Dr. Chapa (0:00)

Foreign.

Co-host (0:08)

Vitamin C. Could this ingredient be the difference between dull, tired looking skin.

Dr. Chapa (0:14)

And brighter, healthier looking skin?

Co-host (0:17)

My next guest says yes. But with thousands of skincare products out there touting this powerhouse ingredient, how do.

Dr. Chapa (0:23)

You know if you're using it right? And what does vitamin C really do.

Co-host (0:26)

For your skin anyway?

Dr. Chapa (0:28)

So of course there's been years, I mean, decades of press around vitamin C and some of that is well deserved. Vitamin C is a remarkable agent for overall immune function and for keeping us well. Of course there's been some press and some buzz around it looking it making your skin look brighter and looking younger. I mean, there's been all of these claims for vitamin C. Some of those are valid, some of those are hyperbole, but nonetheless, vitamin C really does do body good. Well, of course we've covered vitamin C on this show, not for skin health, but for vaginal health. Okay, so let me tell you where I'm going, guys. This was on January 18, 2020. January 18, 2020, y'. All. Five years ago we had an episode called Vaginal Vitamin C for bv. Yep, it's data. That was the title. Vaginal Vitamin C for bv. Yep, it's its data. That was five years ago. Now in the Green Journal, lo and behold, there's a new systematic review and meta analysis examining this very issue. Now, it's not the only systematic review to look at vitamin C as a vaginal acidifier to keep bacterial vaginosis at bay. There was actually another one that was published earlier this year. Of course, we're in 2025. That was published in March of 2025 out of ACTA, Obstetrics and Gynecology. Portuguesa. So not Scandinavia, but this was Acta Obstetrics and Gynecology. It was in Portuguese out of Acta, from the Portuguese folks. That was a separate meta analysis. So now we have two different data points. We have this recent systematic review and meta analysis. We have a previous systematic review from March of 2025. And so here's a question that I'm throwing out there. Did we get it right or did we get it wrong five years ago, y', all, as I've said many times before, with all humility, trust me, with all humility. I hope that's one of the reasons you listen to the show because sometimes we're kind of ahead of the curve here. January 18, 2020, we reviewed all of that data. Michael, put the link, let's put the link on the show notes for that episode. January 18, 2020. I don't wanna just reference it. I want to actually put, you know, the link in our show notes. Yeah, yeah, let's put that in there. So that would be on our link in our show notes. We covered this five years ago. So here's a question. Did we get it right or are we way off base? Y', all, let me give you a little spoiler. Even though we're gonna review this brand new publication from the Green Journal that just came out October 23, 2025. And then briefly, briefly, we're just gonna touch on the Acta Obstetrics and Gynecology from Portuguese. That's in Portuguese from March of 2025. Cause both of them say the. Let me give you a spoiler what we told you five years ago about using vitamin C as a vaginal acidifier. Yep, it's data. We told you that five years ago. So now that we've blown our own horn, let's return back to our humility. And then let's go out of the intro. We come back, we're going to cover these two publications, but our main one that we're focusing on is the one that just came out in the Green Journal. This is Systematic Review and Meta Analysis, the title of which appropriately is called Intravaginal Vitamin C for the Treatment and Prevention of Bacterial Vaginosis. Now, before I get out of the intro, one second, one thing. I'm not saying that vitamin C by itself is the way to go as treatment, although there's plenty of data that monotherapy, by just changing the ph and restoring that balance in the microbiome that is good enough, that rivals in some studies, antimicrobial therapy, AKA flagyl. So now I'm a pretty darn traditionalist. I like to give antibiotic therapy for this. But my point is it may not always be necessary. There is data that monotherapy works and or as an adjuvant. So to be clear, this is for, quote, the treatment and prevention of bv. So it hits both arms, either as monotherapy or as adjuvant and or as a preventative tool. Now, this is all very timely because remember, and we covered this as well, ACOG released the update to the guidance about the consideration of treatment male partners for female patients with BV as a way to reduce recurrence. We actually covered that original study when that came out, and then we covered the clinical practice update saying that we should at least consider treating the male partner. Now, remember, we said words matter. There's something that says we recommend treating the male partner. And then it says, says or could say we, we, we. You should consider. And that's what the terms were. Consider treating the male partner. So there's a lot of room there for interpretation. And, and it's not a firm set directive recommendation. It's just a suggestion. You should consider treating the male partner. So there's plenty of ways to get around and to try to head off recurrent bv. Treating the male partner as a. Considered a treatment. Considered option for treatment or acidification of the vagina. Once again, we covered this five years ago and spoiler, we were right. So I think I've set it up enough. Let's get out of the intro, we'll come back and we'll tackle this new systematic review and meta analysis very quickly because there's. I just, I just want to tell you what you need to know and then we'll wrap it up. We'll be right back. This is Dr. Chapa's OBGYN no Spin podcast. Oh, so I was told. I didn't give the reference