Information from Libby Edwards, MD - Mid-Charlotte Dermatology & Research

DESQUAMATIVE INFLAMMATORY VAGINITIS

Desquamative inflammatory vaginitis (DIV) is a syndrome of vaginal redness, a yellow or green-yellow vaginal discharge, and vulvar irritation. The cause is unknown, but DIV is not associated with infection, cancer, diet, other medical problems, infertility, or sexually transmitted diseases. Presumably, this condition is inflammation of the skin lining the vagina from the patient's immune system becoming overactive and inflaming the skin.

It is seen in primarily in pre-menopausal women. Irritation, burning, soreness, rawness, pain with sexual activity, and sometimes vaginal discharge are the usual presenting complaints. The opening to the vagina and the inside of the vagina itself are usually red, and more severe cases exhibit redness of the entire mucous membranes of the vulva and mild swelling of the labia minora (inner lips). However, the more outside skin of the vulva looks fairly normal except for mild redness that is probably caused by contact with irritating vaginal secretions. These secretions are yellow, and often heavy.

Under the microscope, vaginal secretions show many white blood cells (pus cells). Cells from the skin of the vagina also show signs of inflammation, and lactobacilli (the "good" bacteria) are usually absent.

Vaginal biopsies are nonspecific but show inflammation. Routine and fungal vaginal cultures are negative. Occasionally, group B streptococcus is found, but treatment generally does not cure symptoms. These bacteria are presumably unimportant, and they are found normally in many women.

An antibiotic such as clindamycin cream in the vagina at bedtime is a treatment of choice, even though this is not an infection. Clindamycin helps inflammation even when infection is not present; in fact, it is often used for acne, which also is not an infection. Cortisone creams and suppositories such as a hydrocortisone acetate suppository inserted every night can be used, as can specially compounded suppositories of combined clindamycin and hydrocortisone. If group B streptococcus is found on a vaginal culture, it will be treated just in case the strep is playing a role, which is unlikely. Patients receiving both antibiotics and a cortisone should certainly receive a weekly medicine, such as Diflucan by mouth, to prevent a yeast infection. These treatments often stops day in and day out irritation and burning, but pain with intercourse mayor may not persist.