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1. Gastro-intestinal System 2. Cardiovascular system 3. Respiratory System 4. Nervous system 5. Infections 6. Endocrine system 7. Obstetrics, gynaecology, and urinary-tract disorders 8. Malignant Disease and Immunosuppression 9. Nutrition and Blood 10. Musculoskeletal and joint diseases 11. Eye 12. Ear, Nose and Oropharynx 13. Skin 14. Immunological products and vaccines 15. Anaesthesia 16. Palliative Care 17. Miscellaneous Preparations
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Home > Formulary : Adult > Chapters > 7. Obstetrics, Gynaecology and Urinary-tract Disorders >

BNSSG Adult Joint Formulary

7.6 Vaginal and vulval conditions

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Last edited: 24-10-2024

7.6.1 Vaginal and vulval infections, bacterial

First line drugs Second line drugs Specialist drugs Secondary care drugs

 

Clindamycin cream (TLS Green)

Metronidazole 0.75% gel (TLS Green)

Dequalinium chloride (Fluomizin® 10mg vaginal tablets) (TLS Amber Specialist Recommended)

  • For treatment of bacterial vaginosis

Dequalinium chloride (Fluomizin® 10mg vaginal tablets) (TLS Red)

  • For treatment of trichomoniasis vaginalis

 

7.6.2 Vaginal and vulval infections, fungal

Clotrimazole 1% cream (TLS Green)

Clotrimazole pessary 500mg (TLS Green)

 

 

7.6.3 Vaginal atrophy

Yes! vaginal moisturiser (TLS Green)

  • For vaginal atrophy in post-menopausal women with oestrogen sensitive conditions for whom topical oestrogens are not suitable i.e. patients with a history of breast or endometrial cancer
  • Use nightly until see a benefit and then twice weekly

Estriol cream 0.1% (TLS Green) 

Estradiol vaginal tablets 10micrograms  (TLS Green) (local use)

Estring® Vaginal Ring (TLS Blue)

  • Reserved for patients who are unable to use vaginal pessaries, or for those who have tried vaginal creams or pessaries for several months without clinical benefit

Imvaggis® Pessary (TLS Blue)

  • 2nd line after vaginal moisturisers for women with oestrogen-sensitive conditions following discussion with oncologist or menopause specialist
  • 4th line for women who have not tolerated other formulary options

Ospemifene® tablets (TLS Amber Specialist Recommended)

For moderate to severe vulvovaginal atrophy in women who have:

  • History of breast cancer for whom low dose estriol (Imvaggis®pessary) is unsuitable or;
  • A significant local allergy to vaginal oestrogens or;
  • For those who have failed to respond to all other formulary options after several months of treatment

Prasterone (DHEA) gel (TLS Red)

  • Reserved for postmenopausal women who are taking an aromatase inhibitor
  • Or as a last line option for women who are intolerant to all other formulary options for VVA due to allergy or issues with absorption.

 

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