ABSTRACT
For thousands of years, women have been administering a wide range of substances to the vagina, primarily for contraception or for the treatment of infection. The Kahun Papyrus, an ancient Egyptian treatise on gynecology, mentions such contraceptive methods as the use of a vaginal suppository containing crocodile dung mixed with honey and sodium carbonate. In the Papyrus of Ebers, another ancient Egyptian document on medicine, the recommended method was to insert into the vagina Acacia tips containing gum arabic, which, when dissolved in water, liberated lactic acid. This latter preparation is not dissimilar in concept to modern-day intravaginal administration of lactic acid pessaries to restore or maintain the natural, slightly acidic pH of the vagina. More alarmingly, in the nineteenth century, abortion, suicide, and homicide attempts using vaginally administered arsenic and other poisons were not uncommon. Thus, it has long been realized that exogenous chemicals, when administered intravaginally, could find their way into the systemic circulation. However, this belief was not formalized until the publication of the seminal study by David Macht [1] in 1918, which described the absorption of alkaloids, inorganic salts, esters and antiseptics through the vagina, thus demonstrating for the first time the potential for systemic drug delivery via this route.
