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Desquamative inflammatory vaginitis

INTRODUCTION

Women who present because of a qualitative or quantitative alteration in vaginal discharge should be evaluated by clinical examination and appropriate laboratory tests, such as pH and microscopy. Bacterial vaginosis, vulvovaginal candidiasis, and trichomonas vaginitis are the most common causes of vaginal discharge in premenopausal women. When these conditions have been excluded, other causes of vaginal discharge must be considered in the differential diagnosis of women with vaginal complaints. (See "Approach to women with symptoms of vaginitis".)

Desquamative inflammatory vaginitis is a chronic clinical syndrome of unknown etiology. Most investigators believe it is primarily an inflammatory vaginitis of non-infectious etiology, with secondary bacterial microbiota disruption [1]. However, others consider the primary defect to be an alteration in vaginal flora (eg, Escherichia coli), and have termed the constellation of findings “aerobic vaginitis” [2-4].

EPIDEMIOLOGY

Desquamative inflammatory vaginitis occurs in both premenopausal and postmenopausal women. It is more common in perimenopausal women.

ETIOLOGY

The author and most North American investigators believe desquamative inflammatory vaginitis is an inflammatory vaginitis of non-infectious etiology, with secondary bacterial microbiota disruption [1]. Some other investigators believe the disorder is due to altered vaginal flora (eg, Escherichia coli), and have termed the spectrum of findings “aerobic vaginitis” [2-4]. No consistent microbiologic pathogen has been identified except for the near absence of lactobacilli in almost all women [5].

CLINICAL FINDINGS

Desquamative inflammatory vaginitis is characterized by pain (dyspareunia, vaginal/introital pain, burning) with diffuse exudative vaginitis and epithelial cell exfoliation, resulting in profuse vaginal discharge (usually yellow but may be gray or green). In a large series of 98 patients diagnosed with desquamative inflammatory vaginitis (mean age 49.6 years), 70 to 90 percent had purulent vaginal discharge, dyspareunia, and vaginal inflammation [5].

       

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Literature review current through: Oct 2014. | This topic last updated: Feb 18, 2014.
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