{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T23:14:52Z","timestamp":1772234092860,"version":"3.50.1"},"reference-count":42,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2020,2,1]],"date-time":"2020-02-01T00:00:00Z","timestamp":1580515200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>While intimate feminine hygiene products are widely used as part of daily cleansing routines, little is known about how these products impact the vulvovaginal area and its microbiome stability. This 4 week clinical study assessed tolerance of a novel gel wash containing lactic acid (pH 4.2) for external daily use when used on the external genital area and its effects on skin moisturization, vulvar skin pH, and the vulvar microbiome. After a 7 day pre-study conditioning period, 36 healthy females in three balanced age groups (18\u201329, 30\u201344, and 45\u201355 years) used the gel wash to cleanse their external genital area (mons pubis and vulva) and entire body at least once per day for 28 days. Skin tolerance of the gel wash was assessed by the gynecologist. Effects of the gel wash on vulvar skin microbiota were studied by performing bacterial 16S rRNA and fungal internal transcribed spacer (ITS) microbial richness and diversity analysis. Based on gynecologic assessment after 28 days of use, the gel wash showed acceptable tolerance, with no signs of increased dryness, redness, edema, itching, stinging, or burning. Use of the gel wash was associated with a significant increase in both short-term (single application) and longer-term (daily use for 28 days) skin moisturization. There was no significant change in vulvar skin pH over time with daily product use, and the gel wash did not significantly affect the natural vulvar microbiome species richness or diversity for bacteria or fungi. Results showed that this gel wash is a mild, moisturizing cleanser that maintains the natural pH and microbial diversity of vulvar skin. To our knowledge, this was the first study to assess the effect of an antimicrobial feminine gel wash on the natural pH and vulvar microbiome habitat of the skin using bacterial 16S rRNA and fungal ITS genetic sequencing techniques.<\/jats:p>","DOI":"10.3390\/antibiotics9020055","type":"journal-article","created":{"date-parts":[[2020,2,3]],"date-time":"2020-02-03T11:28:31Z","timestamp":1580729311000},"page":"55","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["A 28 Day Clinical Assessment of a Lactic Acid-containing Antimicrobial Intimate Gel Wash Formulation on Skin Tolerance and Impact on the Vulvar Microbiome"],"prefix":"10.3390","volume":"9","author":[{"given":"Elizabeth","family":"Bruning","sequence":"first","affiliation":[{"name":"Reckitt Benckiser LLC, Montvale, NJ 07054, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Chen","sequence":"additional","affiliation":[{"name":"Reckitt Benckiser LLC, Montvale, NJ 07054, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen A.","family":"McCue","sequence":"additional","affiliation":[{"name":"Reckitt Benckiser LLC, Montvale, NJ 07054, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph R.","family":"Rubino","sequence":"additional","affiliation":[{"name":"Reckitt Benckiser LLC, Montvale, NJ 07054, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8024-5600","authenticated-orcid":false,"given":"Jeremy E.","family":"Wilkinson","sequence":"additional","affiliation":[{"name":"RTL Genomics, Research and Testing Laboratory, Lubbock, TX 79424, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan D. G.","family":"Brown","sequence":"additional","affiliation":[{"name":"Alba Science Ltd., Edinburgh EH1 3RH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,2,1]]},"reference":[{"key":"ref_1","first-page":"58","article-title":"Role of female intimate hygiene in vulvovaginal health: Global hygiene practices and product usage","volume":"13","author":"Chen","year":"2017","journal-title":"Women\u2019s Health"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Farage, M.A., and Maibach, H.I. (2016). Tissue structure and physiology of the vulva. The Vulva: Anatomy, Physiology and Pathology, Informa Healthcare.","DOI":"10.3109\/9781420005318"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1111\/j.1346-8138.2007.00395.x","article-title":"Sanitary napkin contact dermatitis of the vulva: Location-dependent differences in skin surface conditions may play a role in negative patch test results","volume":"34","author":"Wakashin","year":"2007","journal-title":"J. Dermatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1038\/nrmicro2537","article-title":"The skin microbiome","volume":"9","author":"Grice","year":"2011","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"4680","DOI":"10.1073\/pnas.1002611107","article-title":"Vaginal microbiome of reproductive-age women","volume":"108","author":"Ravel","year":"2011","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1016\/j.cll.2014.08.006","article-title":"The changing landscape of the vaginal microbiome","volume":"34","author":"Huang","year":"2014","journal-title":"Clin. Lab. