Chronic and recurrent Bacterial Vaginosis and vaginal yeast infections are becoming more common due to biofilms, medication resistant strains, use and overuse of antibiotics, immunocompromising conditions, inability to replenish and maintain the vaginal lactobacillus, or poor vaginal health practices.
Boric acid has been used as a treatment for these 2 vaginal infections (and many other health conditions) with great success for centuries and while the why/how boric acid works is still not fully explained or understood, scientists do know that it does break down the bacteria’s biofilm and yeast cell walls making those pathogens more susceptible to our body’s natural defenses and/or prescription medications.
You also may have heard that boric acid “restores” your pH (or something similar), or that it “acidifies” the vagina. This is incorrect and based on the spread of misunderstood and incomplete information. I explain this below, it’s worth the scroll, I promise.
But before you run to your local store and end up bringing home pesticide quality boric acid I want to provide some basic information about this chemical compound so you know what it is and is not, and what it can and cannot do for your vaginal health, such as boric acid will not kill bacteria, it is not an antibiotic.
The Nitty Gritty of this Gritty Treatment
Boric acid is a chemical compound of boron, oxygen and hydrogen. You may have heard some people refer to it as “rat poison” and that it shouldn’t be used in your vagina, however, boric acid was used for over 100 years before it was known to kill pests! So, you could turn the tables and tell people they shouldn’t be using a vaginal treatment to kill rats….jus’ sayin’….
Boric acid, and even just boron, has been studied and was shown to NOT be harmful to human reproduction. Rats in studies that showed reproductive harm were given boron and boric acid at extremely high doses, but even when studies looked at people who lived and worked in boron mines, who were exposed to boron everyday, who were breathing it in, swallowing it’s dusty particles, they did not show any different reproductive effects when compared to people in the region who were not exposed to the boron mines.(https://link.springer.com/article/10.1007/s00204-020-02700-x)
The controversy around boric acids ability to restore vaginal pH comes from people’s misunderstanding of this chemical compound. The chemical compound boric acid has a 5.0pH. The vagina prefers to be between 3.5-4.5 pH in order to inhibit the growth of pathogenic (bad) bacteria. So if your vaginal pH is already below 5.0 and you insert boric acid, the boric acid will RAISE your pH to 5.0 temporarily. Inserting boric acid to “acidify” your vagina will only do so if your vaginal pH is currently above 5.0…hopefully that makes sense, I had to use a lot of repeat numbers there!
In other words, if your vaginal pH is elevated due to menstrual blood, semen, arousal fluid, mid-cycle ovulatory cervical mucus, or a lack of lactobacillus, for example, then boric acid can bring the pH down BUT ONLY to 5.0pH, boric acid cannot lower the environment any lower than that, and as I just mentioned-the vagina needs to be between 3.5-4.5 pH for proper health and pathogenic prevention.
Boric acid is really great at disrupting what is called a biofilm, though! A biofilm is a thin, slimy, protective matrix of “goop” covering bacteria that helps the bacteria adhere to a surface. Boric acid also disrupts and destroys the protective fungal cell membranes of yeasts/candida. Studies are showing these protective layers to be the main contributor to infection recurrence and resistance. The exact mechanism of how boric acid works to break down these barriers isn’t yet proven but current studies believe it breaks down
- Biofilms: by disrupting something called the Extracellular Polymeric Substance (EPS) and has been found to inhibit certain enzymes that are essential for the formation and stability of biofilms as well as having it’s own antimicrobial and astringent properties. By interfering with these enzymes, boric acid can prevent the biofilm from establishing or maintaining itself., however, it is suggested that it works by penetrating and disrupting the fungal cell membrane wall and bacterial biofilm membranes making the little buggers more susceptible to our body’s natural defenses and prescription medications.
- Yeast cell walls: Yeast cell walls contain things called glucans and chitin, which are polysaccharides that provide structural integrity<–the main key info to know. The weak acidic conditions created by boric acid can weaken these polysaccharides, making the cell wall more susceptible to damage. Boric acid’s astringent properties can extract moisture from the yeast cell wall, leading to dehydration. This dehydration can disrupt the integrity of the cell wall structure and weaken its ability to function properly. It also interferes with certain enzymes yeast need to maintain their cellular walls.
Typical Dosing and Side Effects
You are able to purchase safe boric acid for use in capsules and other types of vaginal suppositories in many stores and online, however I urge you to talk with your doctor or pharmacist and do some research into which product you purchase so you know you are getting a high quality product that will actually benefit you.
The current treatment protocols:
- Typical dosing for an active yeast infection (per study data), without a prescription antifungal, is one 600 mg boric acid capsule or vaginal suppository inserted 1-2 times per day for 14 days. True recurrent or infections that are not completely responsive to prescription antifungals will require the simultaneous use of an oral systemic antifungal with the boric acid use.
