Should You Use Boric Acid Suppositories for BV and Yeast Infections?

We’ve all hit the search engine when the standard treatment options for resistant, complicated, or frequent infections aren’t cutting it. While down your virtual rabbit hole, you might have come across boric acid suppositories for BV and yeast infections. 

Maybe antibiotic treatment for bacterial vaginosis (BV) left you with a yeast infection in its place or, despite popping over-the-counter (OTC) antifungal suppositories like vaginal Tic Tacs, another yeast infection comes creeping in. So, can boric acid be the solution? 

Boric acid is a compound that claims to treat vaginal infections. It's been used for centuries and research shows that it's safe for vaginal health. In recent years, it's started to make a comeback. That said, testimonials can be conflicting. While some say it knocked out their recurrent bacterial vaginosis or yeast infection when nothing else worked, others will warn of uncomfortable side effects and express safety concerns. In these cases, it’s hard to know what information is well-researched and science-backed.  

That’s why we’ve broken down the ins and outs of boric acid suppositories for BV and yeast infections below.

What is boric acid? 

Boric acid is a white powder composed of boron, oxygen, and hydrogen, and made from borax, a naturally occurring mineral.

When it’s used for vaginal infections, it comes in the form of powder or a capsule to insert vaginally as a suppository. It’s known to have antifungal and antiviral properties that emerging research suggests may help with recurrent vaginal infections.

Some folks use boric acid washes to help with issues like vaginal odor and itching. However, there's not a lot of solid research or regulation for these products, so it's hard to know for sure how well they work and how they deliver the medication.

FYI, generally, boric acid prescribed by a doctor (like the boric acid you can get through clinical care with Evvy) tends to be purer and less likely to cause adverse reactions than boric acid purchased OTC or on Amazon.

Is it safe to put boric acid in your vagina?

Boric acid suppositories are generally safe when taken as prescribed or medically advised, especially in the short term.

Some people worry about boric acid's safety because it's linked to borax (sodium borate decahydrate), an ingredient commonly used in household cleaners. Even though they're made from the same compound, boric acid and borax are not the same thing. 

Boric acid suppositories are only for inserting into your vagina. They should never be taken orally because they can be toxic if eaten in “extreme amounts” (15-20 grams for adults and 5 grams for infants). 

However, boric acid vaginal suppositories are typically 600 milligrams and are generally considered safe if used as directed: inserted in the vagina, not consumed orally. To put it another way, an adult would need to consume 25 vaginal capsules at once to reach toxic levels. 

Will boric acid help treat a yeast infection?

A yeast infection, aka vulvovaginal candidiasis, is a common vaginal infection caused by an overgrowth of yeast (a type of fungus), usually Candida albicans. Sometimes it’s caused by the more drug-resistant (and lesser known) strain Candida glabrata. 

Boric acid can be really effective in treating vaginal yeast infections, especially when other antifungal treatments haven't worked, or when you're dealing with recurring infections caused by unusual yeast species. In some cases, boric acid might work even better than the first-line treatments like antifungals, especially when you're up against atypical Candida species.

For example, the Centers for Disease Control and Prevention (CDC) guidelines recommend 600 mg of boric acid in a gelatin capsule administered vaginally once daily for three weeks for recurrent non-albicans vulvovaginal candidiasis. However, like many other instances in vaginal health, there needs to be more research on the effectiveness of boric acid on all types of Candida.

Speaking of atypical Candida strains, a 2007 study found boric acid suppositories solved 63.6% of Candida glabrata infections (a less common vaginal yeast species that can be resistant to OTC treatment, whereas Candida albicans causes most yeast infections).

By comparison, in the same study, fluconazole — commonly prescribed to treat vulvovaginal candidiasis — only resolved 28.6% of infections. Some research suggests antifungal resistance is a growing problem when treating yeast infections.

If your infections refuse to disappear or bounce back all the time, like a Marvel superhero, it may be worth talking to your doctor about vaginal boric acid.

Overall, research suggests that boric acid may be as effective as or even more effective than traditional prescription antifungal medicines.

A 2018 review of multiple studies that looked at the use of boric acid, vaginally, specifically recommends boric acid treatment for antifungal-resistant infections. We’ll be keeping an eye on the FDA and CDC guidelines to see how they evolve based on this emerging research.

Do boric acid suppositories work for BV?

Bacterial vaginosis is a term used to diagnose vaginal imbalances caused by the overgrowth of "bad" bacteria, such as Gardnerella vaginalis, Atopobium vaginae, and Prevotella bivia. Treating BV is a little more complicated overall, and it’s unclear if boric acid can treat bacterial vaginosis.

Sometimes, the first-line BV treatment (antibiotics) works but then sparks a yeast infection, meaning you’ve essentially swapped one vaginal infection for another.

Current treatment for symptomatic bacterial vaginosis includes antibiotics like metronidazole and the use of intravaginal boric acid. However, these treatments often have high recurrence rates and can lead to secondary candida infections.

Anecdotally, many people find that boric acid helps treat BV symptoms. Surprisingly, there is not much research to back up boric acid as an effective treatment for bacterial vaginosis.

In a 2009 study, researchers investigated the combined use of boric acid and antibiotics for treating bacterial vaginosis. The study found that a one-week antibiotic treatment, followed by a three-week course of vaginal boric acid, kept 87% of patients symptom-free 12 weeks after diagnosis. However, the positive results did not last for everyone, as 50% of patients experienced a return of symptoms three months after the treatment had ended.

Bacterial vaginosis recurrence can be hard to ward off, even with dual treatment. One of the reasons why finding a long-term cure for bacterial vaginosis is so challenging is that certain BV-causing bacteria can form biofilms, hardy little walls of bacteria that antibiotics aren’t able to penetrate.

