Medical Advice

DIV

What is DIV?

DIV (which stands for Desquamative Inflammatory Vaginitis) is an uncommon condition which results in a sore vagina with a chronic discharge. Virtually every person who has it experiences pain with sex.

When you have a look, the inner surface of your labia minora (inner lips) looks red and raw often with many little purple spots called petechiae. They look like blood spots, and in fact they are.

Who gets DIV?

It happens most often to women after menopause but can occur at any age. It does not happen to children. There is sometimes a trigger (see below under what causes DIV) but sometimes it just happens out of the blue.

What is the cause of DIV?

We do not know what causes DIV. We think it might result from a change in the natural balance of bacteria that normally live in the vagina but the truth is, it has not been worked out yet.

We know that a proportion of women with DIV also have problems with chronic diarrhoea. Some seem to get it when they take estrogen treatment but other seem to be helped by estrogen treatment. In some cases it starts when people have a course of antibiotics. These are all things that can disturb the natural harmony of the inside of the vagina.

How is DIV diagnosed?

There is no one diagnostic test for DIV. It has a characteristic appearance but it is what is called by doctors a diagnosis of exclusion. This means they have ruled out other causes of an inflamed vagina. These causes include chronic thrush, lichen planus, estrogen lack after menopause and drug reactions.

A biopsy can be done but this is not really diagnostic of DIV. Vaginal swabs either show no infection or a bacteria called Group B Streptococcus (GBS). However many women have GBS without having DIV.

DIV is a difficult diagnosis because it is uncommon and many doctors have never seen it or heard of it. Many patients go many years without a diagnosis.

How is DIV treated?

DIV almost always responds very rapidly to antibiotic cream (clindamycin, metronidazole) applied into the vagina, combined with a mild cortisone (steroid) ointment. Most patients are better in a few weeks.

About half the patients who are treated this way get better permanently and half need ongoing treatment to stop them having further attacks.

What should I do if I think I might have DIV?

See your GP and have a vaginal swab. If this does NOT show thrush, if you have not taken any new medications and if many other treatments have not worked for you, either ask for a trial of antibiotic cream (not oral antibiotics, these are not effective) or if your GP is not familiar with DIV, a referral to a specialist.

If you have a problem with chronic diarrhoea, do something about it!

Is DIV dangerous?

No DIV is a very harmless and easily treated condition.

The outcome of treated DIV is nearly always very good.