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Desquamative vaginitis

Author: Dr Amanda Oakley, Dermatologist, Waikato Hospital, Hamilton New Zealand, 2009.

Desquamative vaginitis is an uncommon form of vaginitis (inflamed vagina) affecting adult women. It is characterised by:

Other symptoms may include pain on passing urine (dysuria), bleeding after intercourse, malodour and dryness. These symptoms often persist for months or years.

Examination findings

The doctor may comment that the vagina and the vestibule (opening to vagina) appear inflamed. Clinical signs include:

 

What is the cause of desquamative vaginitis?

Desquamative vaginitis is a chronic inflammatory condition of unknown cause in which the lining of the vagina desquamates or peels away. It may represent more than one disorder, including a type of erosive lichen planus.

By definition, it is not an infection, despite the usefulness of antibiotics in the treatment of many patients. It may occur in both premenopausal and postmenopausal women.

An association with broad-spectrum antibiotics has been noted in some patients. Other possible factors include chronic diarrhoea, intrauterine device (IUD) and prior vaginitis due to infection.

Investigations

Swabs should be taken from the vagina for microscopy and culture, as desquamative vaginitis may be similar to or complicated by infectious causes of vaginitis. The laboratory may report the presence of non-pathogenic bacteria (e.g., streptococcus species), epithelial and inflammatory cells.

Biopsy of the affected tissue (vulva or vagina) are likely to reveal nondiagnostic and nonspecific inflammatory changes.

Treatment

The treatment of desquamative vaginitis is not always effective. General care should include gentle cleansing of the external genitalia with water and non-soap cleansers. Vaginal moisturisers may be helpful for dryness. Topical antifungal agents should not be used in the absence of confirmed yeast infection (vulvovaginal candidiasis or thrush).

The most successful treatment for desquamative vaginitis appears to be the combination of:

Treatment should be continued for several weeks. If this is unsuccessful, other treatments that may be tried include:

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