Health Care Professional Information
Common Name
Bitter gourd, bitter apple, wild cucumber, bitter cucumber, balsam apple, balsam pear, margose, la-kwa, leprosy gourd, karela, kugua, cerasee.
Clinical Summary
Bitter melon is a perennial plant that grows in the tropical and subtropical regions of Asia, South America, East Africa, and the Carribean. It is used both as food and in medicine to treat diabetes, cancer, viral infections, and immune disorders. The nutritional value of bitter melon is due to its high mineral and vitamin content, whereas its bitterness is attributed to the presence of alkaloids, momordicosides, and momordicines.
In vitro and animal studies indicate anticancer (3) (7) (8) (13), antiviral (9) (10), and lipid lowering (11) effects. Bitter melon was also shown to exert hypoglycemic effects in both healthy and diabetic patients (1) (2) (20), but further studies are required to recommend its use (14).
Bitter melon had no effect on natural killer cell activity in a study of cervical cancer patients (6).
Bitter melon can have additive effects when combined with insulin or oral hypoglycemic agents.
Purported Uses
- Cancer prevention
- Diabetes
- Fever
- HIV and AIDS
- Infections
- Menstrual disorder
Constituents
Fruit:
- Glycosides: momordin, charantin
- Alkaloids: momordicin
- Others: polypeptide-P
- Oils (seed only): stearic, linoleic, oleic acids
- Glycoproteins: alpha-momorcharin, beta-momorcharin, lectins
- Others: vicine (pyrimidine nucleoside), protein MAP30
- Cucurbitane triterpenoids
(1) (16)
Mechanism of Action
The compounds present in bitter melon including vicine, charantin, and polypeptide-P increase glucose uptake and glycogen synthesis in the liver, muscle, and adipose tissue, and improve glucose tolerance. Studies with hepatic enzymes in mice revealed reduction in glucose-6-phosphatase and fructose-1,6-bisphosphatase activity, and increased glucose oxidation by G6PDH pathway. Bitter melon displays cytotoxic activity against leukemic cells in vitro (guanylate cyclase inhibitor) and has a cytostatic effect on MDA-MB-231 human breast cancer cells xenografted into mice. MAP30 also demonstrates dose-dependent inhibition of HIV-1 integrase leading to poor viral DNA integration, thus inhibiting T lymphocyte and monocytes.
(1) (2) (3). Bitter melon also inhibits P-glycoprotein and can alter the pharmacokinetics of drugs by inhibiting the P-glycoprotein-mediated efflux (12).
It may affect fat and carbohydrate metabolism by stimulating the synthesis and release of thyroid hormones and adiponectin, and by enhancing the activity of AMP-activated protein kinase (AMPK) (21).
Warnings
Red arils (covering on seed) are reportedly toxic in children, causing vomiting, diarrhea, and death (1).
Contraindications
Bitter melon is contraindicated in pregnant women as it can induce bleeding, contractions, and abortion.
Adverse Reactions
- Hypoglycemia and hepatotoxicity were reported in animal studies (18).
- Toxicity: Ingestion of vicine (seed) may cause favism characterized by headache, fever, abdominal pain, and coma (17).
Case Reports
- A 22-year-old man experienced atrial fibrillation with rapid ventricular response following ingestion of bitter melon two days before his admission for his dyspeptic complaints. He ingested crushed bitter melon and drank two tablespoons of its juice three times a day, and on the morning of admission as well. His symptoms improved after administering antiarrhythmic medication (15).
- A 40-year-old man developed acute gastric ulceration following consumption of half a liter of concentrated homemade liquid extract of bitter melon. His symptoms included severe epigastric pain and hematemesis, which were managed with intravenous fluids, blood transfusion and intravenous rabeprazole (19).
- Gastrointestinal problems have been reported with use of bitter melon (22).
Herb-Drug Interactions
Insulin: Bitter melon may have an additive effect when used concomitantly.
Hypoglycemics: Bitter melon may have additive effect when used concomitantly.
