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What the vaginal boric acid profiteers don't want you to know
Boric Acid doesn’t balance the vaginal pH, it’s an antiseptic
It seems that vaginal boric acid is the new natural “it” product promoted by vaginal profiteers and influencers.
I’ve seen its use increase among my patients over the past few years, paralleling an explosion of new over the counter (OTC) boric acid products and heavy marketing from celebrities, influencers, naturopaths, and functional medicine providers. From the claims these people make about boric acid, it’s pretty clear those selling and promoting it have no understanding of how boric or the vaginal ecosystem work. Or if they do know, they don’t care. Always hard to know which is worse.
I decided it was time to tackle boric acid again (I’ve addressed it in detail in my book The Vagina Bible) as I was tagged by countless people this week on Instagram, when two influencers by the names of Cat and Nat promoted a brand of vaginal boric acid called pH D for what they *ahem* called a “stinky vag.”
Side rant. Almost every damn day I speak to some woman who has been made to feel that her vagina stinks by the patriarchy, and here were two women blasting that message (as well as bad information about boric acid) to their over 600,000 followers. Color me enraged.
Okay, back to boric acid.
Boric acid is an old therapy that predates our understanding of the vaginal ecosystem. It was used for its antiseptic and astringent (meaning it dries tissues) properties. Other natural things that were put in the vagina as medicinals back in the day included lead and arsenic. Ye olde vaginal therapy does not equate with Ye olde helpful and safe vaginal therapy. In other words, just because something is “old” or “traditional” doesn’t mean it is good. And for the record, lead and arsenic are as natural as boric acid.
The vagina is filled with healthy bacteria that we don’t want to kill, but boric acid is a general antiseptic, meaning it can kill yeast and harmful bacteria as well as the healthy bacteria. The data we have supports that it is directly damaging to the bacteria and yeast, meaning it is cytotoxic or kills cells. While the exact mechanism of how it kills cells is unknown (there are some theories), we know that it doesn’t work by lowering the pH. This is important, because a common misconception is that boric acid works by lowering the pH in some kind of gentle, restorative action of vaginal bacterial harmony. It doesn’t. Boric acid isn’t even a strong acid, the vagina is normally more acidic.
Even if boric acid were a strong acid, vaginal acidification products do not work. Nothing external—meaning no medicinal, herb, or pharmaceutical inserted vaginally—can regulate vaginal pH, as this is accomplished by the vaginal bacteria. Balancing vaginal pH with an external product is simply not possible. At some point we may find a way to introduce healthy bacteria into the vagina for women who suffer from recurrent bacterial vaginosis, but we are not there yet.
Boric acid is also an astringent, meaning it can dry tissues. We know astringents are harmful for the vagina as they damage the mucus and the cells (mucosa), leading to irritation and an increased risk of acquiring some sexually transmitted infections (STIs), such as HIV, if exposed. Astringents were common in “old time” vaginal therapies for several reasons. Historically, women were believed to be “too wet” (not just the vagina, every tissue), so many therapies for women revolved around drying tissues. Also, vaginal wetness was erroneously a sign of being promiscuous, so therapies that brought about dryness were unfortunately desirable as dry and tight was equated with good. It’s also important to note for those with a vaginal infection that it is easy to mistake the dryness from the boric acid as a cure for the infection, when really you are just less wet due to the astringent. Meaning symptoms are suppressed, not treated.
The sad irony about believing boric acid can “balance” the vagina is that it can actually kill the good bacteria and the astringent can damage the mucus and the vaginal tissues. I’ve certainly seen many people irritated from boric acid use, and after I posted about it several doctors on Instagram chimed in that they have seen this as well.
Ok, so if boric acid can damage the ecosystem and injure the vagina, why use it?
The Two Uses of Boric Acid
Some therapies have potentially harmful side effects, but they are still needed. The best example is chemotherapy. It is cytotoxic or harmful to almost all tissues, but it is more damaging to cancer cells and so the risks are tolerated because they are outweighed by the benefits. This is a good analogy for vaginal boric acid.
First, boric acid can kill yeast that is resistant to the typical antifungals, the medications normally given for yeast, such as fluconazole and miconazole etc.. This yeast is called azole-resistant yeast as the drugs commonly used are known as azoles. Here boric acid works about 70-80% of the time. The azole (prescription and over the counter) medications are better for a run of the mill yeast infection, as unlike boric acid, they only kill yeast and they are not astringents. The Centers for Disease Control and Prevention agrees with me and only suggests boric acid for azole-resistant yeast. You need a vaginal culture that is sent to the lab to know if you have this kind of yeast.
