a procedure to instill the drug into vagina. will be helpful for neophyte nurses and student nurses.

1. Prepared by-
Aashish Parihar
m.sc. nursing

2. Introduction
Advantages
Disadvantages
Forms of medication
General instructions
Articles required
Procedure

3. Introduction
Vagina is route for administration for
contraceptives, antifungal and anti microbial.
It is used for the achievement of local and
systemic absorption.
Vaginal medications include suppositories,
creams, gels, and ointments.
Suppositories melt when they contact the
vaginal mucosa, and their medication diffuses
topically (as effectively as creams, gels, and
ointments).
Vaginal medications usually come with a
disposable applicator that enables placement of
medication in the anterior and posterior fornices.

4. Advantages
Prolonged release.
Minimal systemic side effects.
An increase in bioavailability.
Use of less total drug than an oral dose.
First-pass metabolism can be avoided.
Self medication is possible.

5. Disadvantages
Patient incompliance.
Only a few drugs are administered by this route.
Variability in drug absorption related with
menstrual cycle, menopause and pregnancy, can
also limit vaginal drug delivery route usage.
Influence with sexual intercourse.
Gender specificity.

6. Forms of vaginal medication
Many different types of formulations have been applied
vaginally as-
 Tablets
 Vaginal suppositories or pessaries (globular, oviform
or cone-shaped, and weighing about 5 g each. )
 Douches (aqueous solutions that are administered into
the vagina for cleansing purpose. )
 Foams
 Sprays
 Gels
 Creams
 Vaginal rings
(Creams, gels, sprays and foams are used as vehicles for
drugs such as anti-infective or contraceptive agents.)

7. General instructions
To prevent damage, suppositories must be stored
in refrigerator.
Foams, jellies, and cream are administered with
an inserter or applicator.
Perineal pads may be used to collect excess
drainage after inserting a suppository.
Good aseptic technique must be followed.
Good perineal hygiene must be maintained.
The patient should be encouraged to empty her
bladder as she has to lie down for 20 minutes
The patient can either lie supine with knees up or
lateral with knees up
Always lubricate the pessary or applicator before
inserting

8. Articles required
A clean tray containing-
 Medication administration record (MAR)
 Nonsterile gloves
 Mackintosh
 Prescribed vaginal suppository or any other form of
vaginal medication
 Perineal pads
 Water-soluble lubricant
 Disposable applicator
 Tissue paper/ cotton balls
 Paper bag
 Kidney tray
And
 Side screen

9. Procedure
Preliminary assessment-
 Review the physician’s order, patient’s name, name and form
of vaginal medication, dosage and time.
 Explain procedure to patient. If client plans to self-administer,
be very specific with instructions.
 Gather necessary equipment.
 Follow the rights of medication administration.
 Ask the client to void.
 Provide for privacy.
 Wash hands
 Don Nonsterile gloves.
 Position the client in a dorsal recumbent position with knees
flexed and hips rotated laterally or in a Sims’ position.
 Assess perineal area, inspect vaginal orifice, note any odor or
discharge from the vagina, and inquire about any problems
such as itching or discomfort.

10. Procedure
 If secretion or discharge is present, cleanse the
perineal area with soap and water.
 Remove suppository from the foil wrapper and, if
applicable, insert into applicator tip.
 Apply a small amount of lubricant to rounded tip of
suppository.
 If not using an applicator, apply a small amount of
lubricant to gloved index finger.
 With non dominant hand, spread labial folds. Insert
the suppository into the vaginal canal at least 2 inches
(5 cm) along the posterior wall of the vagina or as far
as it will go
 If using an applicator, insert as described above and
depress plunger to release suppository.

11. Procedure
After care-
 Wipe the perineum with clean, dry tissue.
 Instruct the client to remain in bed for 15 minutes.
 Wash applicator under cool running water to clean and
return to appropriate storage in the client’s room.
 Remove gloves, turning them inside out, dispose them.
 Wash hands.
 Record on the MAR the drug’s name dosage, route, and
date and time of administration; document any evidence
of discharge or odor from the vagina.
 Check with the client in 15 minutes to ensure that the
suppository did not slip out and to allow the client to
verbalize any problems or concerns.
 Observe for effectiveness of the medication; inspect the
condition of the vaginal canal and external genitalia
between applications.