What is desquamative vaginitis?
Desquamative vaginitis is an uncommon form of vaginitis (inflamed vagina) affecting adult women. It is characterised by:
- Blood-stained profuse vaginal discharge
- Painful intercourse (dyspareunia)
- Itch (pruritus vulvae) and/or burning (vulvodynia).
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 in desquamative vaginitis
The vagina and the vaginal vestibule appear inflamed. Clinical signs include:
- Thinned tissue
- Yellow secretions
- Purpura (bleeding under the skin)
- Contact bleeding
- A greyish film.
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 non-specific aerobic vaginitis. Some cases may be due to 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.
How is desquamative vaginitis diagnosed?
Desquamative vaginitis is diagnosed if there is at least one of the following symptoms:
- Vaginal discharge
- Wet mount should confirm vaginal inflammation with increased parabasal and inflammatory cells.
- Culture should exclude infection: Group A streptococcus, Staphylococcus aureus, trichomoniasis.
- Vaginal pH is > 4.5.
Investigations in desquamative vaginitis
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 mixed non-pathogenic bacteria (eg, non-haemolytic streptococcus species), epithelial and inflammatory cells (aerobic vaginitis). There is a reduction in normal lactobacilli.
Biopsy of the affected tissue (vulva or vagina) are likely to reveal nondiagnostic and nonspecific inflammatory changes.
Treatment of desquamative vaginitis
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).
The most successful treatment for desquamative vaginitis appears to be the anti-inflammatory combination of:
- Clindamycin 2% vaginal cream
- Hydrocortisone 1% cream or 10% foam.
Treatment should be continued for at least several weeks and may be required long term (typically, twice weekly). If this is unsuccessful, other treatments that may be tried include:
What is the outcome for desquamative vaginitis?
Treatment usually leads to complete remission of symptoms, when treatment can be stopped, or reduced symptoms requiring at least intermittent on-going treatment. If treatment is ineffective, consider other diagnoses and change treatment.