Sexual Health > Vaginal Health > Conditions

This Uncommon Type of Vaginitis Can Be Difficult to Diagnose

While DIV is often confused with other vaginal conditions, treatment is possible.

Desquamative inflammatory vaginitis (DIV) is a mouthful to say, but can have some pretty bothersome symptoms for those who have it.

DIV is one of the more uncommon types of vaginitis, and it can be difficult to diagnose and treat. The research is lacking with DIV, but experts believe anywhere from 2 percent to 20 percent of people have it.

So what are the symptoms, why is it so hard to get treatment—and how can you find relief if you have DIV? We reached out to the experts to help demystify this vaginal condition.

What exactly is DIV?

According to Kecia Gaither, MD, MPH, FACOG, who is double board-certified in OB-GYN and Maternal-Fetal Medicine, DIV is a form of vaginitis that seems to happen mainly in Caucasian women around the time of menopause.

Basically, the skin around and in the vagina is inflamed, but it's not actually an infection—such as with a yeast infection. It's also not contagious.

However, it does disrupt that careful balance of bacteria in your vagina. If you were to look under a microscope, you'd see lots of white blood cells from the inflammation, and not very many lactobacilli, the bacteria you want to be there. You know, the bacteria that's found in probiotic supplements and yogurt.

Why is it so hard to diagnose?

"DIV has symptoms similar to many other vulvovaginal conditions," said Megan Gray, M.D., an OB-GYN at Orlando Health Physician Associates. "The hallmark symptoms are vaginal discharge and vaginal pain. Infections, such as bacterial vaginosis, vaginal yeast, and trichomoniasis have similar symptoms."

Gaither explained other common symptoms of DIV can include:

Vaginal inflammation
Rash
Burning or itching
Painful intercourse
Redness
Areas of bruising

Gray noted another challenge is the lack of a specific test that can actually diagnose DIV. What providers do is diagnose by exclusion. "Meaning other causes for the symptoms have to be ruled out," she explained. Which, of course, no one with an itching, burning vagina wants to hear.

According to Gaither, DIV can also mimic sexually transmitted infections (STIs). Oftentimes, it gets misdiagnosed as trichomoniasis, a common STI that also causes burning, itching, redness, and white, yellow or green discharge.

Your provider might diagnose you with DIV if you have been treated for other vaginal infections several times without any relief in your symptoms. It can be frustrating to have to go through the process of elimination when you're feeling miserable.

Remember, you're your best advocate when it comes to your medical care and it's important to continue to seek answers if you feel your treatment isn't working.

What treatment options are available?

The treatment for DIV will vary from person to person depending on your symptoms. According to Gaither, you'll most likely be prescribed a topical medication that you apply as a cream or ointment to the affected area. It could be an antibiotic, such as clindamycin, or a corticosteroid. Some people are prescribed both.

Antibiotics are used to help bring back a balanced bacterial ecosystem to the vagina. Steroids can help reduce inflammation and redness in your vulvar and vaginal area.

"Treatment is generally prolonged for weeks to months," Gaither said.

Remember, you're your best advocate when it comes to your medical care and it's important to continue to seek answers if you feel your treatment isn't working.

Some people might, unfortunately, have their symptoms return over and over, becoming a chronic or long-term condition. For others, one round of treatment takes care of it. The good news is, these medications can help keep DIV symptoms under control.

"If you've been treated for conditions, such as bacterial vaginosis or vaginal yeast infection and you're still having symptoms, ask your provider about the possibility of DIV," Gray advised. It might feel awkward or embarrassing talking about your symptoms, but it helps to be open with your provider in order to get the right treatment.

And, Gray added, if you feel your provider isn't addressing your concerns, reach out to someone else for a second opinion.