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1067\/mob.2001.115867","article-title":"Defense factors of vaginal lactobacilli","volume":"185","author":"Aroutcheva","year":"2001","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1128\/jcm.27.2.251-256.1989","article-title":"Prevalence of hydrogen peroxide-producing Lactobacillus species in normal women and women with bacterial vaginosis","volume":"27","author":"Eschenbach","year":"1989","journal-title":"J. Clin. Microbiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1099\/jmm.0.46607-0","article-title":"Preliminary characterization of the normal microbiota of the human vulva using cultivation-independent methods","volume":"56","author":"Brown","year":"2007","journal-title":"J. Med. Microbiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"76","DOI":"10.7883\/yoken.64.76","article-title":"Influence of menstruation on the microbiota of healthy women\u2019s labia minora as analyzed using a 16S rRNA gene-based clone library method","volume":"64","author":"Shiraishi","year":"2011","journal-title":"Jpn. J. Infect. Dis."},{"key":"ref_11","unstructured":"Royal College of Obstetricians & Gynecologists (2020, January 30). The Management of Vulval Skin Disorders. Green-top Guideline No. 58. Available online: https:\/\/www.bashh.org\/documents\/UK%20national%20guideline%20for%20the%20management%20of%20vulval%20conditions%202014.pdf."},{"key":"ref_12","first-page":"99","article-title":"The Middle East and Central Asia guidelines on female genital hygiene","volume":"19","author":"Arab","year":"2011","journal-title":"BMJ Middle East."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"429","DOI":"10.2340\/0001555570429431","article-title":"Differences in the skin surface pH and bacterial microflora due to the long-term application of synthetic detergent preparations of pH 5.5 and pH 7.0. Results of a crossover trial in healthy volunteers","volume":"70","author":"Korting","year":"1990","journal-title":"Acta Derm. Venereol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"41","DOI":"10.2340\/00015555674147","article-title":"Influence of repeated washings with soap and synthetic detergents on pH and resident flora of the skin of forehead and forearm. Results of a cross-over trial in health probationers","volume":"67","author":"Korting","year":"1987","journal-title":"Acta Derm. Venereol."},{"key":"ref_15","first-page":"147","article-title":"Changes in skin pH and resident flora by washing with synthetic detergent preparations at pH 5.5 and 8.5","volume":"42","author":"Korting","year":"1991","journal-title":"J. Soc. Cosmet. Chem."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Fashemi, B., Delaney, M.L., Onderdonk, A.B., and Fichorova, R.N. (2013). Effects of feminine hygiene products on the vaginal mucosal biome. Microb. Ecol. Health Dis., 24.","DOI":"10.3402\/mehd.v24i0.19703"},{"key":"ref_17","first-page":"99","article-title":"In vitro inhibition of commercial douche products against vaginal microflora","volume":"8","author":"Pavlova","year":"2000","journal-title":"Infect. Dis. Obstet. Gynecol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1007\/BF01961138","article-title":"In vitro antibacterial activity of antiseptics against vaginal lactobacilli","volume":"11","author":"Juliano","year":"1992","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1097\/NMC.0b013e3181cae9da","article-title":"An updated review of evidence to discourage douching","volume":"35","author":"Cottrell","year":"2010","journal-title":"MCN Am. J. Matern. Child Nurs."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"O\u2019Hanlon, D.E., Moench, T.R., and Cone, R.A. (2013). Vaginal pH and microbicidal lactic acid when lactobacilli dominate the microbiota. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0080074"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1590\/S0104-42302011000400015","article-title":"Use of a lactic acid plus lactoserum intimate liquid soap for external hygiene in the prevention of bacterial vaginosis recurrence after metronidazole oral treatment","volume":"57","author":"Bahamondes","year":"2011","journal-title":"Rev. Assoc. Med. Bras."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1016\/j.resmic.2017.04.001","article-title":"The role of lactic acid production by probiotic Lactobacillus species in vaginal health","volume":"168","author":"Tachedjian","year":"2017","journal-title":"Res. Microbiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.ajog.2010.07.010","article-title":"Contemporary perspectives on vaginal pH and lactobacilli","volume":"204","author":"Linhares","year":"2011","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1111\/1471-0528.13115","article-title":"The vaginal microbiome, vaginal anti-microbial defence mechanisms and the clinical challenge of reducing infection-related preterm birth","volume":"122","author":"Witkin","year":"2015","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1016\/0190-9622(90)70268-M","article-title":"Sodium lauryl sulfate-induced irritant contact dermatitis in vulvar and forearm skin of premenopausal and postmenopausal women","volume":"23","author":"Elsner","year":"1990","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_26","first-page":"77","article-title":"Effect of low-concentration sodium lauryl sulfate on human vulvar and forearm skin. Age-related differences","volume":"36","author":"Elsner","year":"1991","journal-title":"J. Reprod. