Desquamative Inflammatory Vaginitis

Desquamative inflammatory vaginitis (DIV) is a fairly rare condition in the spectrum of different causes of vaginitis. It’s also one that that is poorly understood, with very few studies published on its symptoms, diagnosis and treatment. In fact, it may not even be an infection.

DIV can resemble atrophic vaginitis, or thinning of the vaginal tissue. However, it can occur in women with normal estrogen levels. By the time women are diagnosed, their symptoms frequently have lasted years and they have typically been treated dozens of times for a “vaginal infection” without long-term improvement in their symptoms.

Symptoms and diagnosis. The classic symptoms of DIV are excessive yellow discharge that is very sticky and dries on the vulva like it is glue. The discharge is typically not foul smelling. On the parts of the vulva where discharge dries it becomes red, inflamed and itchy. Women frequent resort to wearing panty-liners all the time because the discharge ruins their underwear. In addition, DIV typically causes vestibular inflammation and dyspareunia

The diagnosis of DIV is made when a physician examines the discharge under a microscope and sees a huge amount of white blood cells and immature cells of the vagina called parabasal cells.  The pH of the discharge is typically 5.5 or greater and vaginal cultures typically show an increase in Staph or Strep bacteria and an absence of the “good” lactobacilli.   

We’re not sure what causes DIV. There are three current theories. Some vaginal infectious disease experts think that DIV may be related to an infection of an unknown organism.  Another theory is that it is due to estrogen deficiency. Lastly, some vulvar specialists think that it may be an early form of a skin disease called erosive lichen planus.

Treating DIV. Treatment for DIV consists of either antibiotic or corticosteroid therapy. The antibiotics most used are clindamycin (Cleocin) and metronidazole (Metrogel), either suppositories or cream inserted into the vagina every night for about two weeks. Another option is to use intravaginal hydrocortisone, alone or in combination with clindamycin. We typically treat women with a combination of clindamycin, hydrocortisone, and estrogen in a compounded cream. While this is a “shot-gun” approach, in our experience this combination treats DIV much better than when we have used each individual medication or even when we have used a combination of just two of the three medications.