Introduction - vaginitis Introduction Demographics Causes Examination findings Differential diagnoses Diagnosis Investigations Treatment Outcome
Vaginitis means an inflamed vagina. The term is loosely used to refer to any vaginal condition that results in a vaginal discharge. it can be due to infectious and non-infectious causes.
Desquamative vaginitis 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.
Desquamative vaginitis is rare. It affects adult women, who may be pre- or post-menopausal.
The precise cause of desquamative vaginitis is unknown. It is now classified as a severe form of aerobic vaginitis.
By definition, it is not an infection, despite the usefulness of antibiotics in the treatment of many patients.
The vagina and the vaginal vestibule appear inflamed. Clinical signs include:
The differential diagnosis includes other forms of vaginitis, especially erosive lichen planus.
Desquamative vaginitis is diagnosed if there is at least one of the following symptoms:
In addition:
Swabs should be taken from the vagina for microscopy (wet mount examination). Culture is also undertaken to detect infectious causes of vaginitis.
There is a reduction in normal lactobacilli. The laboratory may report the presence of mixed non-pathogenic bacteria (eg, non-haemolytic streptococcus species and coagulase negative staphylococci), epithelial and inflammatory cells (aerobic vaginitis).The AV score may be reported.
Biopsy of the affected tissue (vulva or vagina) are likely to reveal nondiagnostic and nonspecific inflammatory changes.
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 antibacterial and anti-inflammatory combination of:
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:
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.
ISSVD Vulvovaginal Disorders: an algorithm for basic adult diagnosis and treatment
Vulvovaginal Disorders: A Pathway to Diagnosis and Treatment
