What are the other Names for this Condition? (Also known as/Synonyms)

• DIV (Desquamative Inflammatory Vaginitis)
• Inflammatory Vaginitis, Desquamative Type

What is Desquamative Inflammatory Vaginitis? (Definition/Background Information)

• Desquamative Inflammatory Vaginitis (DIV) is an uncommon condition that affects women during the early stages of menopause. According to current scientific research, limited information is known about DIV
• The cause of Desquamative Inflammatory Vaginitis is unknown; however, scientific theories report that it may be caused by any of the following: An unknown organism, estrogen deficiency, or that it is an early form of a skin disease, called erosive lichen planus
• Perimenopausal women are more likely to be affected by the condition. Those who have any condition resulting in estrogen deficiency, a vaginal infection, and/or erosive lichen planus may be at a higher risk for Desquamative Inflammatory Vaginitis
• The condition may result in heavy vaginal discharge, painful intercourse, inflamed and itchy vulva, thinning of vaginal tissue, and a greyish film covering the vagina
• The presence of characteristic symptoms forms the basis of diagnosis of Desquamative Inflammatory Vaginitis. In many, a vaginal swab helps may be necessary. The treatment measures include topical steroids and oral antibiotics
• The prognosis of Desquamative Inflammatory Vaginitis is generally good; however, it depends on a prompt diagnosis and how individuals respond to treatment

Who gets Desquamative Inflammatory Vaginitis? (Age and Sex Distribution)

• Premenopausal and postmenopausal women can both be diagnosed with Desquamative Inflammatory Vaginitis
• Perimenopausal women, women going through physiological changes that mark the transition into menopause, are the most likely candidates for Desquamative Inflammatory Vaginitis
• All races and ethnic groups can be affected

What are the Risk Factors for Desquamative Inflammatory Vaginitis? (Predisposing Factors)

There are currently no definitive known risk factors for Desquamative Inflammatory Vaginitis. However, the following may affect a women’s chances of getting the condition.

• Any condition resulting in estrogen deficiency increases the risk. But, it is also important to note that Desquamative Inflammatory Vaginitis can occur in individuals with normal levels of estrogen
• Any infections of the vagina can increase the risk for DIV
• Erosive lichen planus: It is a condition that can affect the mouth, esophagus, and genital region, and is caused by caused by an overactive immune system

It is important to note that having a risk factor does not mean that one will get the condition, A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Desquamative Inflammatory Vaginitis? (Etiology)

According to current scientific research, the cause of Desquamative Inflammatory Vaginitis is unknown. However, the following 3 theories are proposed to explain the cause of DIV.

• It may be related to an infection, caused by an unknown organism
• It occurs because of deficiency in the hormone estrogen
• It is an early form of a skin disease called Erosive Lichen Planus

What are the Signs and Symptoms of Desquamative Inflammatory Vaginitis?

The signs and symptoms associated with Desquamative Inflammatory Vaginitis may include:

• Heavy vaginal discharge, typically with no odor and having a yellow to greenish-yellow color. The discharge may be sticky and can dry on the vulva causing irritation
• Painful intercourse (or dyspareunia): Some women report a raw, scratchy feeling during intercourse
• Inflamed and itchy vulva
• Thinning of vaginal tissue (atrophic vagina)
• Bleeding upon contact, as well as bleeding under the vaginal mucosa
• A greyish film covering the vagina

How is Desquamative Inflammatory Vaginitis Diagnosed?

Desquamative Inflammatory Vaginitis is diagnosed in the following manner:

• Complete medical history and a thorough physical examination (including a pelvic examination)
• Assessment of signs and symptoms
• Analysis of vaginal swab: A swab of vaginal secretion is taken and tested. The observational markers helpful in diagnosis include:
  • A vaginal pH greater than 5
  • Excessive white blood cells in the discharge
  • Decreased levels of lactobacilli, a type of good bacteria
  • Absence of Candida albicans, a yeast commonly found in the vagina

The above findings are noted on a microscopic examination of vaginal secretions.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis. 

What are the possible Complications of Desquamative Inflammatory Vaginitis?

The potential complications due to Desquamative Inflammatory Vaginitis include:

• Emotional stress due to excessive discharge
• Painful intercourse can lead to relationship issues
• Treatment with estrogen medication can lead to side effects related to estrogen therapy
• Bleeding and itching can be intense, leading to a decreased quality of life

How is Desquamative Inflammatory Vaginitis Treated?

The treatment measures for Desquamative Inflammatory Vaginitis may include the following:

• A combination treatment of 2% clindamycin vaginal cream and a 1% hydrocortisone cream or a 10% hydrocortisone foam
• Use of other topical steroids
• Metronidazole cream; a cream that is used to treat the redness associated with DIV
• Oral antibiotics
• Estrogen cream

How can Desquamative Inflammatory Vaginitis be Prevented?

As there is no known definitive cause for Desquamative Inflammatory Vaginitis, there are currently no specific methods or guidelines available to prevent the condition. Nevertheless, the following measures may be considered:

• General care of the genitalia, including gentle cleansing with water and a non-soap cleanser
• Avoiding baths, instead taking showers
• Minimize time in a wet bathing suit: This helps in decreasing contact with moist clothing, which can make the condition worse
• Reduced alcohol and sugar consumption
• Wearing cotton underwear

What is the Prognosis of Desquamative Inflammatory Vaginitis? (Outcomes/Resolutions)

• The prognosis of Desquamative Inflammatory Vaginitis may depend on the severity of the signs and symptoms, the response to treatment, as well as the promptness of diagnosis
• Women, who respond well to treatment, have a better prognosis than those who do not respond as well
• In many cases, a diagnosis of DIV may not be made during the first few visits to a healthcare provider. This can result in a delayed diagnosis, and thus, complicate the prognosis
• For the majority of individuals with appropriate treatment, the prognosis is good
• In some, Desquamative Inflammatory Vaginitis can be difficult to treat and may require continuous treatment. Regular follow up visits with the healthcare provider are important and encouraged.

Additional and Relevant Useful Information for Desquamative Inflammatory Vaginitis:

Desquamative Inflammatory Vaginitis may not be diagnosed accurately during the initial visits to the healthcare provider. Individuals may be misdiagnosed and have their symptoms treated many times for a “vaginal infection” without improvement in signs and symptoms.