How Do Other Vaginal Preparations Work?

Other vaginal preparations are medications that are not categorized into any of the specific classes of medications used in women’s health. Each of the other vaginal preparations works in unique ways and they are used in the maintenance of vaginal health, for pregnancy termination, and treatment of several conditions associated with reproductive health.

The medications that are grouped under other vaginal preparations include:

• Vaginal acetic acid: Vaginal acetic acid is a weak acidic solution used to restore and maintain natural pH in the vagina and to prevent bacterial and fungal overgrowth.
• Astodrimer: Astodrimer is a medication, currently in clinical trials for use in the prevention and treatment of bacterial vaginosis (BV), a condition of overgrowth of normal vaginal bacteria. Astodrimer prevents BV-causing bacteria from attaching to the vaginal lining. Astodrimer also has antiviral effects and is being investigated for use in the prevention of viral infections such as HSV-2 and HIV.
• Dinoprostone: Dinoprostone is a synthetic form of prostaglandin, a naturally occurring compound that makes the uterine muscles contract and the cervical opening soften and dilate. Dinoprostone is used to terminate the pregnancy, induce labor and childbirth, and control postpartum uterine bleeding. 
• Intravaginal prasterone: Intravaginal prasterone is a synthetic form of dehydroepiandrosterone (DHEA), a natural inactive steroid that is converted to active androgen or estrogen. Intravaginal prasterone works like natural estrogen to ease pain during sexual intercourse caused by postmenopausal vulvovaginal dryness and atrophy.
• Intravaginal progesterone gel: Intravaginal progesterone gel is a synthetic form of the natural female sex hormone progesterone, used to regularize menstruation. It is also used in assisted reproductive technology (ART), to prepare the endometrium to receive and maintain pregnancy.
• Vaginal estradiol: Vaginal estradiol is a synthetic form of natural estradiol, one of the three types of the female hormone estrogen. Vaginal estradiol is used to supplement the natural deficiency in women to relieve perimenopausal symptoms such as hot flushes, vulvovaginal atrophy, and the resultant pain during vaginal intercourse.
• Vaginal metronidazole: Vaginal metronidazole is an antibacterial agent used to treat bacterial vaginosis. Vaginal metronidazole kills bacteria by disrupting bacterial DNA synthesis and is effective against many types of vaginal bacteria such as Gardnerella vaginalis, Mobiluncus species, and Peptostreptococcus species.

Vaginal preparations are applied into the vagina with an applicator or inserted into the vagina. Other vaginal preparations include the following:

• Vaginal gel
• Vaginal cream
• Vaginal insert
• Vaginal suppository
• Vaginal ring
• Endocervical gel

Vaginal preparations are approved by the FDA for use in the following:

Vaginal acetic acid

• Restoration and maintenance of vaginal acidity

Astodrimer (pending FDA approval)

• Prevention and treatment of bacterial vaginosis (vaginal bacterial overgrowth)

Dinoprostone

• Cervical ripening (softening and dilation of the cervix in pregnant women who require labor induction at full term or near term)
• Pregnancy termination

Intravaginal prasterone 

• Moderate to severe dyspareunia (painful sexual intercourse due to perimenopausal vaginal dryness)

Intravaginal progesterone gel 

• As part of assisted reproductive technology (ART) treatment for infertility in women with progesterone deficiency.
• Secondary amenorrhea (absence of menstruation) is due to hormonal imbalance, and not because of pathologic reasons such as uterine fibroids or cancer.

Vaginal estradiol

• Menopausal vasomotor symptoms (hot flashes)
• Vulvar and vaginal atrophy in menopause
• Moderate to severe dyspareunia

Vaginal metronidazole

• Treatment of bacterial vaginosis

Side effects of other vaginal preparations vary with each type of drug. A few of the most common side effects include:

• Vaginal acetic acid:
  • Local stinging and burning
• Astodrimer:
  • Vulvovaginal candidiasis (Candida yeast infection)
• Dinoprostone:
  • Abnormal uterine contractions
  • Hypertonic uterine dysfunction (excessively frequent uterine contractions) with or without fetal distress
  • Gastrointestinal upset
  • Back pain
  • Warm feeling in vagina
  • Fever
• Intravaginal prasterone:
  • Vaginal discharge
  • Abnormal Papanicolaou (Pap) smear
• Intravaginal progesterone gel:
  • Breast enlargement, pain, and tenderness
  • Cramps and abdominal pain
  • Somnolence (drowsiness)
  • Mood swings
  • Nausea
  • Dizziness
  • Depression
  • Sleep disorder
  • Nervousness
  • Perineal pain
  • Urinary difficulties
  • Headache
  • Musculoskeletal pain
• Vaginal estradiol:
  • Headache
  • Vulvovaginal mycotic (fungal) infection
  • Vulvovaginal pruritus (itching)
  • Back pain
  • Abdominal pain
  • Diarrhea
• Vaginal metronidazole:
  • Bacterial infection
  • Headache
  • Pruritus (itching)
  • Abdominal pain
  • Nausea
  • Diarrhea
  • Dysmenorrhea (painful menstruation)
  • Pharyngitis (throat inflammation)

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Generic and brand names of some of the other vaginal preparations include:

• acetic acid vaginal
• Acid Jelly
• astodrimer (pending FDA approval)
• Cervidil
• Crinone
• dehydroepiandosterone, intravaginal
• DHEA, intravaginal
• dinoprostone
• Endometrin
• Estrace Vaginal
• estradiol intravaginal
• estradiol vaginal
• Estring
• Fem pH
• Femring
• Imvexxy
• Intrarosa
• MetroGel Vaginal
• metronidazole vaginal
• Nuvessa
• prasterone, intravaginal
• Prepidil
• Prochieve
• progesterone intravaginal gel
• Progesterone, Vaginal
• Prostaglandin E2
• Prostin E2
• Vagifem
• Vandazole
• VivaGel BV (pending FDA approval)
• Yuvafem