Intravaginal Formulation Strategies for Vaginal Disorders: Optimizing Phytochemical and Biological Preparations—A Review

Recurrent vaginal disorders remain a significant clinical challenge despite available antimicrobial and hormonal therapies. Therefore, natural, probiotic, and biological intravaginal preparations have been investigated as locally delivered adjunctive or supportive approaches for infectious, inflammatory, and atrophic vaginal conditions, with growing attention to how dosage form, mucosal retention, drug release, and patient acceptability influence clinical utility. This structured narrative review of 119 studies across six databases synthesizes clinical evidence for phytochemical-based and biological intravaginal preparations, organized into five formulation categories: creams and gels, suppositories and vaginal tablets, douches and washes, probiotic preparations, and combined phytochemical–biological preparations. Across formulation types, creams and gels were associated with application convenience and local symptom relief, whereas suppositories and vaginal tablets offered longer mucosal contact, dosing precision, and sustained exposure. Herbal intravaginal preparations were the most diverse, encompassing traditional medicine-derived creams, gels, suppositories, tablets, washes, and fumigation-based approaches. Among these, Zataria multiflora- and Sophora flavescens-based formulations were supported by comparatively consistent clinical signals. Probiotic preparations provided an important microbiome-directed model, whereas combined phytochemical–biological preparations remained preliminary. These findings support moving beyond active ingredient selection toward intravaginal formulation optimization. However, heterogeneity in formulations, comparators, outcome measures, and follow-up durations limited direct comparisons across studies.