Efficacy of Honey Vaginal Application on A Wide Scale of Patients

with Dyspareunia
Original
Article Aimy Essam Mitwally1, Ahmed Shamel Hefny2 and Emad Salah2

Department of Obstetrics &Gynecology, Faculty of Medicine, 1Cairo University, 2new Giza

University, Cairo, Egypt

ABSTRACT
Objective: Most people who lead healthy lifestyles tend to use natural products as supplements, complementary medicine
or alternative treatments. Honey is God’s precious gift to mankind. Honey has been highly appreciated and extensively
used since ancient history due to its high nutritional and therapeutic values we aim to assess the effectiveness of intravaginal
honey in reducing dyspareunia.
Materials and Methods: Our study took place in the department of Obstetrics and Gynecology at Kasr Elainy From May
2018 till August 2019 the study was done on 300 participants, according to the calculated Sample size. The participants
were divided into Group A (150 participants) and Group B (150 participants). Group A received Placebo treatment in
the form of KY gel to be applied by the patient intravaginally for 3 weeks, while group B would apply pure bee honey
intravaginally also for 3 weeks.
Results: Applying pure bee Honey intravaginally daily at bed time can help moisturize dry vagina and treat infection and
thus improve symptoms of dyspareunia. Honey is superior to Ky gel with the same over the counter availability with no
side effects.
Conclusion: Reduction of Dyspareunia can be one of the many benefits of honey and improvement was related to
consistent use.

Key Words: Dyspareunia, intravaginal honey, pilot study.

Received: 04 January 2024, Accepted: 12 January 2024
Corresponding Author: Aimy Essam Mitwally, Department of Obstetrics &Gynecology, Faculty of Medicine, 1Cairo
University, Cairo, Egypt, Tel.: +2 01100662255, E-mail: aimyesam8@gmail.com
ISSN: 2090-7265, May 2024, Vol.14, No. 2

INTRODUCTION Dyspareunia can have a negative impact on a woman's

mental and physical health, body image, relationships
Honey is a known, loved nutrient that has long been with partners, and efforts to conceive. It can lead to,
known for its health benefits. We would like to highlight or be associated with, other female sexual dysfunction
disorders, including decreased libido, decreased arousal,
a new addition to its benefits which is, being used
and anorgasmia. Significant risk factors and predictors
intravaginally for improving dyspareunia[1].
for dyspareunia include younger age, education level
below a college degree, urinary tract symptoms, poor to
Dyspareunia in women is defined as recurrent or fair health, emotional problems or stress, and a decrease
persistent pain with sexual activity that causes marked in household income greater than 20%[6,7-9]. Natural honey
distress or interpersonal conflict[2]. It may be classified can be defined as a sweet, flavorful liquid substance
as entry or deep. Entry dyspareunia is pain with initial or of high nutritional value and immense therapeutic
attempted penetration of the vaginal introitus, whereas benefit[10]. Most bacteria, viruses and fungi are sensitive to
deep dyspareunia is pain that occurs with deep vaginal medicinal honey, as it is a very effective broad-spectrum
penetration. Dyspareunia is also classified as primary (i.e., antimicrobial agent. Researchers have demonstrated the
occurring with sexual debut and thereafter) or secondary antimicrobial activity of natural honey against Bacillus
subtilis, Escherichia coli, Pseudomonas aeruginosa and
(i.e., beginning after previous sexual activity that was not
Staphylococcus aureus as well as other Gram-positive
painful)[2]. Determining whether dyspareunia is entry or
and Gram-negative bacteria[11-14]. These authors opine that
deep can point to specific causes, although the primary the formation of hydrogen peroxide (H2O2) enhances the
vs. secondary classification is less likely to narrow the antibacterial capability of honey.The other beneficial health
differential diagnosis[3-5]. effects of varieties of natural honey and apitherapeutic

Personal non-commercial use only. EBX copyright © 2024. All rights reserved DOI:10.21608/EBWHJ.2024.260664.1289

