First of all, it is important to understand that there are no studies telling us exactly how to use gentian violet in the vagina. The information below is extracted from a variety of sources and should be considered a “best guess” based on bench research, some clinical experience, anecdotal reports from patients, an assorted collection of posts on other sites, some papers from the 1950’s and 60’s, and alternative medicine reviews that don’t say how people specifically used gentian violet just that they used it. This is level 5 evidence (the lowest quality) and thus has a grade D recommendation. Caveat emptor.
So why this post as I’m always spouting on about evidence-based medicine? Well, it’s not that gentian violet doesn’t kill yeast, studies tell us that it is fungicidal. It’s just we don’t really know the best concentration, method of application, and duration or use or data on long-term implications of use for the vagina. It’s used effectively in the mouth for HIV patients it’s probably safe for the vagina. However, I recognize women are looking for other options and in addition I’ve been looking into gentian violet for biofilms (I will post on that soon, biofilms may play a role in recurrent yeast and it’s really fascinating stuff). Given I know the relevant studies, am a vulvovaginal expert, and have a fellowship in infectious diseases I felt ideally suited to combine what the best that the literature, common sense, and clinical experience have to offer.
What is gentian violet? It is a coal-tar derivative. It takes chemistry and some nasty chemicals to get from coal to coal-tar and then from coal-tar to gentian violet (the formula is found in textbooks on industrial chemistry). While gentian violet technically starts out as coal, which is natural, whether it’s a natural product is all in how you define “natural” (i.e. marketing).
Concentrations of gentian violet greater than 1% should not be used as this can be very irritating, especially to the delicate tissues of the vagina. Some of the older studies painted the vaginal walls in the office with 1% gentian violet, though how often I just don’t know as these studies are from the 1950’s and I can’t retrieve them (the limitations of 1950’s microbiology and the ethics of pre-IRB studies notwithstanding). I have used 1% in the office, Recent studies with oral use for thrush find that 0.5% is effective and one small study found that a concentration of 0.1% (and even lower) was very effective at killing yeast in the mouth and caused less staining. Unfortunately, we don’t have studies to tell us the optimal concentration for vaginal use, but certainly it suggests that diluting the gentian violet can be considered to reduce irritation and mess (how dilute you can go is unknown, but for those who are chemistry-minded trying a lower dose might be appealing. If you do go lower, please post a reply below).
Gentian violet is very messy. It will stain everything. You should use gloves when applying it and the best way to get it into the vagina at home is with a tampon (instructions below). It will also stain your vulvar skin and even after the tampon is removed you will have a purple discharge that can stain, so wearing a pad at all times and underwear that you don’t care about. Use dark towels to cover the floor when you insert the tampon (or squat very carefully over the toilet). It is not possible to stress enough how messy this is and how much it stains. You can consider putting Vaseline on your labia to prevent staining on your vulva.
You should not be sexually active while using gentian violet. Intercourse can cause small breaks in the skin and when this happens the gentian violet could potentially leave a permanent tattoo. Also, gentian violet will stain your partner and no one wants a purple penis, fingers, or lips.
The tampon should be left in for 3 to 4 hours and then removed. The optimal duration for home use has not been defined; some people think 5 days is enough and others think up to 12 days is needed. Some people say twice a day (with oral yeast in HIV patients twice a day is recommended, but that’s the mouth and HIV patients, so not a fair comparison). If you have any irritation using gentian violet you should stop using it and be seen by your doctor.
What you need:
- Disposable gloves
- Gentian violet 1%
- A disposable Tupperware type plastic container for mixing the gentian violet and soaking the tampon
- Tampons with a plastic applicator (a cardboard applicator will fall apart in the liquid)
- A tablespoon (and possibly teaspoon) that you won’t mind throwing away
- Dark towels
- Vaseline to coat your skin (if you choose)
- Underwear that you won’t mind throwing away
- Plastic baggies (for throwing away the tampon applicator, you don’t want to risk stains as you chuck the tampon in the trash, but obviously you can avoid this step if you like)
Step One: Wash your hands. Apply Vaseline to protect the skin of your vulva if you decide on that option. Have your pad secure in the underwear that you are going to put on and close at hand. Wash your hands again and dry them well. Put on the disposable gloves. (you can also apply the Vaseline while the tampon is soaking up the gentian violet if mixing up the stuff with your bottoms off bothers you and you think you can be quick about it).
Step Two: Add one tablespoon of gentian violet 1% to the Tupperware container. If you plan on diluting it add another tablespoon of water and you will have a 0.5% solution (based on the oral studies for thrush 0.5% is probably fine and likely to be less irritating). You don’t need much liquid. If you want to make a 0.1% solution use one teaspoon of gentian violet and three tablespoons of water.
Step Three: Take the tampon out of the wrapper and put the tip in the gentian violet. The liquid will soak up into the tampon through the opening at the tip. Let it soak about ¾ of the way up. This will not take very long (a few minutes at most).
Step Four: Insert the tampon as you normally would and put the applicator in the baggie to throw away. Remove the tampon after 3-4 hours and discard, remove sooner if you have irritation.
Repeat this for 5 to 12 days depending on your symptoms. Starting at once a day seems reasonable.
If you fail this or any other treatment for yeast you should get a yeast (mycology) culture before retreating. Many women and their health care providers incorrectly diagnose chronic yeast based on symptoms or the and what they see (or think they see) under the microscope. A mycology culture is the gold standard. You don’t want to use any treatment repeatedly for a problem that you may not have.
THIS POST IS NOT DIRECT MEDICAL ADVICE.