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About Desquamative Inflammatory Vaginitis (DIV)
Women suffer from many different vaginal complaints with similar symptoms. In fact the complaints that are the most common are related to vaginitis and are at the top of complaints for visits to the ob-gyn. Most of these conditions are not life threatening, but they can be painful and uncomfortable. Most cases of vaginitis are caused by bacterial or fungal infections that are easily identifiable by lab tests. However, the causes of desquamative inflammatory vaginitis are unknown. Some researchers speculate that the condition may be triggered by an infection or by an autoimmune disease. In some cases low levels of estrogen may trigger a bout of DIV. The condition can occur at any time in a woman’s life. As with any other vaginitis, the condition cannot be self-diagnosed or diagnosed by symptoms. Diagnosis requires reliable laboratory confirmation.
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As with many other vaginal infections, DIV presents with an unusual discharge. It is greenish/yellow containing white blood cells making it purulent (containing pus) and also contains squamous epithelial cells, hence its name. The discharge has little or no odor.
Besides the unusual discharge, other symptoms include:
- post coital bleeding
- painful intercourse (dyspareunia).
- an irritated vulvar that can be itchy
The condition is not transmitted sexually, nor is it related to any known diseases.
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Diagnosis of DIV
A swab of the vaginal secretions and discharge is taken at the doctor's office. The ensuing test results allow the doctor to rule out infections that may cause similar symptoms. The results for a DIV diagnosis show inflamed cells on the walls of the vagina (epithelium). The areas that are inflamed exhibit red, well defined borders. There is also a tissue film over the lesions which can easily be removed. The lesions sometimes bleed and are responsible for the post coital bleeding. Sometimes similar lesions can be found in other mucosal membranes, for example in the mouth. The lesions if found in the mouth, resemble those caused by lichen planus, and this had led some scientists to wonder if there is a link between the two conditions.
Other diagnostic markers include:
- A vaginal pH of greater than 5
- Excessive white blood cells in the discharge
- Decreased levels of lactobacilli
- Absence of Candida albicans
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DIV is treatable. It can be treated by using intravaginal corticosteroids to reduce inflammation or with the antibiotic vaginal cream, clindamycin, which also has anti-inflammatory properties. Treatment with hydrocortisone usually requires 4 weeks of treatment. Since an infection is not sexually transmitted it is not necessary to treat the sexual partner of an infected individual.
In recurring cases, treatment sometimes can be prolonged requiring repeat treatments. In some case the patient is prescribed estrogen to helps diminish the chances of the condition returning. Doctors also recommend follow up after the treatment regime to ensure the condition is resolved.
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Preventing Future DIV Infections
It is recommended that women should,
- Use plain soap to clean genital area
- Take showers instead of baths
- Remove wet bathing suits as soon possible
- Cut back on sweets and alcohol
- Use cotton underwear
These simple solutions can help prevent vaginal infections.
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Nyirjesy, Paul MD et al., “Causes of Chronic Vaginitis: Analysis of a Prospective Database of Affected Women" Obstetrics & Gynecology: November 2006 - Volume 108 - Issue 5 - pp 1185-1191
J K Oates and D Rowen, “Desquamative inflammatory vaginitis. A review." Genitourin Med. 1990 August; 66(4): 275–279.