191
honey vaginal application & dyspareunia

practices include treatment of general body pain, chest bed time and before intercourse (if it were to take place), to
pain, menstrual pain, fatigue, vertigo, postnatal disorders, be applied regularly every day, for a duration of 3 weeks.
male impotence, and respiratory distress such as cough, During the first week no recording of the pain score is
bronchitis, pharyngitis, throat aches, and urinary tract required from the patient, and accordingly it is explained to
infection (URTI). These effects might be connected with the Patient that the treatment will need time to work before
the high energy content of honey, in addition to its effects any improvement can be felt. On the following 2 weeks
against bacterial infection and inflammatory processes[15,16]. Patients are instructed to attempt intercourse at least twice
In one reproductive study, Zaid et al.[17] reported the effects per week and record their pain score following each act of
of tualang honey from Malaysia on menopausal rodents. intercourse.
The observation of uterine atrophy prevention informed
the suggested use of honey as an alternative to hormone Group B is instructed to apply pure bee honey daily,
replacement therapy by these authors. intravaginally for 3 weeks in the same fashion as the
placebo group, and then do the same recording of their
The conclusion can be drawn that the antioxidant pain score, following each act of intercourse, in the later
constituents, anti-inflammatory activity, free radical 2 weeks as well. Results were then compared between the
scavenging capability, reduction in necrotized tissue and 2 groups.
the provision of a rich energy source are among the more
important mechanisms of honey’s effects[18-20]. Inclusion criteria

This study aims to add to the benefits of honey, that not Women in childbearing age as well as postmenopausal
only is it a nutrient with antibacterial activity to be used women could participate. Candidates were between the
for wound infection and common colds, but that through ages of 20 to 60 years old.
intravaginal application can be used to reduce discomfort
felt during intercourse for those with such complaint and
Patients have experienced the dyspareunia after a period
is a remedy available in almost every home in addition to
of painless intercourse, and refer to it as deep dyspareunia,
having no side effects.
not on touch of the vestibule.

PATIENTS AND METHODS

Patients with vaginal infection on examination were
included if first line treatment to treat the infection has not
Our study took place in the department of Obstetrics caused relief of symptoms.
and Gynecology at Kasr Elainy From May 2018 till
August 2019 the same study was done on 300 participants,
Patients with vaginal examination revealing vaginal
according to the calculated Sample size. The participants
dryness or no obvious cause for the dyspareunia were
were divided into Group A (150 participants) and Group B
particularly included.
(150 participants).

Exclusion criteria
Results were then statistically analyzed and the Sample
size was calculated using the (G power software) to detect
the efficacy of honey vaginal application on a wide scale Patients were excluded if the Dyspareunia was
of patients with dyspareunia, and accordingly it was found dating since the onset of sexual activity (primary), was
that an appropriate size would be 150 participants per related to a certain position, and if the dyspareunia was
group, so a total of 300 participants. vestibular(superficial)and was due to and organic cause
such as vulvar dermatosis or vaginal anomalies or pelvic
Group A received Placebo treatment in the form of KY floor myalgia, Patients were excluded if they proved to be
gel to be applied by the patient intravaginally for 3 weeks, sensitive to either products in the study groups, Patients
while group B would apply pure bee honey intravaginally were also excluded if they were concomitantly using other
also for 3 weeks. lubricants or hormonal therapy.

Dyspareunia was defined as continuous unremitting Patients instructions

or intermittent pain associated with intercourse. Deep
dyspareunia was defined as dyspareunia following
deep penetration. Secondary dyspareunia was defined Patients were first subjected to a pelvic examination to
as dyspareunia developing after a period of painless point out the exact site of the pain, followed by speculum
intercourse[5,6]. examination to rule out exclusion criteria. Patient
were counseled that the relief would not to be expected
The placebo treatment assigned for Group A was following the first application but rather on regular use of
recommended to be applied intravaginally by the patient at the treatment.

192
 Mitwally et al.

Group A were then given Placebo treatment (in the (Table 2) show; no significant difference in the mean
form of a bottle filled with Ky gel), while Group B would basal NPS between dyspareunia patients received placebo
apply pure bee honey. Ky gel was chosen for placebo and those received honey (p value =0.71).
treatment due to its lubricant effect and being usually the
first line of treatment tried by most couples experiencing Significant decrease in NPS mean in dyspareunia
dyspareunia due to the over counter availability with no patients applied honey compared two those received
need for prescription. Patients were instructed to apply 1 placebo treatment in all records all through the study
cm of either the placebo or the honey just at the introitus (p value <0.001).
using a syringe and then wait for 2 days without treatment
to test for any sensitivity for either product. Table 2: recorded pain between both groups

