Tolerance of Chlorhexidine Gluconate Vaginal Cleansing Solution: A Randomized Controlled Trial

Abstract

Objective:

The aim of this research was to compare the tolerance of 4% chlorhexidine gluconate (CHG)/isopropyl alcohol versus 7.5% povidone–iodine (PI) vaginal cleansing solutions in patients undergoing hysteroscopic procedures.

Materials and Methods:

For this randomized controlled trial at a university hospital, women at least 18 years old, who were undergoing diagnostic or operative hysteroscopy procedures, were randomized to either PI or CHG antiseptic as a vaginal preparation in a single-blinded fashion. The primary outcome was the presence and severity of vaginal dryness, vaginal burning, vaginal itching, unusual vaginal discharge, and burning or pain with urination. Patients completed a standardized survey at 3 timepoints: preoperatively (T0); immediately postoperatively (T1); and 24–48 hours postoperatively (T2).

Results:

Of 134 patients recruited and randomized, 123 (63 = PI, 60 = CHG) were analyzed at T0 and 97 patients completed all follow-up surveys. When controlling for age, menopause, catheterization, and T0 scores, patients treated with CHG had significantly higher rates of vaginal dryness (adjusted odds ratio (aOR): 4.38; 95% confidence interval (CI): 1.06–17.96; p = 0.042), vaginal burning (aOR: 6.45; 95% CI: 2.33–17.86; p < 0.001), and burning or pain with urination (aOR: 3.30; 95% CI: 1.18–9.19; p = 0.022). At T1, 54.2% of CHG versus 34.9% of PI patients had adverse symptoms. At T2, patients receiving CHG noted significantly more vaginal burning (aOR: 5.05; 95% CI: 1.85–13.78; p = 0.002), unusual discharge (aOR: 3.56; 95% CI: 1.13–11.26; p = 0.030), and burning or pain with urination (aOR: 4.78; 95% CI: 1.66–13.78; p = 0.004). At T2, 68.8% CHG versus 43.8% PI patients experienced adverse symptoms.

Conclusions:

Use of CHG vaginal preparation was associated with significantly worse vaginal and urinary symptoms, compared with PI, both in the immediate postoperative period and 24–48 hours postoperatively. Patients treated with CHG vaginal antiseptic for clean-contaminated gynecologic surgeries should be warned about the potential adverse side-effects.