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

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.