Desquamative inflammatory vaginitis (DIV) is a syndrome characterized by yellow or greenish/yellow vaginal discharge, often accompanied by pain with intercourse and vulvar irritation. DIV is not a sexually transmitted infection, nor is it associated with cancer, diet, or other medical conditions. In DIV, the lining of the vagina becomes inflamed causing symptoms. It is not known what causes DIV.

The usual symptoms are a heavy vaginal discharge, usually with little or no odor, painful intercourse and perhaps vulvar irritation and itching. On examination, the opening to the vagina (introitus) and vagina may look red and inflamed. A yellow vaginal discharge is usually present.

During the examination, we collect samples of vaginal secretions to rule out other infections. Under the microscope many white blood cells (pus cells) are seen, and there is an absence of normal vaginal bacteria called lactobacilli. The pH of the vagina is high in women with DIV.

The cause of DIV is unknown, although it is thought to be either some sort of infection or an autoimmune, inflammatory problem. A lack of estrogen may help to trigger the problem.

Treatment of DIV is usually an antibiotic vaginal cream containing clindamycin, an antibiotic which also has anti-inflammatory properties. Sexual partners are not treated, and it is not necessary to refrain from sexual activity during treatment as long as intercourse is comfortable.

Usually DIV is cured after one course of medication, but it may recur and require repeat or prolonged treatment. Another treatment that may be prescribed is a hydrocortisone vaginal cream which is prepared by a compounding pharmacy and inserted into the vagina every night for 4 weeks. We will often add estrogen, either initially or at a later visit, to decrease the chances of recurrence.

A follow-up appointment will be scheduled after treatment is completed to be sure that the DIV has resolved.

Written by Cynthia Bayer, CRNP, MS 5/08
Reviewed by Paul Nyirjesy, MD 5/08

The information on these pages is provided for educational purposes only and should not be used for diagnosis or as a substitute for consultation with a physician or healthcare professional. If you have specific questions or concerns about your health, you should consult your healthcare provider.