The term inflammatory vaginitis (IV) distinguishes a mild to moderate pattern from the florid inflammatory pattern of desquamative inflammatory vaginitis (DIV). Many symptomatic women who have an obvious abnormal wet prep with an inflammatory response do not meet the criteria for DIV. These women typically have a copious discharge with a subtle odor and vulvovaginal irritation that is mildly annoying rather than distressing, as with DIV.

Desquamative inflammatory vaginitis is one of those uncommon forms of chronic purulent vaginal discharge that you won’t see frequently in a women’s health practice, but you need to know of its characteristics and you must consider it when the most common causes of abnormal discharge in pre- and postmenopausal women such as bacterial vaginosis, vulvovaginal candidiasis, and trichomonas vaginitis, have been excluded. DIV is considered a noninfectious cause of inflammatory vaginitis with the highest incidence in perimenopausal Caucasian women.¹ One of the challenges with DIV is that the symptoms and signs are nonspecific, but the main symptoms are purulent discharge, vestibule-vaginal irritation and dyspareunia. A vaginal wall exam appears inflammatory with increased erythema and petechiae. Vaginal pH is >4.5. Under the microscope, a wet mount of the vaginal secretions shows up as an increase in inflammatory cells and immature squamous cells, called parabasal cells. Microscopic viewing also reveals numerous leukocytes and few to no lactobacilli. The background has clumps of bacteria, and squamous cells are speckled with bacteria.