(4) (5)
Literature Summary and Critique
Ooi CP, Yassin Z, Hamid TA. Momordica charantia for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2010 Feb 17;2:CD007845.
This review was conducted to determine the antidiabetic potential of bitter melon. The Cochrane Library (issue 4, 2009), MEDLINE, EMBASE, CINAHL, SIGLE and LILACS (all up to November 2009) were searched for studies. Randomized controlled trials that compared bitter melon with a placebo or another intervention, pharmacological or non-pharmacological, were included. Three studies met the inclusion criteria of which two compared preparations from different parts of the plant to placebo; there was no statistically signficant difference between bitter melon and placebo. The third study found the effects of bitter melon to be comparable to glibenclamide, an antidiabetic drug. Serious adverse events were not reported in any of the three trials.
The authors concluded that the current evidence to recommend bitter melon for type 2 diabetes mellitus is insufficient. Additional studies are needed to validate its use.
Dosage (Inside MSKCC Only)
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References
- DerMarderosian A, editor. The Review of Natural Products. St. Louis: Facts and Comparisons; 1999.
- Huang KC. The Pharmacology of Chinese Herbs, 2nd ed. New York: CRC Press; 1999.
- Lee-Huang S, et al. Inhibition of MDA-MD-231 human breast tumor xenografts and HER2 expression by anti-tumor agents GAP31 and MAP30. Anticancer Res 2000;20:653-9.
- Brinker F. Herb Contraindications and Drug Interactions, 3rd ed. Sandy (OR): Eclectic Medical Publications; 2001.
- Srivastava Y, et al. Antidiabetic and adaptogenic properties of momordica charantia extract: an experimental and clinical evaluation. Phytotherapy Res 1993;7:285-9.
- Pongnikorn S, Fongmoon D, Kasinrerk W, Limtrakul PN. Effect of bitter melon (Momordica charantia Linn) on level and function of natural killer cells in cervical cancer patients with radiotherapy. J Med Assoc Thai. 2003 Jan;86(1):61-8.
- Deep G, Dasgupta T, Rao AR, Kale RK. Cancer preventive potential of Momordica charantia L. against benzo(a)pyrene induced fore-stomach tumourigenesis in murine model system. Indian J Exp Biol. 2004 Mar;42(3):319-22.
- Xiong SD, Yu K, Liu XH, et al. Ribosome-inactivating proteins isolated from dietary bitter melon induce apoptosis and inhibit histone deacetylase-1 selectively in premalignant and malignant prostate cancer cells. Int J Cancer. 2009 Aug 15;125(4):774-82.
- Lee-Huang S, Huang PL, Chen HC, et al. Anti-HIV and anti-tumor activities of recombinant MAP30 from bitter melon. Gene. 1995 Aug 19;161(2):151-6.
- Fan JM, Zhang Q, Xu J, et al. Inhibition on Hepatitis B virus in vitro of recombinant MAP30 from bitter melon. Mol Bio Rep 2009 Feb;36(2):381-8.
- Nerurkar PV, Lee YK, Linden EH, et al. Lipid lowering effects of Momordica charantia (Bitter Melon) in HIV-1-protease inhibitor-treated human hepatoma cells, HepG2. Br J Pharmacol. 2006 Aug;148(8):1156-64.
- Konishi T, Satsu H, Hatsugai Y, et al. Inhibitory effect of a bitter melon extract on the P-glycoprotein activity in intestinal Caco-2 cells. Br J Pharmacol. 2004 Oct;143(3):379-87.
- Ray RB, Raychoudhuri A, Steele R, Nerurkar P. Bitter Melon (Momordica charantia) Extract Inhibits Breast Cancer Cell Proliferation by Modulating Cell Cycle Regulatory Genes and Promotes Apoptosis. Cancer Res. 2010 Feb 23. [Epub ahead of print]
- Ooi CP, Yassin Z, Hamid TA. Momordica charantia for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2012 Aug 15;8:CD007845.
