From the Research
Definition and Characteristics of Desquamative Vaginitis
- Desquamative inflammatory vaginitis (DIV) is a distinct entity of vaginitis that can be distinguished from other diagnostic possibilities by careful clinical evaluation and focused trials of treatment 1.
- It is characterized by yellow vaginal discharge, vulvovaginal pruritus, burning, and dyspareunia 2.
- The syndrome is also marked by profuse vaginal discharge, vulvovaginal irritation, dyspareunia, and vaginal erythema 3.
Diagnosis and Differential Diagnosis
- Diagnosis necessitates specific wet smear findings and exclusion of other causes of purulent discharge 3.
- DIV can be confused with bacterial vaginosis (BV) or aerobic vaginitis (AV), but it differs from these conditions in terms of its inflammatory response and epithelial atrophy 4.
- A diagnosis of DIV should be considered in women presenting with persistent vaginitis and nonspecific symptoms such as pelvic pain 3.
Treatment and Management
- Effective treatment of DIV is available using clindamycin and/or glucocorticoids 3.
- Treatment of AV, which can be severe and called desquamative inflammatory vaginitis, requires a combined local treatment with antibiotics, steroids, and/or estrogen 4.
- In cases with Candida present, antifungals must be tried first to see if other treatment is still needed 4.
Pathophysiology and Etiology
- The etiology of DIV is unknown, but it is proposed to be a mucous membrane manifestation of vitamin D deficiency, resulting in desquamation of the vaginal epithelium and discharge 2.
- The loss of epithelium leads to altered vaginal pH levels, mucous membrane fragility, inflammation, and secondary infection 2.
- Historical triggers such as diarrhea or antibiotic treatment may contribute to the development of DIV 1.