Apple Cider Vinegar is NOT Recommended for Vaginal Health
Apple cider vinegar should not be used for vaginal health maintenance or treatment of vaginal infections, as it lacks evidence-based support from clinical guidelines and may cause harm, while proven effective treatments with topical azoles and oral fluconazole are readily available.
Why Apple Cider Vinegar is Not Recommended
Absence from Clinical Guidelines
- The CDC STD Treatment Guidelines, IDSA recommendations, and ACOG guidelines make no mention of apple cider vinegar as a treatment option for any vaginal condition 1, 2, 3.
- Established first-line treatments for vulvovaginal candidiasis include topical azole antifungals and oral fluconazole, which achieve 80-90% cure rates 2.
Limited and Concerning Evidence
- Only a single case report from 2017 describes successful treatment of vaginal candidiasis with apple cider vinegar in one patient who had failed other therapies 4.
- A 2019 laboratory study found that Candida species (the most common cause of vaginal yeast infections) were actually less susceptible to apple cider vinegar compared to bacteria, and the product showed cytotoxicity at concentrations as low as 0.7% 5.
- Alternative treatments including vinegar are noted to have potential undesirable side effects and have not been tested by well-designed clinical studies 6.
Safety Concerns
- The acidic nature of apple cider vinegar can disrupt the normal vaginal pH and potentially damage delicate vaginal tissues 5.
- 45% of over-the-counter products marketed for vaginitis in the feminine hygiene section cannot be confirmed as effective for treating infectious vaginitis 7.
What You Should Use Instead
For Uncomplicated Vaginal Yeast Infections
- Topical azole antifungals (clotrimazole, miconazole, terconazole) for 1-7 days OR single-dose oral fluconazole 150mg achieve >90% response rates 2, 3.
- Diagnosis should be confirmed with clinical symptoms plus microscopic identification of yeast/pseudohyphae or positive culture 2.
For Recurrent Infections (≥3 episodes in 12 months)
- Induction therapy with topical azole or oral fluconazole for 10-14 days 2.
- Maintenance therapy with fluconazole 150mg weekly for 6 months keeps 90.8% of women disease-free compared to 35.9% with placebo 2.
For Non-albicans Candida Infections
- Boric acid 600mg in a gelatin capsule vaginally daily for 2 weeks is the recommended alternative, with approximately 70% clinical and mycologic eradication rates 1, 2.
Special Populations
- Pregnant women should only use topical azole therapy for 7 days, never oral fluconazole 2, 3.
- HIV-infected women receive identical treatment as non-HIV-infected women 2, 3.
Common Pitfalls to Avoid
- Do not use unproven alternative treatments when evidence-based therapies are available and highly effective 2, 7.
- Avoid self-diagnosis and self-treatment without proper confirmation of the diagnosis, as different types of vaginitis require different treatments 3.
- Do not use products that can disrupt normal vaginal pH or cause tissue damage 5.