Patients who were then legible for the study were

Placebo N=150 Honey N =150 P value
instructed to apply 3 cm of either treatments intravaginally,
Basal pain 6.57±1.22 6.62±1.26 0.71
using a syringe, to be done daily before bedtime and
immediately before any act of intercourse if it were to take 1st record 6.58±1.27 5.46±1.49 <0.001
place. Patients are allowed to stand after that and walk 2nd record 6.44±1.17 4.73±1.44 <0.001
normally to the bathroom if they wish to do so. Patients 3 record
rd
6.42±1.06 4.02±1.5 <0.001
were not asked to abstain from intercourse during the first 4th record 6.38±1.1 3.21±1.58 <0.001
week but were asked to attempt penetration at least twice
per week during the latter 2 weeks and make a score of (Table 3) show; no significant difference in the mean
their pain using the Numeric Rating Scale (with 10 being NPS in dyspareunia patients received placebo treatment
the worst pain and 0 being free of pain) following each act between all records all through the study (p value =0.1).
of intercourse.
Significant progressive decrease in NPS mean with time
Statistical analysis in dyspareunia patients applied honey (p value <0.001).

Data were coded and entered using the statistical Table 3: comparison of dysparunia between both groups
package SPSS (Statistical Package for the Social sciences)
version 25. Data was summarized using mean, standard
Basal 1st 2nd 3rd 4th
deviation quantitative data and using frequency (count) P value
pain record record record record
and relative frequency (percentage) for categorical data. Placebo
6.57 6.58 6.44 6.42 6.38 0.1
Comparisons between quantitative variables were done N =150
using unpaired t test. For comparing categorial data, Chi Honey
6.62 5.46 4.73 4.02 3.21 <0.001
square (c2) and fisher exact tests were performed. Repeated N=150
measure ANOVA was done to compare NPS in each group
all through the study. Correlations between quantitative No significant difference in basal pain severity
variables were done using Pearson’s correlation. P-values between the two groups of patients. The severity of pain
less than 0.05 were considered as statistically significant. is significantly in patients applied honey in compare to
patients received placebo in all records (p value<0.001).
50.7% of dyspareunia patients received placebo and 50 %
RESULTS
of those applied honey had severe pain at the basal record,
the severity is progressively decreased with time in patients
Three-hundred dyspareunia patients were included received honey in compare to received placebo all through
in the study, and divided in to two groups; group 1:150 the study; to become 24% of group II patients had severe
patients received placebo; group 2: 150 patients received pain in compare to group I whose 44% had severe pain in
honey with no significant differences between the two the first record (p value <0.001). 14.7% of group II patients
groups regarding (age, BMI, DOD) (P value = 0.43, 0.46, had severe pain in compare to group I whose 36% of them
and 0.74) respectively (Table1). had severe pain in the second record (p value <0.001).
6.7% of group II patients had severe pain in compare to
Table 1: background characteristics
group I whose 38.7% of them had severe pain in the third
record (p value <0.001). 2.6 % of group II patients had
severe pain in compare to group I whose 29.3 % of them
Placebo N=150 Honey N =150 P value had severe pain in the second record (p value <0.001).
Age 36.6±9.89 35.76±9.06 0.43
BMI 24.46±4.38 24.84±4.52 0.46 Correlation analysis between dyspareunia, DOD and
DOD (months) 12.46±4.9 12.65±5.00 0.74 age, BMI in all participating patients