- Typical dosing for an active BV infection (per study data) requires the simultaneous use of an oral antibiotic, most common prescriptions are from the Nitromidazole family (Metronidazole/Flagyl, Tinidazole, Secnidazole/Solosec) or Clindamycin. Typical dosing based on study data is 7 days of the antibiotic and 21 nights of boric acid that was started on the same day as the antibiotic. So, start both treatments on the same day but the boric acid will be used longer.
- Typical dosing for prophylactic or preventative use is one 300-600 mg boric acid capsule or vaginal suppository inserted 1-2 times a week, or after sexual intercourse that involved semen entering the vagina.
Check out my post about probiotics as well as it is another great addition to combating repeated infections along with a proper prescription and boric acid-a triple threat if you will, but also in helping to create a healthy vaginal environment that can prevent infections from starting.
Side effects and warnings
Side effects of using a boric acid vaginal suppository include: watery vaginal discharge, redness, mild burning sensation, and a gritty sensation in the vagina. Some have reported mild spotting while using boric acid as well so between the mild spotting and discharges while using this product, it’s probably best to keep some liners or pads on hand. Do not insert tampons or have vaginal penetration while using boric acid.
You can help relieve these symptoms. Many of the symptoms are due to it’s astringent properties so you could consider a helpful trick: mix the powder from 1 capsule (600mg or less) with a little water based lube that is BOTH pH and osmotically correct for the vagina like from brands Good Clean Love or AhYes!UK. Use just enough of the lube to make a gel, then use a 3ml/similar sized syring (found at most pharmacies/drug stores/online) to insert the gel mix into your vagina. You’ll want to do this when you are already in bed for sleeping since the mix is now liquid/gel and it will run back out pretty quickly if you are standing or moving around.
Obligatory warnings: DO NOT EAT. Stop using this medication and call your Dr. if you have: new or worsening symptoms (itch, vaginal discharge, etc.), a strong vaginal burning sensation, high fever, or symptoms that go away and come back. Get emergency medical help if you have signs of an allergic reaction such as hives, difficult breathing, swelling of your face, lips, tongue and throat. You should not use boric acid if you are allergic to it or if you have: pain or tenderness in your pelvis or lower stomach, fever, chills, nausea, vaginal bleeding, Pelvic Inflammatory Disease, an active sexually transmitted infection, high blood pressure, heart disease, a weak immune system, blood vessel disorder, or if you are pregnant or breastfeeding. NO drug interactions have been reported involving boric acid.
A note on the claim that boric acid is toxic, here is what the National Pesticide Information Center warns:
- Minimum oral lethal doses of boric acid in humans have been estimated from accidental poisonings to be in the range of 500-2000 mg for adults, 300-600 mg for children and <500 mg for infants.
- Acute ingestion of boric acid or borate salts in humans has rarely led to severe toxicity. Commonly reported symptoms include nausea, vomiting (often with blue-green coloration), abdominal pain and diarrhea (which may contain blood or have a blue-green color). Other less commonly reported symptoms include headaches, lethargy, weakness, restlessness, tremors, unconsciousness, respiratory depression, kidney failure, shock and death.14,17,18
- Large oral exposures have resulted in an intense red skin rash within 24 hours of exposure, followed by skin loss in the affected area 1-2 days after the skin coloration first appears. These skin rashes typically affect the face, palms, soles, buttocks and scrotum.17
- Infants ingesting small amounts of boric acid in acute exposures displayed irritability, vomiting, erythema, exfoliation, diarrhea and nervous system affects.11,19 Chronic exposure to borax in infants has led to seizures, vomiting and diarrhea.11
All of the warnings about boric acid being toxic and dangerous are related to ORAL ingestion, not vaginal use. So please, just don’t eat the boric acid.
Side Note: Some studies have shown that a very small percentage of women with recurrent vulvovaginal candidiasis (RVVC) develop vestibulitis/vestibulodynia and in those patients the pain from using boric acid may exacerbate the vestibulits/vestibulodynia.
Only a VERY small percentage of women with BV infections can resolve their infection with boric acid and this is most likely due to:
- Breaking down the bacteria’s biofilm defense system leaving the pathogenic organisms vulnerable and
- Their body having both a strong vaginal immune response that was able to clear the infection on its own and a quick return of necessary lactobacillus that created sufficient amounts of lactic acid to both acidify the environment and harm the pathogens.
However, using boric acid alone to try and cure a BV infection is not a successful treatment for most women you will also need a prescription antibiotic to take along with the boric acid to successfully eliminate your BV infection.
And as always, feel free to reach out to me with any questions here on the website or on Twitter and Instagram @healthyhooha !
Sources:
https://www.ncbi.nlm.nih.gov/m/pubmed/25935553/
https://www.ncbi.nlm.nih.gov/m/pubmed/26834706/
https://www.ncbi.nlm.nih.gov/m/pubmed/19704395/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1784796/
https://www.drugs.com/mtm/boric-acid-vaginal.html
Healthy Hooha 
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