Infectious complications of hysterectomy remain common despite the use
of prophylactic antibiotics. Most are caused by contamination of the
surgical site by vaginal bacteria which are not controlled by current
methods of pre-operative antisepsis. The medical literature concerning
antiseptic preparation of the vagina for surgery was reviewed to disc
over the evidence on which practice may be based. A search using Medli
ne, Current Contents, the Cochrane Library and the reference lists of
articles on the subject and of major gynaecology textbooks produced 13
comparative studies. No conclusive randomized controlled trials were
found and most of the studies had severe methodological problems limit
ing interpretation of their results. The scant available data suggest
that use of vaginal antiseptics before the patient arrives in the oper
ating room is probably not useful, and that application of povidone-io
dine vaginal gel at the beginning of abdominal hysterectomy is suffici
ently promising to justify further investigation.