193
honey vaginal application & dyspareunia

There was significant positive correlation between the that the lubricant effect of honey would be the cause for
age of the patients and the severity of pain at the basal the improvement. The precise effect Honey has on the
records (p value =0.03, r =0.125). Also, between age and vaginal epithelium needs further studies to be conducted
DOD (p value= 0.011, r = 0.147). on the other side there on the cell level. However, the improvement caused by
was significant positive correlation between DOD and age Honey, could be due to the antifungal effect of honey. The
(p value= 0.02, r = 0.135), and BMI p value <0.001, r= most appraised point after the application by most patients
0.238) (Tables 4,5). was the reduction in offensive vaginal discharge and the
burning sensation usually felt after intercourse.
Table 4: detailed comparison between basal and recorded pain
The application of Honey intravaginally has been
in both groups
studied before for evaluating the effect of Honey on Yeast
infection.
Placebo N=150 Honey N =150 P value
Basal pain According to a paper published online 2013 comparing
No pain 0(0%) 0(0%) the effect of honey and miconazole against Candida
Mid 0(0%) 0(0%) 0.9 albicans, concluded that the inhibitory effect of honey
Moderate 74(49.3%) 75(50%) without the fungicide effect is a very good trend in the
Severe 76(50.7%) 75(50%)
treatment of vaginal candidiasis[18].
1st record
No pain 0(0%) 0(0%) The antimicrobial properties of honey have been
Mid 0(0%) 16(10.7%) <0.001
confirmed in different studies, which could be the effect of
Moderate 84(56%) 98(65.3%)
Severe 66(44%) 36(24%) the following factors: Osmotic effect: Eighty-two percent
of honey contains a high concentration of carbohydrates,
2nd record
No pain 0(0%) 0(0%) but a low volume of water. It could inhibit the growth of
Mid 0(0%) 28(18.7%) <0.001 bacteria by cell dehydration. Fungi are more resistant to high
Moderate 96(64%) 100(66.7%) osmotic pressure than bacteria, Acidity: The honey pH, 3.2-
Severe 54(36%) 22(14.7%) 4.5, is due to the organic acids particularly glutamic acid,
3rd record pyruvic acid, malic, and citric acid, whereas, the minimum
No pain 0(0%) 0(0%) pH for bacteria growth is 7.2-7.4, Hydrogen peroxide
Mid 0(0%) 56(37.3%) <0.001
(H2O2) is often produced in diluted honey as a result of
Moderate 92(61.3%) 84(56%)
Severe 58(38.7%) 10(6.7%) glucose oxidation and Stimulation of the immune system
4th record
by B and T-cell cytogenesis and neutrophil activation[19-22].
No pain 0(0%) 0(0%)
Mid 0(0%) 94(62.7%) <0.001 The effect of intravaginal Honey on dyspareunia
Moderate 106(70.7%) 52(34.7%)
Severe 44(29.3%) 4(2.6%)
improvement could also be attributable to the hormone like
properties of Honey, which would be the cause of sense of
improvement in the group of patients, whom the complain
Table 5: P value of pain compaired to different parameters
of dyspareunia, is mainly due to vaginal dryness. It has
been suggested before in previous studies that honey can be
Basal pain Age BMI DOD
used as an alternative for Hormone replacement therapy[17].
r 1 .125* -.002 .147*
Basal pain P value .030 .970 .011
In a previous study, Bee pollen and honey were tested
N 300 300 300 300
for the alleviation of hot flushes and other menopausal
r .147* .135* .238** 1
symptoms in breast cancer patients, showed evidence that
DOD P value .011 .020 <.001
honey and bee pollen improve menopausal symptoms in
N 300 300 300 300 breast cancer patients receiving antihormonal treatment. As
it was observed there was an increase in the serum levels
DISCUSSION of estradiol with honey treatment in patients receiving
aromatase inhibitors/inactivators[23].
The application of honey intravaginally for
improvement of dyspareunia has not been studied before. Another study, Daily consumption of Tualang honey for
However, applying Honey intravaginally is not new for
2 weeks in female adult ovariectomized rats, a model for
many. This is a common practice among some countries
menopausal symptoms, provided protective and beneficial
such as Yemen owing to the known benefits of Honey.
effects. Tualang honey was shown to prevent uterine
atrophy, vaginal epithelium atrophy, promote increased
The sense of improvement felt by our Candidates in this
study caused by Honey and not by KY gel would exclude bone density and suppress the increased of body weight[17].

