Desquamative Inflammatory Vaginitis

What is desquamative inflammatory vaginitis (DIV)?

Desquamative inflammatory vaginitis (DIV) is type of vaginal inflammation that’s not related to an infection. Desquamative refers to cells in your body that are coming off or shedding. Inflammation is your body’s way of reacting or defending itself. Vaginitis is a word for various disorders that cause inflammation or infection of your vagina.

With DIV, the cells that line your vagina become irritated, red and inflamed. This inflammatory reaction causes symptoms like increased vaginal discharge and vaginal itching.

Your provider rules out bacterial, fungal or sexually transmitted infections (STIs) with a laboratory test before diagnosing DIV. Treatment for DIV involves placing medication in your vagina.

Who gets DIV?

Any woman or person assigned female at birth (AFAB) can get DIV. It’s more common if you’re white and nearing menopause.

How common is this condition?

DIV is uncommon and is the least common type of vaginitis.

Is desquamative inflammatory vaginitis painful?

Yes, DIV can be painful. You may feel pain, itching or irritation around your vagina or vulva (external genitals). Sexual intercourse could also become uncomfortable.

What are the symptoms of desquamative inflammatory vaginitis?

Some of the most common symptoms of DIV are:

• An increase in vaginal discharge.
• Yellowish green vaginal discharge.
• Itching and burning in your vulva (vulvodynia) or inside your vagina.
• Redness in your vulvar area (when you spread the lips of your vagina).
• Painful sexual intercourse (dyspareunia).
• Bleeding after sex.

What causes desquamative inflammatory vaginitis?

The exact cause is unknown. Healthcare providers believe it’s associated with vaginal atrophy (when your vagina becomes thin and dry), which occurs when estrogen levels decrease. This happens when you’re nearing menopause or if your provider has removed your ovaries.

How is it diagnosed?

DIV isn’t well understood. Diagnosing the condition often means ruling out other types of vaginitis first.

Your healthcare provider will begin with a pelvic exam. If you have DIV, your provider may notice:

• An excess amount of yellowish vaginal discharge.
• Your vaginal tissue is red, thin and inflamed.
• Rash-like bumps in your vagina.

During the pelvic exam, they’ll remove a sample of your vaginal discharge and test it under a microscope. Testing your vaginal discharge is necessary because symptoms of DIV are similar to other types of vaginal infections and sexually transmitted infections (STIs).

How is it treated?

Treatment for desquamative inflammatory vaginitis (DIV) involves applying an antibiotic or steroid medication inside your vagina. Antibiotics help with bacteria and steroids help with inflammation.

You’ll insert the medication inside your vagina with an applicator (like a tampon) for several days or weeks to treat DIV. Use the medication as directed by your provider.

Most people find some relief with treatment. However, others experience lingering symptoms that may come and go. It may be helpful to wear panty liners or sanitary pads due to the volume of vaginal discharge in your underwear.

How can I prevent DIV?

Because DIV is associated with a decrease in estrogen levels, there’s not much you can do to prevent it. It’s not related to contagious bacteria or sexually transmitted infections (STIs). Avoiding scented soaps and sprays around your vagina is helpful to prevent vaginal irritation. You also shouldn’t douche as this can lead to infection.

What’s the outlook for desquamative inflammatory vaginitis?

If you’ve had DIV, it may or may not return. Your healthcare provider can discuss treatment options with you. Some people have DIV once, while others have recurrent DIV that’s only managed with medication.

When should I see my healthcare provider?

Contact your healthcare provider if you have any of the following symptoms:

• Increased vaginal discharge, especially if it’s yellow or green.
• Itching, irritation or pain in your vagina or vulvar area.
• Vaginal pain during sexual intercourse or with daily activities.
• Pain in your pelvic region.
• Irregular vaginal bleeding or bleeding after sex.

The above symptoms may suggest DIV; however, these symptoms also occur in people with vaginal infections and sexually transmitted infections (STIs).

A note from Cleveland Clinic

Healthcare providers aren’t quite sure why some people get desquamative inflammatory vaginitis (DIV), but it may be related to declining estrogen levels. Contact your provider if you have an increase in vaginal discharge and vaginal irritation. Your provider will order tests to rule out more common forms of vaginitis like yeast infection, trichomonas or bacterial vaginosis (BV). Antibiotics and steroid medications treat DIV.