Boric acid can also be used as part of a multi-step regimen for refractory, recurrent bacterial vaginosis (BV), although the studies supporting this are not great. Boric acid alone doesn’t treat bacterial vaginosis. If it did, it would be listed as a first or second line therapy by the Centers for Disease Control and Prevention, but it isn’t. When we use boric acid in this situation we are hoping it can destroy any biofilm, which is a coating that bacteria can develop that makes them harder to kill. If boric acid does disrupt the biofilm, it is likely due to the astringent properties, meaning the boric acid is mechanically damaging the biofilm.
Standard pharmaceuticals are preferred for regular bacterial vaginosis as they are more effective. In addition, metronidazole and tinidazole (the preferred therapies) can’t damage lactobacilli (the most common good bacteria in the vagina). People who get yeast after being treated with metronidazole or tinidazole are not getting a rebound yeast infection from these antibiotics, rather, they likely had a co-infection with both yeast and bacterial vaginosis and once the BV was treated, the yeast became obvious. Clindamycin, the other pharmaceutical for bacterial vaginosis, can damage lactobacilli, which is likely why it is associated with rebound yeast infections. Clindamycin is still much better than boric acid.
So that’s what you need to know about boric acid. It doesn’t acidify the vagina, it’s a cytotoxic astringent and should only be used in two specific situations when it’s felt that the benefits outweigh the risks.
Now let’s look at the claims made by ph D about their boric acid product.
Here is their advertising on Amazon
“Supports vaginal balance”
If the makers of this product think boric acid balances the vagina, then they have no understanding of how the vagina maintains its ecosystem or how it maintains pH. Boric acid does not “support” the “natural balance” (a meaningless term), if anything can cause harm as it is cytotoxic and an astringent. It cannot restore the pH of the vagina.
“Safe and effective care for vaginal odor caused by menstruation, intimacy, exercise and menopause.”
So much to unpack here. But let me give it a go:
Menstruation doesn’t cause an odor. If the smell of blood bothers you, boric acid will not help as it cannot neutralize the smell of blood. Suggesting menstruation has an odor is highly problematic, especially for a woman founded brand. This is literally using the patriarchy to move a product.
Intimacy doesn’t cause an odor, unless the smell of ejaculate bothers you (but that is a penis problem, not a vagina problem). If you develop odor after intercourse that can be a sign of bacterial vaginosis or trichomonas, but as discussed, boric acid is not first or second line treatment for bacterial vaginosis. In this situation it is best to get a diagnosis and the right therapy. Recurrent bacterial vaginosis should be managed with a knowledgeable expert. The basic strategy involves treating the odor-causing bacteria with antibiotics (and this may need to be long-term). Condoms can be very helpful for those who partner with men and the birth control pill with estrogen or a vaginal estrogen tablet can also be helpful in some situations.
Exercise doesn’t cause vaginal odor. The vagina doesn’t have sweat glands. What in the ever loving fuck do the people at pH D think happens with exercise? Putting boric acid in the vagina will not treat or prevent body odor.
Menopause. FOR THE LOVE OF VAGINA DO NOT PUT BORIC ACID IN THE VAGINA TO DEAL WITH ANY SYMPTOMS OF MENOPAUSE. Boric acid is an astringent, meaning it is a drying agent. It will cause the most harm to a vagina in menopause. And the last thing a vagina in menopause wants is to be more dry. Some women can notice a shift in their normal scent with menopause as the bacterial communities are switching. If this is bothersome, see a provider to make sure it is nothing else. Options are over the counter moisturizers or prescription vaginal estrogen or vaginal DHEA.
As for staying confident? I can see how a woman might feel less comfortable or confident about her vagina after hearing about stinky vaginas from female influencers and reading false information about how their vagina can supposedly sweat from the folks at pH D. I suppose the implication here is that ph D can take those “worries” away?
And founded by a woman?! That doesn’t mean a product is good. Someone on Instagram was snarky to me about that, as if I should give women profiting off disinformation a pass? Women can be profiteers too, which is exactly what is happening here. Every company that sells boric acid as a way to “balance” the vagina or provide some kind of “regular tune up” is spreading false information about vaginal health and capitalizing on vaginal shame. And that is not okay by me. And finally, the name ph D. Sorry, that makes it sound like this is backed by science.
And no, the CDC isn’t “hiding” or “afraid” of data on boric acid. I’ve seen that conspiracy theory as well. The CDC literally mentions boric acid in the guidelines for resistant yeast and refractory bacterial vaginosis. What is the possible nefarious motivation for listing it for one condition and not another?
Vaginal shame is profitable because many women have untreated or under treated vaginal conditions. It is even easier to capitalize on this when a medication, like boric acid, actually has some legitimate uses. Vaginal profiteers take advantage of this to create confusion in order to expand the use of the same product to situations where it is not only unnecessary, but inappropriate.
Boric acid is no great vaginal rebalancer. It is an antiseptic and an astringent that has two uses as far as vaginal infections are concerned and both should be under the supervision of an experienced provider, but that truth won’t move a lot of product. And a lot of people are counting on obfuscating that truth.