Understanding Desquamative Inflammatory Vaginitis

Desquamative inflammatory vaginitis (DIV) is a vulvovaginal condition whereby the cells in the vagina become inflamed and peel away.

DIV is not well understood, often being blamed as an infection, when it isn’t clear if this is actually true. Aerobic vaginitis may be seen, and is often discussed as the beginning stages of desquamative inflammatory vaginitis.

Desquamative inflammatory vaginitis can look like atrophic vaginitis due to low oestrogen (such as occurs after menopause), but can occur in premenopausal women.

Women may not be diagnosed for years, with ongoing symptoms and multiple unsuccessful treatments for ‘infections’. Desquamative inflammatory vaginitis may be associated with chronic diarrhoea, intrauterine devices (IUDs), and vaginitis caused by a prior infection.

Symptoms of desquamative inflammatory vaginitis

Excessive yellow or greenish discharge, or in some cases may be bloody
Discharge can be quite sticky and may stick to the labia
Discharge may be malodourous
Discharge causes inflammation – red, itchy
Painful intercourse (dyspareunia)
Bleeding after sex
Itch
Burning
Pain
Pain on urination
Dryness

Diagnosing desquamative inflammatory vaginitis

Diagnosis is by examination of vaginal discharge under a microscope (typically done in-office), and a lot of white blood cells and immature vaginal cells are found. These cells are called parabasal cells.

The pH is about 5.5 or more, and vaginal culturing may show increased levels of Staph or Strep bacteria. An absence of lactobacilli is also characteristic.

A diagnosis of DIV may be made if there is vaginal discharge, dyspareunia, itching and/or burning. A wet mount (microscope investigation) will confirm increase parabasal cells and inflammatory cells, plus a vaginal pH of over 4.5, and exclusions of Group A Streptococcus, Staphylococcus aureus, and trichomoniasis.

Causes of desquamative inflammatory vaginitis

There are currently three theories – DIV may be an infection of an unknown organism; caused by oestrogen deficiency; or the beginning of a skin condition called erosive lichen planus.

Treating desquamative inflammatory vaginitis

Treatment is likely to include antibiotic or steroid treatments. The antibiotics used are typically clindamycin and metronidazole, either as a vaginal suppository or gel.

Intravaginal hydrocortisone, with or without antibiotics, and with or without oestrogen cream, may be used. Topical antifungal creams are not recommended if there is no yeast present.

Treatment should continue for several weeks, but may be required long-term in some cases. Home care may include gentle washing of the vulva with warm water and non-soap cleansers. A vaginal moisturiser may be useful.