194
 Mitwally et al.

Also, another study aiming to assess the estrogenic REFERENCES

activity of Manuka honey, proved Manuka honey to have
estrogenic activity, as monitored using MCF-7 breast 1. Lewis RW, Fugl-Meyer KS, Corona G, et al.
cancer cell growth promotion assay[24]. Definitions/epidemiology/risk factors for sexual
dysfunction. J Sex Med. 2010;7(4 pt 2):1598–1607.
Candidate estrogenic components from honey are likely
to be flavonoids. Past research showed that flavonoids 2. Ferrero S, Ragni N, Remorgida V. Deep dyspareunia:
mediate estrogenic activity[25-30]. causes, treatments, and results. Curr Opin Obstet
Gynecol. 2008;20(4):394–399.
In order to enumerate the benefits on applying
Honey intravaginally, it should also be mentioned that 3. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in
intravaginal honey has been tried before in previous the United States: prevalence and predictors [published
studies for infertility treatment. In a study byAbdelhafiz,et correction appears in JAMA. 1999;281(13):1174].
al. to evaluate the efficacy of pericoital intravaginal JAMA. 1999;281(6):537–544.
applications of a mixture of Egyptian bee honey and royal
jelly (H/RJ) in the midcycle for the treatment of infertility 4. Eteraf-Oskouei T, Najafi M. Traditional and modern
due to asthenozoospermia, concluded that this might uses of natural honey in human diseases: A review.
be a simple and reasonably effective method of treating Iran J Basic Med Sci. 2013;16(6):731–742.
asthenozoospermia[31].
5. Alvarez-Suarez JM, Tulipani S, Diaz D, Estevez Y,
Another study by Kavousi M., et al.[32] studying the Romandini S, Giampieri F, et al. Antioxidant and
effect of a natural vaginal product based on honey on the antimicrobial capacity of several monofloral Cuban
success of intrauterine insemination (IUI) in infertility honeys and their correlation with color, polyphenol
treatment, concluded that it seems that the use of this content and other chemical compounds. Food Chem
vaginal product for a longer period of time and across Toxic. 2010;48(8–9):2490–2499. doi: 10.1016/j.
several menses cycles before IUI, may produce more fct.2010.06.021.
positive results.
6. Olaitan PB, Adeleke EO, Ola OI. Honey: a reservoir
Recommending Honey over Ky gel is related also to for microorganisms and an inhibitory agent for
the rare but possible side effects that may occur with KY microbes. Afr Health Sci. 2007;7(3):159–165.
gel; Signs of an allergic reaction, like rash; hives; itching;
red, swollen, blistered, or peeling skin with or without
7. Ajibola A. Phd thesis. Johannesburg, South Africa:
fever; wheezing; tightness in the chest or throat; trouble
University of the Witwatersrand; 2013. Effects of
breathing, swallowing, or talking; unusual hoarseness; or
dietary supplementation with pure natural honey on
swelling of the mouth, face, lips, tongue, or throat ,Signs of
metabolism in growing Sprague-Dawley rats.
skin infection like oozing, heat, swelling, redness, or pain,
Very bad skin irritation, Bleeding that is not normal from
the affected part and Fever. 8. Atwa AA, AbuShahba RY, Mostafa M, Mohamed IH.
Effect of honey in preventing gingivitis and dental
caries in patients undergoing orthodontic treatment.
CONCLUSION
Saudi Dent J. 2014;26(3):108–114. doi: 10.1016/j.
sdentj.2014.03.001.
Honey is superior to Ky gel and with easy access just
as the later. Honey can in addition help reduce infection
9. Molan P. Why honey is effective as a medicine. 1. Its
symptoms such as excessive vaginal discharge and
use in modern medicine. Bee Wrld. 1999;80:79–92.
offensive discharge, which Ky gel can't do. As per our
participants Honey didn't cause any sense of stickiness, nor
did it flow again out of the vagina following application, 10. Basualdo C, Sgroy VS, Finola MM, Marioli J.
which might be the reason holding some from trying it Comparison of the antibacterial activity of honey from
intravaginally, due to its sticky consistency. Accordingly, different provenance against bacteria usually isolated
improving dyspareunia symptoms can be added to the from skin wounds. Vet Microbiol. 2007;124:375–381.
many benefits of Honey. Applying honey intravaginally
can help treat candidiasis, improve dyspareunia and may 11. Vit P, Huq F. Systematic reviews on interventions
also benefit in treatment of infertility. with honey in cancer. In: Vit P, Roubik DW, editors.
Stingless bees process honey and pollen in cerumen
CONFLICT OF INTERESTS pots. Facultad de Farmacia y Bioanálisis, Universidad
de Los Andes; Mérida, Venezuela: 2013. pp. 1–9.
http:123456789/35292
There are no conflicts of interest.