- Erden I, Ordu S, Erden EC, Caglar SO. A case of atrial fibrillation due to Momordica charantia (bitter melon). Ann Saudi Med. 2010 Jan-Feb;30(1):86-7.
- Liu JQ, Chen JC, Wang CF, Qiu MH. New cucurbitane triterpenoids and steroidal glycoside from Momordica charantia. Molecules. 2009 Nov 25;14(12):4804-13.
- Cunnick J, Takemoto D. Bitter melon (Mormordica charantia). J Nat Med 1993;4:16-21.
- Tennekoon KH, Jeevathayaparan S, Angunawala P, Karunanayake EH, Jayasinghe KS. Effect of Momordica charantia on key hepatic enzymes. J Ethnopharmacol 1994;44:93-7.
- Nadkarni N, D'Cruz S, Sachdev A. Hematemesis due to bitter melon (Momordica charantia) extract-induced gastric ulcerations. Indian J Gastroenterol. 2010 Jan;29(1):37-8.
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Chaturvedi P. Antidiabetic potentials of Momordica charantia: multiple mechanisms behind the effects. J Med Food. 2012 Feb;15(2):101-7.
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Saokaew S, Suwankesawong W, Permsuwan U, Chaiyakunapruk N.Safety of herbal products in Thailand: an analysis of reports in the thai health product vigilance center database from 2000 to 2008.Drug Saf. 2011 Apr 1;34(4):339-50.
Consumer Information
How It Works
Bottom Line: Bitter melon can lower blood glucose levels, but it is not known how it interacts with insulin or other medications.
Several active substances in bitter melon have been studied in both animals and humans. These experiments show that these substances act in the same way as insulin, by increasing the entry of glucose into cells and promoting its processing and storage in the liver, muscle, and fat. Bitter melon also prevents the conversion of stored nutrients to glucose and the release of this glucose into the blood. However, researchers have not established the correct dosage of bitter melon for effectively treating the high blood glucose levels in diabetes, and therefore it cannot be recommended as a replacement therapy for insulin or hypoglycemic drugs.
Bitter melon extracts are able to kill leukemia cells in the laboratory and slow the growth of breast cancer in mice, but it is unknown whether these effects occur in humans. A study in humans showed bitter melon had little effect on the immune system of cervical cancer patients. In laboratory tests, bitter melon extracts also inhibit the ability of HIV to insert its DNA into the chromosomes of human cells, but it is also not known whether this effect would occur in humans.
Purported Uses
- To prevent cancer
A few laboratory studies show that bitter melon extracts can kill certain cancer cells, but it has not been studied in cancer patients.
- To treat type 2 diabetes
A handful of small clinical trials show that bitter melon extracts can lower blood glucose levels, but larger and better-designed clinical trials are needed to fully support this use.
- To reduce fever
No scientific evidence supports this use.
- To treat HIV and AIDS
Preliminary laboratory studies show that bitter melon can slow the ability of HIV to insert its genes into human chromosomes.
- To treat infections
Bitter melon extracts can kill certain viruses on contact in the laboratory, but human data are lacking.
- To relieve menstrual problems
This claim is not backed by research.
Research Evidence
Diabetes mellitus
A review of three clinical trials was done to find out the antidiabetic effects of bitter melon. Two studies did not find a clinically meaningful difference between bitter melon and placebo. The third study showed bitter melon to be comparable to an antidiabetic drug called glibenclamide. Serious adverse events were not reported in any of the three trials. The authors concluded that there is not enough evidence to recommend bitter melon for type 2 diabetes mellitus. More research is needed.
Patient Warnings
- The covering on bitter melon seeds (called red arils) are toxic in children, causing vomiting, diarrhea, and death.
Do Not Take If
- You are pregnant (Bitter melon can cause vaginal bleeding, premature contractions, and abortion).
- You are taking insulin (Bitter melon may have additive effects).
- You are taking hypoglycemic medication for diabetes (Bitter melon may have additive effects).