for that little TV cameo spot in our intro. That was the Dr. Oz Show. That was back in November of 2021 when he talked about vitamin C and getting brighter skin. Not what we're talking about. And the Dr. Oz Show. Not a sponsor. All right, so now that we've cleared that up, let's get to this new publication again, fresh off the heels of a head of print, because this hasn't officially come out yet, but was released ahead of print on October 23, 2025. This is actually out of Canada. Get out. Get out. A out of Canada. And it's a systematic review and meta analysis. This was actually quote, presented at the Canadian Society Clinical Investigation Clinician Investigator Trainee association of Canada at their annual joint meeting. This was presented earlier in April of 2025 out of Toronto. Toronto. Toronto, Canada. Trento. Get out. Eh? Okay, anyway, so this was presented originally at that meeting and now it's published in the Green Journal. So to be very clear, this is not one individual trial. It is a systematic review and meta analysis. And they included randomized trials including non pregnant patients with intravaginal vitamin C as treatment for acute BV or prevention of recurrence. So let's say that again. This was like, hey, you've got bv. Here's your vitamin C and that's going to go right up the juju. Don't drink it. Okay. Don't take your emergency for bv. While emergency may be good for you overall, I don't know. That's debated, but can't hurt. This is vaginal. And do not put a packet of emergency up the vagina. This is. Don't do that because there's other things in there that can be irritating. This is just vitamin C by itself as treatment for acute BV or the prevention of recurrence. Kind of neat. So let me just read you this very quickly because the short of it is, guys, we covered this five years ago. And yeah, as an acidifier. Why not sure if it can help. Just like boric acid capsules can help in the vagina. And if you're going to recommend that to a patient, make sure that you tell them, look at me in the face. Look at me in the face over here. Hey, ice to me, ice to me. Do not eat the capsule of boric acid. That would be bad. Okay? Boric acid vaginal suppository used as directed because it's doing the same darn thing. Okay? Now boric acid freaks some people out. It kind of freaks me out because it's boric acid. But used correctly, there's plenty of data and we covered that as well in the past. There's data for Gent Violet. It's called the Purple vagina and we covered that. I think the title was called the Purple Vagina for both BV and yeast recurrence. So there's a lot of ways to get ahead of this, guys. But I thought this was so timely. Number one, remember, it's our commandment to let you know what's hot in press. And this just came out days ago from when we're recording this. And then number two, with that publication of have the consideration of treating the male partner for prevention of recurrent bv, I thought this was worth mentioning. So anyway, now that we've said all that, quote, nine trials were included. So that's nine. That's it. It's not 50, not 100. We're talking about nine with an N of 1,107. 1107. All right, fine. Eight evaluated primary treatment of BV with a maximum follow up of 30 days. So let's stop there. We're not talking about long term success. We're saying I'm gonna give you, you've got bv, I'm gonna give you intravaginal vitamin C and see what happens. And we're gonna see how it goes at a month hence. That's one of the limitations here, is that we don't have a lot of data as to how well this is prevented later on down the road. And I get what you're saying. Cause I'd say it too. 30 days. I mean, is that it? Yeah, I mean, that's what most of these studies had. Quote, most trials use a vitamin C dose of 250mg daily for six days. They go on to say among these trials, four compared vitamin C with a control group, meaning placebo or nothing, and four compared it with metronidazole. They go on to say, quote, only one trial compared vitamin C with placebo and they looked for the prevention of recurrence after antibiotic cure. All right, so four of these trials said vitamin C with a control, either placebo or nothing, four compared with flagyl, and then one trial compared vitamin C with placebo for recurrence of BV after antibiotic cure. So that's the pool that we're looking at. All right, so short of it is, did vitamin C help with either the elimination or the prevention of recurrence at a very short interval? Okay, remember, these are short interval follow up. Well, the answer was, yeah, it seemed to do something. Quote, treatment with intravaginal vitamin C 250 milligrams daily for at least six days may increase cure for bacterial vaginosis in the short term and may prevent recurrence. However, here's the catch, guys. Additional randomized trials are needed especially to evaluate recurrence beyond one month, end quote. So I want to be very clear here. Intravaginal vitamin C is not gonna keep BV away for a year. It's probably not gonna do that. We know it works for the short term and we know that it could likely be helpful as an adjuvant. Like say, hey, I'm gonna give you an antibiotic. I'm also gonna give you or prescribe to you vaginal vitamin C so we can help boost that microbiome support to make the vagina return back to its normal acidity to keep things in check. And that can likely be helpful. So remember, vitamin C has been looked as both monotherapy as adjuvant therapy or replacement therapy, meaning replacement therapy. Meaning if you get a recurrence, I'm not gonna treat you again with an antibiotic. I'm just gonna give you vitamin C to re. Establish balance. It's just an option. Guys, the take home message before we take a quick break. And I'm gonna give you the result from ACTA in the Portuguese journal. Now it's, it's in English and the reference will be in our, in our show notes. This is not the only study that says that this works. Now remember, this is one systematic review and meta analysis. I'm going to give you the one From March of 2025, which was seven months ago, a separate systematic review that was not a meta analysis but also found the exact same thing. I'm going to just give you their quick points here and then we'll wrap it up. So short of it is, According to this October 2025 Green Journal publication is just something else to consider. 