Where should intravaginal antifungal cream be applied for treatment of vulvovaginal candidiasis?

Application Site for Vaginal Antifungal Cream

Intravaginal antifungal creams should be inserted deep into the vagina using the provided applicator, and a separate external cream should be applied to the vulvar (external) skin when external symptoms such as itching or irritation are present. 1, 2

Intravaginal Application

• Insert the cream or suppository deep into the vagina using the applicator provided with the product, typically at bedtime. 1, 2
• The standard dose is 5 grams of cream inserted intravaginally, with frequency depending on the specific formulation (daily for 3-14 days or as a single dose). 1
• After insertion, discard the applicator as directed by the product instructions. 2
• Daytime administration is equally effective as bedtime administration if preferred for convenience, though most products traditionally recommend bedtime use. 3

External (Vulvar) Application

• Apply a small amount of external antifungal cream (typically 2% miconazole or equivalent) to the vulvar skin—the itchy, irritated external genital area—using your fingertip. 2
• External cream should be applied twice daily for up to 7 days to relieve vulvar symptoms such as itching, burning, and irritation. 2, 3
• The external cream addresses symptoms on the outer skin (vulva), while the intravaginal preparation treats the infection inside the vagina. 1, 2

Critical Application Points

• Oil-based vaginal creams and suppositories may weaken latex condoms and diaphragms; advise patients to use alternative contraception during treatment. 1
• The vaginal insert treats the internal infection (vaginitis), while external cream provides symptomatic relief for vulvar involvement (vulvitis). 1, 2
• Patients should complete the full course even if symptoms improve earlier, as premature discontinuation increases recurrence risk. 1

Common Pitfalls to Avoid

• Do not apply intravaginal cream only to external vulvar skin—this will not treat the vaginal infection. 1
• Do not skip the external cream if vulvar itching or irritation is present—internal treatment alone may not relieve external symptoms. 2
• Patients who self-treat with over-the-counter products should have had a prior confirmed diagnosis of vulvovaginal candidiasis; otherwise, they should seek medical evaluation to avoid misdiagnosis and treatment delay. 1, 4