of worm and also inhibit the egg hatching process.	Linalool, Camphor, Geraniol, Coumarins, Linoleic acid.

Source

The immune system in chronic pinworm infections³

While we won’t die from worm infections, untreated infections can be chronic and can lead to further problems due to the immune system being thwarted by the worms.

The immune response is skewed towards a T helper 2 type response and a regulatory response. The regulatory immune network is associated with long-term worm infections and prevents a strong immune response against the worms, ensuring their survival and blocking regular immune action.

The regulatory network is understood to temper the response to other antigens, like allergens or self-antigens, which might result in the host of chronic infection being less susceptible to allergies and autoimmune disease.

Helminth worms may contain molecules that have anti-allergen anti-inflammatory potential, but in turn, that worm-infected people may not respond well to immune treatments like vaccines.

The mucous membranes have their immune systems disabled, and mucin, the immune substance in mucous that covers mucous membranes, is dissolved by the worms. Consider bumping up immune support while using other worming treatments, with echinacea and mushroom blends.

Using probiotics in pinworm infections

Having a healthy gut microbiome improves your defences against invaders. Some probiotics, such as Saccharomyces boulardii, support replenishment of the mucosal barrier of mucous membranes, which are degraded by some parasites to give them unfettered access to the mucous membrane⁴.

Getting support

Vaginal pinworms can be a nightmare, so having a good doctor who is worm-attuned can be the most helpful, while also having a talented herbalist on hand for non-drug treatments.

Book in with one of our vulvovaginal specialist practitioners (expert herbalists!) as needed for further support.

References⁵

Kashyap et al. 2014. Recurrent paediatric pinworm infection of the vagina as a potential reservoir for Enterobius vermicularis. J Helminthol. 2014 Sep;88(3):381-3.
Shetty JB, Kulkarni DV, Prabhu V. Eggs containing larvae of Enterobius vermicularis in vaginal smear. Journal of Cytology / Indian Academy of Cytologists. 2012;29(1):94-96. doi:10.4103/0970-9371.93238.
Tandan T, Pollard AJ, Money DM, et al. 2002. Pelvic inflammatory disease associated with Enterobius vermicularis. Archives of Disease in Childhood 2002;86:439-440.
Raju K, Verappa S, Venkataramappa SM. Enterobius vermicularis infestation masquerading as cervical carcinoma: A cytological diagnosis. Journal of Natural Science, Biology, and Medicine. 2015;6(2):476-479. doi:10.4103/0976-9668.160047.
Choudhury S, Kumar B, Pal DK. Enterobius vermicularis infestation of urinary tract leading to recurrent urinary tract infection. Tropical Parasitology. 2017;7(2):119-121. doi:10.4103/tp.TP_22_17.

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