250 mg vaginal vitamin C for acidification of the vagina can keep BV at bay. Now this isn't to take forever. We're not saying to take, you know, like an apple a day keeps a doctor away, a glass of orange juice every day. We're not saying don't put vitamin C in the vagina daily. Chronically, that's probably not good either. These are burst of treatments and again, most of these were 250mg intravaginal vitamin C for six days. Some protocols vary, some were five, some were seven. But we're not talking about chronic using this for months. That's not what I'm saying. That's not how it's supposed to be done. Let's take a quick break. When we come back, we'll get into this separate publication out of ACTA in Portuguese that quickly looked at this as well. The title of this publication is Intravaginal Vitamin C Supplementation in Bacterial Vaginosis A Systematic Review. We'll be right back. You're listening to the OB gyn no Spin podcast. All right everyone. So this previous publication earlier in 2025, it is in English. And then there's also the, you know, the, the supplement is actually in Portuguese, but it, it was the same thing. It's another systematic review that was a little broader in the sense that it wasn't just randomized control trials. They use inclusion criteria where published articles, trials that met the following, the population of women with an active diagnosis or recurrent history of BV related vaginitis undergoing treatment or prophylaxis with vitamin C compared to placebo or other first line adjuvant therapy or other prophylactic measures, end quote. Now, even though it was a little broader, oddly enough, they used less actual data for the systematic review. So even though they found 264, once you take away duplications, the one that weren't some that weren't actually correct then ended up with five studies that were included. And even though they searched broadly for all kinds of studies, they were randomized. So it was five randomized studies that were included Remember? So, broader search ended up, though with less randomized trials for this review. Short answer is they found the exact same thing again. Remember, our new commitment is tell you what you need to know and then be done with it and then give you clinical implication. Quote, concerning this treatment. Results showed a superiority of BV cure rates and reduction in symptomatology using intravaginal vitamin C compared with placebo, either as monotherapy or as adjuvant therapy regimens. Quote. In the only study evaluating intravaginal vitamin C for prophylaxis of this condition, there was a decrease in BV recurrence after 6 months of intravaginal vitamin C use, with a higher likelihood of no recurrence from the fifth month. End quote. Now, let me be very clear here. There was data again. They used six months of intravaginal vitamin C. Now, hold on, hold on. I have to explain what that means. That does not mean. Just to be clear, that does not mean that they used intravaginal vitamin C every day for six months. In the study that they included, they used vaginal tablets of placebo once a day for six consecutive days per month over six months. All right? So it'd be very clear, even though. Because if you read this, you're like, what? For six months they did the course of treatment. Remember, it's anywhere from five, six or seven days. They did that once a month, kind of as suppressive therapy to keep the pH of the vagina in check. All right? It does not mean that they used vaginal vitamin C every single day for six months. So just wanted to clarify that, because if you just look at that paper or look at the abstract and don't go through the table of the studies that were included, you're like, huh? Daily for six days? No, no, no. Vaginal intravaginal vitamin C for up to six months used as a burst of therapy. And in this case, it was once daily for six days per month for up to six months. So whether you do it that way or you do it after the beginning of symptomatology, either as monotherapy or as adjuvant, this separate meta analysis published earlier this year found the same thing as the one in the Green Journal quote. Intravaginal vitamin C at a dosage of 250mg once a day for six to seven days may constitute a possible treatment regimen for BV. Here it is, guys. Either as monotherapy or as adjuvant therapy. End quote. So we've got two pieces of publications now, two separate authors, totally different areas. One was in Portuguese, one is Canadian, both on the same thing. 250 mg intravaginal vitamin C for anywhere from five, six or seven days can have a role to acidify the vagina. And lo and behold, thankfully, we were right when we covered this on January 18, 2020. Podcast Family I think I've done what we're supposed to do. We've covered this recent publications, one most recently from October 23rd, and as point of reference, we're doing this on October 27th. So that was just four days ago. Podcast Family, as always, we're thankful for you. We're glad you're part of our podcast community. And now that we've done all that, let's take it home. Foreign this has been Dr. Chapa Zobi Gyn no Spin podcast Podcast Family. Thank you for your support. Thank you for listening. And as always, we'll see you on another episode of the no Spin Podcast.