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"293","DOI":"10.3349\/ymj.2006.47.3.293","article-title":"An update of the defensive barrier function of skin","volume":"47","author":"Lee","year":"2006","journal-title":"Yonsei Med. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1111\/j.1467-2494.2006.00344.x","article-title":"Natural skin surface pH is on average below 5, which is beneficial for its resident flora","volume":"28","author":"Lambers","year":"2006","journal-title":"Int. J. Cosmet. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"261","DOI":"10.2340\/00015555-1531","article-title":"Skin pH: From basic science to basic skin care","volume":"93","author":"Ali","year":"2013","journal-title":"Acta Derm. Venereol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1159\/000246568","article-title":"The concept of the acid mantle of the skin: Its relevance for the choice of skin cleansers","volume":"191","author":"Schmid","year":"1995","journal-title":"Dermatology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"242","DOI":"10.2340\/00015555-1534","article-title":"Characterization of vulvar skin of healthy Thai women: Influence of sites, age and menopause","volume":"93","author":"Fujimura","year":"2013","journal-title":"Acta Derm. Venereol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.1111\/j.1365-4632.2012.05582.x","article-title":"Study of the vulvar skin in healthy Japanese women: Components of the stratum corneum and microbes","volume":"52","author":"Miyamoto","year":"2013","journal-title":"Int. J. Dermatol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1111\/j.1365-2133.1979.tb00024.x","article-title":"Quantitative microbiology of human vulva","volume":"101","author":"Aly","year":"1979","journal-title":"Br. J. Dermatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1038\/nature13786","article-title":"Biogeography and individuality shape function in the human skin metagenome","volume":"514","author":"Oh","year":"2014","journal-title":"Nature"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.jdermsci.2015.05.001","article-title":"Pilot study on novel skin care method by augmentation with Staphylococcus epidermidis, an autologous skin microbe\u2014A blinded randomized clinical trial","volume":"79","author":"Nodake","year":"2015","journal-title":"J. Dermatol. Sci."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"343ra82","DOI":"10.1126\/scitranslmed.aad7121","article-title":"Antibiotics, birth mode, and diet shape microbiome maturation during early life","volume":"8","author":"Bokulich","year":"2016","journal-title":"Sci. Transl. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1038\/nm.4039","article-title":"Partial restoration of the microbiota of cesarean-born infants via vaginal microbial transfer","volume":"22","author":"Shen","year":"2016","journal-title":"Nat. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1038\/nm.4272","article-title":"Maturation of the infant microbiome community structure and function across multiple body sites and in relation to mode of delivery","volume":"23","author":"Chu","year":"2017","journal-title":"Nat. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/j.it.2014.04.007","article-title":"Ontogeny of early life immunity","volume":"35","author":"Dowling","year":"2014","journal-title":"Trends Immunol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1038\/jid.1965.164","article-title":"A new method for the quantitative investigation of cutaneous bacteria","volume":"45","author":"Williamson","year":"1965","journal-title":"J. Investig. Dermatol."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"McMurdie, P.J., and Holmes, S. (2013). phyloseq: An R package for reproducible interactive analysis and graphics of microbiome census data. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0061217"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Wickham, H. (2009). Ggplot2: Elegant Graphics for Data Analysis, Springer.","DOI":"10.1007\/978-0-387-98141-3"}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/9\/2\/55\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T08:53:37Z","timestamp":1760172817000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/9\/2\/55"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,1]]},"references-count":42,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2020,2]]}},"alternative-id":["antibiotics9020055"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics9020055","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2,1]]}}}