The efficacy of complementary treatment with marshmallow (Althaea officinalis L.) on vulvovaginal candidiasis: A randomized double-blinded controlled clinical trial

Explore (NY). 2023 Nov-Dec;19(6):813-819. doi: 10.1016/j.explore.2023.04.005. Epub 2023 Apr 17.


Background: Vulvovaginal candidiasis is a common gynecologic infection, and recurring cases are yet incurable. This trial was based on Persian medicine to compare how effective marshmallow aqueous extract 4% plus clotrimazole 1% (CLOT-M) is compared to clotrimazole 1% vaginal creams on VVC.

Methods: This study randomly assigned 100 women with VVC into two groups. The target group (n = 50) was treated with CLOT-M while controls (n = 50) with clotrimazole vaginal creams for seven consecutive nights. Different VVC symptoms and signs, and yeast culture from vaginal discharge were evaluated as the outcome measures before the intervention and 7 and 30 days after.

Results: The efficacy of CLOT-M vaginal cream was assessed during the 1st and 2nd follow-ups, indicating a significant decrease in mean itching (P = 0.001 for both comparisons) and dyspareunia score (P = 0.001 and P = 0.04, respectively) as compared to treatment with clotrimazole vaginal cream. Moreover, after 7 days of the intervention, patients in the CLOT-M group experienced significant improvement in mean dysuria score compared to those in the control group (P = 0.001). Neither cream caused any significant adverse events.

Conclusion: It seems that CLOT-M vaginal cream had a significant effect on the VVC symptoms improvement, without any significant side effects. However, larger sample-sized trials are needed for more evidence-based judgment.

Keywords: Althaea officinalis L.; Clotrimazole; Marshmallow; Traditional Persian medicine; Vaginal cream; Vulvovaginal candidiasis.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Althaea*
  • Antifungal Agents / therapeutic use
  • Candidiasis, Vulvovaginal* / drug therapy
  • Clotrimazole / therapeutic use
  • Female
  • Humans
  • Vaginal Creams, Foams, and Jellies / therapeutic use


  • Clotrimazole
  • Antifungal Agents
  • Vaginal Creams, Foams, and Jellies