As you can imagine (or may know from first-hand experience) a sticky biofilm wallpaper full of harmful bacteria, stuck to your vaginal walls… isn’t ideal.

That’s why researchers hope that combining boric acid with a chemical like EDTA, which breaks up biofilms, could improve outcomes. TOL-463, a new vaginal medicine that recently underwent Phase II clinical trials (also mentioned above), is exactly that; a combination of boric acid and EDTA.

The results show that 88% to 93% of patients with bacterial vaginosis saw their symptoms improve after treatment. However, most bacterial vaginosis patients needed more treatment later on. This isn’t surprising, considering that the study only used boric acid and not antibiotics. These findings suggest that boric acid might be helpful, but it’s not a cure-all.

P.S.: If you have recurrent bacterial vaginosis and suspect a biofilm may have formed, an Evvy test will help you identify if the bacteria causing your bacterial vaginosis are capable of forming a biofilm.

Boric acid side effects 

Vaginal boric acid first-timers can feel anxious about the potential side effects. But a 2011 review in the Journal of Women’s Health found that only 10% of participants, across multiple studies, reported boric acid side effects, from vaginal use.

A similar, but more recent review (2021) backed up these findings, concluding that (vaginally inserted) boric acid treatment was safe for most people.

The review also pointed out that there was barely any (if at all) absorption of boric acid into the bloodstream, over two weeks of using it vaginally.

However, there are currently no clinical studies examining the safety of long-term vaginal boric acid treatment, and, given how many people with vaginas use or consider using boric acid, the lack of research has “gender health gap” written all over it.

Common side effects of vaginal boric acid include:

• Vaginal irritation
• Vaginal itching
• A burning sensation in the vagina
• A gritty sensation in the vagina
• Watery vaginal discharge.

Can you use boric acid suppositories while pregnant? 

Pregnant women would generally be advised against using intravaginal boric acid.

A healthcare provider may recommend boric acid suppositories for recurrent bacterial vaginosis (BV) when the individual experiences frequent infections.

The safety data available on vaginal use of boric acid can’t automatically be applied to pregnant people. For this group (and the developing embryo they carry), there isn’t enough data available to give it a thumbs up for safety and it’s better to err on the side of caution here.

So, should I use boric acid suppositories?

For yeast infections, one study concluded that vaginal boric acid is at least just as effective as antifungals, if not better.

Research has shown that boric acid can be used to treat vaginal infections, including bacterial vaginosis, but it’s not FDA-approved for this use. Many researchers, clinicians, and users believe that boric acid is generally safe and effective for this purpose, even though the evidence is not as strong as for other treatments.

But the creators of the dual boric acid and EDTA treatment (TOL-463), Toltec Pharmaceuticals, could change this if TOL-463 completes its clinical trials, and goes on to secure FDA approval. In the short term, it shows promise as a yeast infection treatment (with a 77%-88% cure rate one-week post-treatment), as well as for bacterial vaginosis.

Even without FDA approval, boric acid suppositories can still be prescribed by an OB-GYN, for vaginal use. Typically it’s much better to use boric acid prescribed by a doctor because it tends to be purer and less likely to cause adverse reactions than boric acid purchased OTC. So let your OB-GYN guide you on this, especially if other treatments haven’t worked.

You may also want to consider leveraging an Evvy test to identify which species of Candida may be present (since boric acid is only CDC-recommended for C. glabrata) or knowing whether you have bacteria that are known to create biofilms since those are the two situations in which research has shown it is effective.

How do I know if boric acid is working as a treatment? 

Taking an Evvy vaginal microbiome test before using boric acid (while you have symptoms) and after will help you understand if the treatment is actually helping your vaginal microbiome shift to a more protective state. An Evvy Membership unlocks our Compare feature, which allows you to view your microbes side by side along with the products used at each test and your symptoms at that time.

Randomized controlled trials, including trial registration and placebo treatment arms, are crucial to validate the results of studies on boric acid. These trials ensure that the study design is robust and that the findings are reliable.

FAQ

How long does boric acid take to cure BV?

When used to treat vaginal infections, boric acid should relieve symptoms of bacterial vaginosis within one to two weeks. One study found that 87% of patients remained symptom-free 12 weeks after diagnosis by using a one-week antibiotic treatment followed by a three-week course of vaginal boric acid. You should speak to your healthcare provider if symptoms persist even after taking prescription treatments.

How often should you use boric acid suppositories?

Most boric acid suppositories are available in 600-milligram doses, which you insert once daily for one to two weeks. That said, a healthcare provider may recommend a different treatment plan based on your case. Although boric acid is considered safe, we’d advise against using it as a maintenance therapy for recurrent infections without speaking to your healthcare provider or OB-GYN first. You should never take boric acid orally because it’s extremely toxic when ingested. It can also be irritating for male partners, so it’s best to avoid receiving oral sex or having unprotected vaginal sex while using boric acid, and for a few days after finishing the treatment.

Can I get boric acid in the pharmacy?

Yes, you can find boric acid vaginal suppositories in most pharmacies and drugstores. It's available over the counter and is relatively inexpensive, ranging anywhere from $15-$30 on average. Although you can find “recipes” online to make your own at home, it’s better to purchase boric acid suppositories specifically formulated for vaginal health.

Have there been any deaths from boric acid suppositories?

If ingested, boric acid is toxic and can be potentially fatal. That said, it's unlikely that accidentally swallowing a vaginal boric acid suppository will kill you. According to the Centers for Disease Control and Prevention (CDC), ingesting about 30 grams of boric acid is toxic to humans and could result in death. For reference, a boric acid suppository typically contains 600 milligrams. Using a suppository vaginally and as directed won’t cause death.