Podcast Summary: Dr. Chapa’s OBGYN Clinical Pearls

Episode: Vaginal Vit C For BV? AGAIN!
Date: October 27, 2025
Host: Dr. Chapa

Overview

This episode revisits the topic of intravaginal vitamin C for bacterial vaginosis (BV), prompted by a brand new systematic review and meta-analysis published in the Green Journal (October 23, 2025). Dr. Chapa discusses what’s new in the data, compares it to past research—including his own 2020 episode on the topic—and highlights the current state of evidence for vitamin C as both a treatment and a preventative option for BV. The tone is lively, evidence-based, and clinical but always practical.

Key Discussion Points & Insights

1. Background on Vitamin C and BV

• Vitamin C in Health: Previously lauded mostly for immune boosting and skin care.
• Shift to Vaginal Use: Dr. Chapa notes, “We’ve covered vitamin C on this show, not for skin health, but for vaginal health.” (00:28)
• BV Recap: Bacterial vaginosis is a common vaginal condition with high recurrence; finding safe, accessible preventative treatments remains a priority.

2. Historical Perspective

• “We were ahead of the curve!”:
  • Dr. Chapa reflects on his January 18, 2020 episode: “We reviewed all of that data... Did we get it right or are we way off base?” (00:51)
  • He builds a case for reviewing past insights in light of new research.

3. Emergence of New Evidence

• Green Journal Systematic Review/Meta-Analysis (Canada, Oct 2025)

  • Scope: Included randomized controlled trials (RCTs) on nonpregnant women using intravaginal vitamin C for acute BV or prevention of recurrence.
  • Key Findings (07:58):
    • Nine trials, N=1107.
    • 8 trials focused on primary BV treatment (max follow-up: 30 days).
    • Typical regimen: 250 mg intravaginal vitamin C daily for 6 days.
    • Comparisons: with placebo/nothing or metronidazole (Flagyl).
    • Result: “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.” (09:10)
    • Limitation: “Additional randomized trials are needed especially to evaluate recurrence beyond one month.” (09:45)

• Practical Pearls

  • Vitamin C appears beneficial as:
    • Monotherapy or adjuvant to antibiotics.
    • A short-burst intervention, not daily or prolonged.
    • “We’re not talking about chronic... That’s not how it’s supposed to be done.” (13:20)

4. Comparison: Other Acidifiers & Treatments

• Boric Acid, Gentian Violet: Other acidifying agents have similar rationales (“If you’re going to recommend [boric acid], do not eat the capsule... Boric acid vaginal suppository used as directed... it’s doing the same darn thing.” [08:23])
• Male Partner Treatment: Updates from ACOG now suggest “consider” treating male partners to help reduce recurrence.

5. Second Systematic Review: ACTA Obstetrics and Gynecology (Portugal, March 2025)

• Broader Inclusion, Smaller Core RCT Set:

  • Five RCTs included despite a broad initial search (18:23).
  • Finding: “Superiority of BV cure rates and reduction in symptomatology using intravaginal vitamin C compared with placebo, either as monotherapy or as adjuvant...” (19:29)

• Unique Regimen for Recurrence Prevention

  • Six months of “burst” therapy: 6 days of vitamin C vaginal tablets monthly for 6 months.
  • Not daily use—“It does not mean that they used intravaginal vitamin C every single day for six months.” (21:02)

6. Clinical Bottom Line

• Effective Short-Term Aid:
  • “250 mg intravaginal vitamin C for anywhere from five, six or seven days can have a role to acidify the vagina.” (22:30)
• Monotherapy or Adjuvant: Replace/augment antibiotics, especially for recurrence or maintenance.
• Need for More Data: Especially for long-term prevention, but encouraging current evidence for a non-antibiotic option.

Notable Quotes & Memorable Moments

• On Evidence Repeating Itself:
  • “Spoiler, we were right.” (01:56)
• On Safe Use:
  • “Don’t put a packet of Emergency up the vagina... 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.” (06:35)
• Practical Caution:
  • “If you’re going to recommend [boric acid]... Look at me in the face over here. Do not eat the capsule of boric acid. That would be bad.” (08:23)
• On Recurrence Studies:
  • “Six months of intravaginal vitamin C does not mean they used intravaginal vitamin C every day for six months... Instead, once daily for six days per month for up to six months.” (21:02)
• On Podcast’s Role:
  • “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.” (11:19)

Timestamps for Key Segments

• 00:28 — Introduction to the topic and historical recap
• 03:50 — Spoiler: 2020 conclusions hold up in 2025
• 07:00 — Summary of new Green Journal review and meta-analysis
• 09:10 — Main conclusion: short-term BV cure/prevention (quote)
• 13:20 — Proper use, burst therapy approach, not chronic
• 15:33 — Discussion on alternative acidifying agents (boric acid, gentian violet)
• 18:23 — ACTA systematic review overview
• 19:29 — ACTA finding: vitamin C as superior to placebo
• 21:02 — Clarifying the “six months” regimen—monthly burst, not daily
• 22:30 — Clinical take-home: vitamin C’s practical role

Conclusion: Take-Home Clinical Pearls

• Intravaginal vitamin C (250mg daily for 5-7 days) is a credible, evidence-based option for short-term treatment and possibly recurrence prevention for BV, either as monotherapy or adjunct.
• Monthly burst therapy (6 days/month) may help prevent recurrences over several months.
• This intervention is NOT meant for chronic, daily, or prolonged continuous use.
• More research is needed for long-term prevention, but the recent systematic reviews reinforce its clinical relevance as a safe, accessible, non-antibiotic strategy.

Host: Dr. Chapa
Podcast Family: “As always, we’re thankful for you. We’re glad you’re part of our podcast community.” (24:34)