195
honey vaginal application & dyspareunia

12. Watanabe K, Rahmasari R, Matsunaga A, Haruyama 23. Münstedt K, Voss B, Kullmer U, Schneider U, Hübner
T, Kobayashi N. Anti-influenza viral effects of honey J.,Bee pollen and honey for the alleviation of hot
in vitro: potent high activity of manuka honey. Arch flushes and other menopausal symptoms in breast
Med Res. 2014;45(5):359–365. doi: 10.1016/j. cancer patients,Mol Clin Oncol. 2015 Jul; 3(4): 869–
arcmed.2014.05.006. 874. Published online 2015 May 4. doi: 10.3892/
mco.2015.559
13. Ajibola A. In: Physiological effects of natural honey
on wounds in animals. 1st ed. Lynch S, editor. KG, 24. Khathleen Henderson et al.,Evaluation of Manuka
Germany: LAP; 2014. Honey Estrogen Activity Using the MCF ... https://
pdfs.semanticscholar.org/24f5/93e0a9e47b0abf381
14. Israili ZH. Antimicrobial properties of honey. 2d6599e596c98dae6e8.pdf1 Dec 2016 ... Aims: To
Am J Ther. 2014;21(4):304–323. doi: 10.1097/ assess the estrogenic activity of Manuka honey using
MJT.0b013e318293b09b. the MCF7 cell ... supplemented with 10% charcoal
stripped FBS and evaluated.
15. Heppermann B. Towards evidence based emergency
medicine: Best BETs from the Manchester Royal 25. Miksicek RJ. Commonly occurring plant flavonoids
Infirmary. Bet 3. Honey for the symptomatic relief have estrogenic activity. Mol. Pharmacol.
of cough in children with upper respiratory tract 1993;44(1):37-43. PMID: 8341277
infections. Emerg Med J. 2009;26(7):522–523.
26. Zava DT, Duwe G. Estrogenic and antiproliferative
16. Meda A, Lamien EC, Millogo J, Romito M, Nacoulma properties of genistein and other flavonoids in
OG. Ethnopharmacological communication human breast cancer cells in vitro. Nutr. Cancer.
therapeutic uses of honey and honeybee 1997;27(1):3140. PMID: 8970179
larvae in central Burkina Faso. J Ethnopharm.
2004;95:103–107. 27. Le Bail JC, Varnat F, Nicolas JC, Habrioux G.
Estrogenic and antiproliferative activities on MCF-7
human breast cancer cells by flavonoids. Cancer Lett.
17. Zaid SM, Sulaiman SA, Sirajudeen NM, Othman
1998;130(1):209-16. PMID: 9751276
NH. The effects of tualang honey on female
reproductive organs, tibia bone and hormonal
28. Han DH, Denison MS, Tachibana H, Yamada K.
profile in ovariectomised rats – animal model for
Relationship between estrogen receptor-binding and
menopause. BMC Compl Altern Med. 2010;10:82.
estrogenic activities of environmental estrogens and
doi: 10.1186/1472-6882-10-82.
suppression by flavonoids. Biosci Henderson et al.;
JABB, 10(3): xxx-xxx, 2016; Article no.JABB.29887
18. Banaeian-Borujeni S1, Mobini GR, Pourgheysari 10 Biotechnol Biochem. 2002;66(7):1479-87. PMID:
B, Validi M.Comparison of the effect of honey and 12224631 DOI: 10.1271/bbb.66.1479
miconazole against Candida albicans in vitro,2013
Jul 30;2:57. doi: 10.4103/2277-9175.115800. 29. van der Woude H, ter Veld MG, Jacobs N, van der
eCollection 2013. Saag PT, Murk AJ, Rietjens IM. The stimulation of cell
proliferation by quercetin is mediated by the estrogen
19. Küçük M, Kolayl S, Karaoğlu Ş, Ulusoy E, Baltac receptor. Mol. Nutr. Food Res. 2005;49(8):763-71
C, Candan F. Biological activities and chemical PMID: 15937998 DOI: 10.1002/mnfr.200500036
composition of three honeys.
30. Galluzzo P, Marino M. Nutritional flavonoids impact
20. Lusby PE, Coombes AL, Wilkinson JM. Bactericidal on nuclear and extranuclear estrogen receptor
activity of different honeys against pathogenic activities. Genes. Nutr. 2006;1(3-4):161-76. PMCID:
bacteria. Arch Med Res. 2005;36:464–7. PMC3454832 DOI: 10.1007/BF02829966

21. Ozlugedik S, Genc S, Unal A, Elhan AH, Tezer M, Titiz 31. Abdelhafiz AT1, Muhamad JA.,Midcycle pericoital
A. Can postoperative pains following tonsillectomy intravaginal bee honey and royal jelly for male
be relieved by honey?: A prospective, randomized, factor infertility,Int J Gynaecol Obstet. 2008
placebo controlled preliminary study. Int J Pediatr May;101(2):146-9. doi: 10.1016/j.ijgo.2007.11.012.
Otorhinolaryngol. 2006;70:1929–34. Epub 2008 Jan 28.

32. 32.Kavousi M, Khadem Ghaebi N, Najaf Najafi M,

22. Boukraâ L, Bouchegrane S. Additive action of honey Mokaberinejad R, Feyzabadi Z, Salari R.Avicenna
and starch against Candida albicans and Aspergillus J Phytomed. 2019 Jul-Aug;9(4):310-321.,
niger. Rev Iberoam Micol. 2007;24:309–11. PMID: 31309070

196