Side Effects
- Low blood sugar
- Liver damage (this has been shown in animals, but not in humans)
- Ingestion of the seeds of bitter melon can cause toxicity to red blood cells, which includes headache, fever, abdominal pain, and coma.
- Reported (Oral): A 22-year-old man experienced atrial fibrillation (rapid irregular heartbeat) following ingestion of bitter melon two days before his admission for his dyspeptic complaints. He ingested crushed bitter melon and drank two tablespoons of its juice three times a day, and on the morning of admission as well. His symptoms improved after administering antiarrhythmic medication.
- Reported (Oral): A 40-year-old man developed acute gastric ulceration following consumption of half a liter of concentrated homemade liquid extract of bitter melon. His symptoms included severe epigastric pain and hematemesis, which were managed with intravenous fluids, blood transfusion and intravenous rabeprazole.
Special Point
Researchers have not established the correct dosage or long-term effects of bitter melon for treating the high blood glucose levels in diabetes, and therefore it cannot be recommended as a replacement therapy for insulin or hypoglycemic drugs.
Last updated: February 12, 2013
abdominal (ab-DAH-mih-nul)
Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)acute (uh-KYOOT)
Symptoms or signs that begin and worsen quickly; not chronic.
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(http://www.cancer.gov/dictionary)antiviral (AN-tee-VY-rul)
A drug used to treat infections caused by viruses.
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(http://www.cancer.gov/dictionary)blood (blud)
A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)blood transfusion (blud tranz-FYOO-zhun)
A procedure in which a person is given an infusion of whole blood or parts of blood. The blood may be donated by another person, or it may have been taken from the patient earlier and stored until needed. Also called transfusion.
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(http://www.cancer.gov/dictionary)breast (brest)
Glandular organ located on the chest. The breast is made up of connective tissue, fat, and breast tissue that contains the glands that can make milk. Also called mammary gland.
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(http://www.cancer.gov/dictionary)breast cancer (brest KAN-ser)
Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.
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(http://www.cancer.gov/dictionary)cancer (KAN-ser)
A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
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(http://www.cancer.gov/dictionary)carbohydrate (KAR-boh-HY-drayt)
A sugar molecule. Carbohydrates can be small and simple (for example, glucose) or they can be large and complex (for example, polysaccharides such as starch, chitin or cellulose).
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(http://www.cancer.gov/dictionary)cell (sel)
The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
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(http://www.cancer.gov/dictionary)cervical (SER-vih-kul)
Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck. Cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the “neck”) of the uterus.
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(http://www.cancer.gov/dictionary)cervical cancer (SER-vih-kul KAN-ser)
Cancer that forms in tissues of the cervix (the organ connecting the uterus and vagina). It is usually a slow-growing cancer that may not have symptoms but can be found with regular Pap tests (a procedure in which cells are scraped from the cervix and looked at under a microscope). Cervical cancer is almost always caused by human papillomavirus (HPV) infection.
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(http://www.cancer.gov/dictionary)clinical (KLIH-nih-kul)
Having to do with the examination and treatment of patients.
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(http://www.cancer.gov/dictionary)coma (KOH-muh)
A condition in which a patient is in a state of deep sleep and cannot be awakened. A coma may be caused by many things, including trauma, drugs, toxins, or certain diseases.
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(http://www.cancer.gov/dictionary)cytotoxic (SY-toh-TOK-sik)
Cell-killing.
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(http://www.cancer.gov/dictionary)diabetes (dy-uh-BEE-teez)
Any of several diseases in which the kidneys make a large amount of urine. Diabetes usually refers to diabetes mellitus in which there is also a high level of glucose (a type of sugar) in the blood because the body does not make enough insulin or use it the way it should.
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(http://www.cancer.gov/dictionary)diabetes mellitus (dy-uh-BEE-teez MEH-lih-tus)
A disease in which the body does not control the amount of glucose (a type of sugar) in the blood and the kidneys make a large amount of urine. This disease occurs when the body does not make enough insulin or does not use it the way it should.
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(http://www.cancer.gov/dictionary)diarrhea (dy-uh-REE-uh)
Frequent and watery bowel movements.
