Herbal medicines for radiation vaginitis: A systematic review and meta-analysis

As a sequela of cervical cancer irradiation, radiation vaginitis provokes vaginal inflammation and may develop into ulcers, necrosis, adhesions and cause pain, which markedly diminishes the quality of life for affected individuals. However, the efficacy of conventional modalities, including medication and physical therapy, has not been satisfactory. Herbal medicines (HMs) demonstrate favorable safety profiles and efficacy in preventing and treating radiation vaginitis.

The registration number for this systematic review is CRD42025627673. Web of Science, Scopus, Embase, PubMed, Clinicaltrials.gov, Cochrane Library, Ovid, Sinomed, PsycholNFO, Wanfang Data, ChiCTR, Chongqing VIP, CINAHL and China National Knowledge Infrastructure (CNKI) for randomised controlled trials (RCT) involving herbal products from their inception to March 1, 2025. Review Manager 5.4 and Stata 15.0 were used to assess risk of bias and conduct meta-analyses. The required information size (RIS) was calculated using TSA software (version 0.9.5.10). Subsequently, the overall certainty of evidence was evaluated with the GRADE profiler (version 3.6).

16 studies containing 18 trials with 984 patients were included. The results showed that HMs were more effective than those of the control group in treating radiation vaginitis. Key indicators of outcomes include radiation vaginitis incidence(RR = 0.51 [0.40, 0.65], p < 0.00001, I2 = 20 %) (GRADE: ⊕⊕⊝⊝low), grade 1(RR = 0.69 [0.45, 1.06], p = 0.09, I2 = 0 %) (GRADE: ⊕⊝⊝⊝very low), grade 2(RR = 0.40 [0.23, 0.67], p = 0.0005, I2 = 0 %) (GRADE: ⊕⊕⊝⊝low), grade 3(RR = 0.27 [0.10, 0.75], p = 0.01, I2 = 0 %) (GRADE: ⊕⊕⊝⊝low), grade 4 (RR = 0.33 [0.05, 2.06], p = 0.24, I2 = 0 %) (GRADE: ⊕⊝⊝⊝very low), total efficiency(RR = 1.26 [1.19, 1.32], p < 0.00001, I2 = 41 %) (GRADE: ⊕⊕⊝⊝low), recovery rate(RR = 1.58 [1.12, 2.23], p = 0.010, I2 = 75 %) (GRADE: ⊕⊝⊝⊝very low), treatment time((SMD = -6.12 [-7.94, -4.30], p < 0.00001, I2 = 85 %) (GRADE: ⊕⊝⊝⊝very low), recurrence rate(RR = 0.41 [0.26, 0.62], p < 0.0001, I2 = 0 %) (GRADE: ⊕⊝⊝⊝very low).

HMs significantly reduced the incidence of radiation vaginitis in patients undergoing radiotherapy for cervical cancer, improved the severity of radiation vaginitis, increased the total efficiency, decreased the recurrence rate of treating radiation vaginitis, and further shortened the treatment time for patients with radiation vaginitis. The adverse event rate of HMs against radiation vaginitis was less than in the conventional treatment group. However, due to the quality of the literature, the study findings warrant cautious interpretation.