Vaginitis refers to an inflammation of the vagina. Bacterial vaginosis (BV), vulvovaginal candidiasis, and trichomoniasis are common forms of vaginitis.1 BV is the most common lower genital tract disorder among women of reproductive age (pregnant and non-pregnant). It is the most common cause of vaginal discharge and malodor.2

BV represents a shift in the balance of the vaginal microflora. It presents with an increase in the vaginal pH, a reduction in lactobacilli, predominantly hydrogen peroxide-producing species, and an increase in the number and/or type of facultative and anaerobic bacteria. The prevalence of BV is estimated range from 8% to 75%.1 BV is associated with a large number of obstetric and gynecologic complications, including preterm labor and delivery, preterm premature rupture of membranes, spontaneous abortion, chorioamnionitis, postpartum endometritis, post-cesarean delivery wound infections, postsurgical infections, and subclinical pelvic inflammatory disease.2

Risk factors for BV include smoking, sexual activity, and vaginal douching.2 It has also been shown that the host’s innate immunity may play a key role in the transition from a healthy state to BV state.3

BV is preventable. Douching can remove the protective lactobacilli should thus be avoided. Male partners can be advised to use condoms in cases of women with recurrent BV. Condoms have been noted to be protective against BV.3 Washing the genital area may also help.4

Maintaining adequate intimate hygiene during pregnancy seems to play a vital role in the prevention of such infections. Women use several intimate hygiene products as part of their daily cleansing routine. Routine washing of the vulva helps prevent accumulation of vaginal discharge, sweat, urine, and fecal contamination. However, the Royal College of Obstetricians and Gynaecologists suggests that washing with water can cause dry skin and make itching worse.5 Additionally, genital hygiene practices have been linked with reduced urinary tract infections (UTI) during pregnancy.6

Therefore, one must look for formulations that can prevent and manage infections and do not cause dry skin. Pongam seed oil is known for its inflammatory activity.7 It has also been shown to have antibacterial and antifungal activity.8 Tea tree oil is a potential agent that can be used to treat vaginal infections.9 These two oils can therefore be used to prevent the development of vaginal infections during pregnancy.

References

1. Bitew A, Abebaw Y, Bekele D, Mihret A. Prevalence of Bacterial Vaginosis and Associated Risk Factors among Women Complaining of Genital Tract Infection. Int J Microbiol. 2017; 2017: 4919404.
2. Yudin MH, Money DM, Boucher M, et al. Screening and Management of Bacterial Vaginosis in Pregnancy. Available from: https://sogc.org/wp-content/uploads/2013/01/gui211CPG0808.pdf.
3. Lakshmi K, Aishwarya JR, Chitralekha S, Menezes GA. Review on Infectious Vaginitis. Research Journal of Pharmaceutical, Biological and Chemical Sciences 2013;4(3):679-88.
4. Available from: https://www.publichealth.va.gov/docs/womens-health-guide/bacterial-vaginosis.pdf.
5. Chen Y, Bruning E, Rubino J, Eder SE. Role of female intimate hygiene in vulvovaginal health: Global hygiene practices and product usage. Women’s Health 2017;13(3):58–67.
6. Badran YA, El-Kashef TA, Abdelaziz AS, Ali MM. Impact of genital hygiene and sexual activity on urinary tract infection during pregnancy. Urol Ann. 2015 Oct-Dec; 7(4): 478–481.
7. Pongamia pinnata (Linn.) Pierre and Inflammation. Badole SL, Patil KY (eds.). In: Polyphenols in Human Health and Disease. Watson RR, Preedy VR, Zibadi S (eds.). Academic Press; 2014.
8. Bandivdekar AH, Moodbidri SB. Spermicidal activity of seed oil of Pongamia glabra. Archives of Andrology2002;48(1):9-13.
9. Mondello F, De Bernardis F, Girolamo A, et al. In vitro and in vivo activity of tea tree oil against azole-susceptible and -resistant human pathogenic yeasts. Journal of Antimicrobial Chemotherapy 2003;51:1223–9.