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(http://www.cancer.gov/dictionary)DNA
The molecules inside cells that carry genetic information and pass it from one generation to the next. Also called deoxyribonucleic acid.
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(http://www.cancer.gov/dictionary)dose-dependent (dose-deh-PEN-dent)
Refers to the effects of treatment with a drug. If the effects change when the dose of the drug is changed, the effects are said to be dose-dependent.
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(http://www.cancer.gov/dictionary)drug (drug)
Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.
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(http://www.cancer.gov/dictionary)epigastric (EH-pih-GAS-trik)
Having to do with the upper middle area of the abdomen.
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(http://www.cancer.gov/dictionary)experimental (ek-SPAYR-ih-men-tul)
In clinical trials, refers to a drug (including a new drug, dose, combination, or route of administration) or procedure that has undergone basic laboratory testing and received approval from the U.S. Food and Drug Administration (FDA) to be tested in human subjects. A drug or procedure may be approved by the FDA for use in one disease or condition, but be considered experimental in other diseases or conditions. Also called investigational.
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(http://www.cancer.gov/dictionary)extract (EK-strakt)
In medicine, a preparation of a substance obtained from plants, animals, or bacteria and used as a drug or in drugs.
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(http://www.cancer.gov/dictionary)fever (FEE-ver)
An increase in body temperature above normal (98.6 degrees F), usually caused by disease.
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(http://www.cancer.gov/dictionary)gastric (GAS-trik)
Having to do with the stomach.
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(http://www.cancer.gov/dictionary)gastrointestinal (GAS-troh-in-TES-tih-nul)
Refers to the stomach and intestines. Also called GI.
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(http://www.cancer.gov/dictionary)glucose (GLOO-kose)
A type of sugar; the chief source of energy for living organisms.
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(http://www.cancer.gov/dictionary)hepatic (heh-PA-tik)
Refers to the liver.
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(http://www.cancer.gov/dictionary)HIV
The cause of acquired immunodeficiency syndrome (AIDS). Also called human immunodeficiency virus.
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(http://www.cancer.gov/dictionary)immune system (ih-MYOON SIS-tem)
The complex group of organs and cells that defends the body against infections and other diseases.
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(http://www.cancer.gov/dictionary)in vitro (in VEE-troh)
In the laboratory (outside the body). The opposite of in vivo (in the body).
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(http://www.cancer.gov/dictionary)ingestion (in-JES-chun)
Taking into the body by mouth.
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(http://www.cancer.gov/dictionary)insulin (IN-suh-lin)
A hormone made by the islet cells of the pancreas. Insulin controls the amount of sugar in the blood by moving it into the cells, where it can be used by the body for energy.
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(http://www.cancer.gov/dictionary)intervention (IN-ter-VEN-shun)
In medicine, a treatment or action taken to prevent or treat disease, or improve health in other ways.
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(http://www.cancer.gov/dictionary)intravenous (IN-truh-VEE-nus)
Into or within a vein. Intravenous usually refers to a way of giving a drug or other substance through a needle or tube inserted into a vein. Also called IV.
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(http://www.cancer.gov/dictionary)kinase (KY-nays)
A type of enzyme that causes other molecules in the cell to become active. Some kinases work by adding chemicals called phosphates to other molecules, such as sugars or proteins. Kinases are a part of many cell processes. Some cancer treatments target certain kinases that are linked to cancer.
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(http://www.cancer.gov/dictionary)leukemia (loo-KEE-mee-uh)
Cancer that starts in blood-forming tissue such as the bone marrow and causes large numbers of blood cells to be produced and enter the bloodstream.
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(http://www.cancer.gov/dictionary)lipid (LIH-pid)
Fat.
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(http://www.cancer.gov/dictionary)liter (LEE-ter)
A measure of volume for a liquid, using the metric system. One liter is equal to 1,000 cubic centimeters (cc), 1,000 milliliters (mm), or 1.0567 quarts (qt). Also called L.
