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BNSSG Adult Joint Formulary

7.6 Vaginal and vulval conditions

Last edited: 17-04-2024

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

Estriol cream 0.1% (Ovestin®) (TLS Green) (local use)

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)

Ospemifene® tablets (TLS Amber Specialist Recommended)

For moderate to severe vulvovaginal atrophy in women who have:

  • History of breast or endometrial 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

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


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