Chapter 15: Medicines optimization: ensuring quality and safety
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Vaginal administration
Definition
Medications are inserted into the vaginal canal usually for local effects such as treatment of infections (e.g. Trichomonas and Candida infections) and contraceptive purposes. They can also be used for systemic effects (e.g. administration of oestrogens and progesterones) but this is less common (Chernecky et al. [39], Perry [281]).
Related theory
Evidence‐based approaches
The advantages of the vaginal route include the following (Hillery et al. [128]):
- The vagina offers a large surface area for drug absorption.
- A rich blood supply ensures rapid absorption of the drug.
- This route can act as an alternative for drugs that cannot be delivered via the oral route (as for suppositories).
- The vaginal route can deliver a drug over a controlled period of time, thus avoiding peaks and troughs, which can result in toxicity and risk ineffectiveness.
The disadvantages of the vaginal route include the following (Hillery et al. [128]):
- The route is limited to drugs that are potent molecules and are therefore easily absorbed.
- The vagina can easily be irritated by the use of devices or locally irritating drugs.
- Care must be taken with the use of vaginal devices to ensure they are sterilized and do not act as a growth medium for bacteria.
- Vaginal bioavailability can be affected by hormone levels and can therefore change during menstrual cycles, with age and during pregnancy.
- Leakage can occur with vaginal preparations. This can be alleviated by using the preparation at night.
- This route may not be acceptable to some patients.
Pre‐procedural considerations
Specific patient preparation
Check the patient's allergy status and also ascertain whether they have recently given birth or undergone vaginal surgery, as this may alter tissue integrity and the level of discomfort. Additionally, review the patient's willingness and ability to self‐administer the medication (Chernecky et al. [39], Perry [281]).
Procedure guideline 15.5
Medication: vaginal administration
Post‐procedural considerations
The patient needs to retain the medication so it is recommended that the medication is administered prior to the patient going to bed, or the patient should remain supine for 5–10 minutes after the pessary is instilled (Chernecky et al. [39], Perry [281]). Explain to the patient that they may also notice discharge following administration and that it is nothing to be concerned about.
