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Background: Uttara basti, the instillation of medicated oil, ghee or decoction into the uterus, vagina or urinary bladder, is one of the most widely used Panchakarma procedures in Ayurvedic gynaecology. It is described in the classical texts as the principal local therapy for disorders of the reproductive tract and is now used in India for female infertility, tubal blockage, endometrial disorders and urinary conditions. Its growing use calls for a critical appraisal of its procedure, indications, safety and evidence base. Objective: To review the classical description of Uttara basti, its contemporary gynaecological applications, the published clinical outcomes and the safety considerations relevant to an intrauterine procedure. Methods: Charaka Samhita, Sushruta Samhita and Ashtanga Hridaya were reviewed for the description of Uttara basti. PubMed was searched up to October 2026 for clinical studies, case reports and reviews on Uttara basti and for evidence on the safety of comparable transcervical procedures. Each cited record was verified against PubMed and findings were synthesised narratively. Results: The classical texts specify instruments, timing in the post-menstrual phase, preparatory oleation and sudation, positioning and post-procedure care. Published studies report tubal patency in 69–80% and conception in 6–40% of women with tubal blockage, and favourable outcomes in case reports of infertility associated with polycystic ovary syndrome and endometriosis, endometrial calcification and uterine fibroids, together with a small comparative pilot study in fibroids. In urology, one comparative study of 60 patients with urethral stricture and several case reports describe benefit. No randomised controlled trial with live birth as an outcome was identified, and adverse events are seldom reported systematically. Evidence from hysterosalpingography and tubal flushing indicates a low but real risk of pelvic infection with transcervical procedures, reduced by screening and selective antibiotic prophylaxis. Conclusion: Uttara basti is a plausible, low-cost and well-described procedure with encouraging preliminary outcomes. Standardised protocols, infection-control safeguards and controlled trials are needed before firm recommendations can be made.