Several postmenopausal patients with desquamative inflammatory vaginitis (DIV) would prefer to receive all their treatments at our office before seeing a specialist. Unfortunately, I cannot find much information on DIV. Should I refer? If not, what do I need to know about this condition?

DIV is a rare and difficult diagnosis, often overlapping with lichen planus, lichen sclerosis, atrophic vaginitis, psoriasis, and a variety of infectious conditions. The first question to ask is whether your office is able to undertake the appropriate diagnostic tests, particularly vulvar biopsy and vaginal culture, to ensure the appropriate disorder is being treated. If white lesions are present, consider colposcopy to rule out human papillomavirus-related changes. If you or your colleagues do not regularly perform vulvar biopsy and/or colposcopy, consider referral to a local gynecologist or dermatologist. If DIV is confirmed by biopsy and clinical assessment, topical steroids, estrogens, and anesthetic agents (e.g., lidocaine [Xylocaine]) can provide some relief of symptoms, but complete remission is often elusive. Research has also pointed to 2% topical clindamycin as a treatment for DIV, especially in women with purulent discharge. Caution patients to avoid any irritants that may exacerbate the condition. For more information, see J Reprod Med. 2008;53: 124-128 and Am J Obstet Gynecol. 1994;171:1215-1220.
—Lisa Stern, APRN