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(http://www.cancer.gov/dictionary)liver (LIH-ver)
A large organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile.
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(http://www.cancer.gov/dictionary)lymphocyte (LIM-foh-site)
A type of immune cell that is made in the bone marrow and is found in the blood and in lymph tissue. The two main types of lymphocytes are B lymphocytes and T lymphocytes. B lymphocytes make antibodies, and T lymphocytes help kill tumor cells and help control immune responses. A lymphocyte is a type of white blood cell.
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(http://www.cancer.gov/dictionary)medication (MEH-dih-KAY-shun)
A legal drug that is used to prevent, treat, or relieve symptoms of a disease or abnormal condition.
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(http://www.cancer.gov/dictionary)metabolism (meh-TA-buh-lih-zum)
The chemical changes that take place in a cell or an organism. These changes make energy and the materials cells and organisms need to grow, reproduce, and stay healthy. Metabolism also helps get rid of toxic substances.
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(http://www.cancer.gov/dictionary)oral (OR-ul)
By or having to do with the mouth.
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(http://www.cancer.gov/dictionary)oxidation (OK-sih-DAY-shun)
A chemical reaction that takes place when a substance comes into contact with oxygen or another oxidizing substance. Examples of oxidation are rust and the brown color on a cut apple.
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(http://www.cancer.gov/dictionary)p-glycoprotein (… GLY-koh-PROH-teen)
A protein that pumps substances out of cells. Cancer cells that have too much p-glycoprotein may not be killed by anticancer drugs.
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(http://www.cancer.gov/dictionary)pharmacokinetics (FAR-muh-koh-kih-NEH-tix)
The activity of drugs in the body over a period of time, including the processes by which drugs are absorbed, distributed in the body, localized in the tissues, and excreted.
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(http://www.cancer.gov/dictionary)placebo (pluh-SEE-boh)
An inactive substance or treatment that looks the same as, and is given the same way as, an active drug or treatment being tested. The effects of the active drug or treatment are compared to the effects of the placebo.
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(http://www.cancer.gov/dictionary)protein (PROH-teen)
A molecule made up of amino acids that are needed for the body to function properly. Proteins are the basis of body structures such as skin and hair and of substances such as enzymes, cytokines, and antibodies.
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(http://www.cancer.gov/dictionary)randomized
Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments.
(http://www.cancer.gov/dictionary)reduction (ree-DUK-shun)
A chemical reaction that takes place when a substance comes into contact with hydrogen or another reducing substance.
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(http://www.cancer.gov/dictionary)response (reh-SPONTS)
In medicine, an improvement related to treatment.
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(http://www.cancer.gov/dictionary)therapy (THAYR-uh-pee)
Treatment.
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(http://www.cancer.gov/dictionary)thyroid (THY-royd)
A gland located beneath the larynx (voice box) that makes thyroid hormone and calcitonin. The thyroid helps regulate growth and metabolism. Also called thyroid gland.
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(http://www.cancer.gov/dictionary)tissue (TIH-shoo)
A group or layer of cells that work together to perform a specific function.
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(http://www.cancer.gov/dictionary)toxic (TOK-sik)
Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects.
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(http://www.cancer.gov/dictionary)toxicity (tok-SIH-sih-tee)
The extent to which something is poisonous or harmful.
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(http://www.cancer.gov/dictionary)transfusion (tranz-FYOO-zhun)
A procedure in which a person is given an infusion of whole blood or parts of blood. The blood may be donated by another person, or it may have been taken from the patient earlier and stored until needed. Also called blood transfusion.
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(http://www.cancer.gov/dictionary)ulceration (UL-seh-RAY-shun)
The formation of a break on the skin or on the surface of an organ. An ulcer forms when the surface cells die and are cast off. Ulcers may be associated with cancer and other diseases.
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(http://www.cancer.gov/dictionary)vaginal (VA-jih-nul)
Having to do with the vagina (the birth canal).
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(http://www.cancer.gov/dictionary)viral (VY-rul)
Having to do with a virus.
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