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How is Desquamative Inflammatory Vaginitis (DIV) different from Pelvic Inflammatory Diease (PID)?
I have had some kind of vaginitis for the last year. It won't go away. I've been on tons of medications and the only thing my doctor can come up with is that I have DIV because all of my tests for bacteria, yeast, stds have been negative.
I don't understand what causes this. If things are inflamed wouldn't I have PID and isn't that treated differently?
I don't understand what causes this. If things are inflamed wouldn't I have PID and isn't that treated differently?
answers (1)
I am sorry to hear that you have been in such discomfort for so long. Sometimes vaginal disorders can be pretty difficult to resolve. I will try to at least help you understand what might be happening.
Pelvic Inflammatory Disease (PID) is typically caused by a sexually transmitted bacterial infection such as gonorrhea (GC) or chlamydia (CT). Rarely, other microoragnanisms can lead to PID. Basically, if a person contracts GC or CT and it is not diagnosed and treated, the infection can spread upwards, from the vagina to the cervix and uterus and then the fallopian tubes and ovaries. As the bacteria spreads, it damages the reproductive tract-- tubes can get scarred and blocked; ovaries can get encased by scar tissue. The results can be ectopic pregnancy (pregnancy in the fallopian tube), chronic pelvic pain, or infertility due to the eggs not being released from the ovary or not being able to pass through the fallopian tubes.
PID symptoms typically come on pretty quickly. The infection can be silently present for months or even years, and then at some point if flares up. The woman can present with fever/chills, significant lower abdominal pain, and abnormal discharge. She will likely report pain with sexual activity.
Prevention: Obviously, you have to be sexually active to get an STD. To reduce risk if you are sexually active, use condoms all the time until both you and a monogamous partner get checked for infections. Then, don't have sex with anyone else.
Early diagnosis of GC and CT helps prevent PID. If you have had unprotected sex, have an exam. It is a very easy test, so don't hesitate to get checked. Same is true for males.
Treatment: antibiotics and then medical follow up to be sure the infection has cleared. There are some types of GC that are resistant to antibiotics, so you want to be sure you are cured.
Desquamative Inflammatory Vaginitis is a very uncommon disorder. Basically, it is a diagnosis made after other problems are ruled out. Symptoms include severe dyspareunia (pain with sex). Interestingly, the vaginal tissue appears to be atrophic, or thin and fragile (much like you might see in a postmenopausal woman that is not taking estrogen). However, the woman is usually still menstruating, so her vaginal tissue should look healthy and well-estrogenized. Vaginal stenosis, a narrowing of the vaginal opening, can occur. This causes further pain with intercourse.
I have had a few patients over the years who presented with these symptoms. In each case, we treated everything possible, but without success. We even increased the amount of estrogen in her pills.
What finally worked was to stop her birth control pills. We did this even though birth control pills usually don't cause problems with vaginal atrophy. These particular patients were on birth control pills that had plenty of estrogen for most people. They just happened to be women who made more estrogen on their own (when not on a pill). Symptoms completely resolved after a few months, and they never used hormonal contraception again.
I would suggest first that you reassess the situation. If you are on a pill and can use another contraceptive method, go of the pill for at least 2-3 months. Give it enough time that you start having regular periods for a few months. Don't use latex condoms, though, as some women are allegic to latex. You may just need to abstain from sex during this time.
Next, talk with your doctor about stopping all products. I have been to numerous GYN conferences, and there is always some expert talking about difficult to treat vaginal problems (does that give you an idea of how difficult these problems are?). They suggest, first and foremost, that if there are no untreated infections, stop ALL use of vaginal preparations, prescription and over-the-counter. No douching, no creams, gels, ointments of any kind, and no tampons or condoms (especially latex and those that have spermicide). Avoid soap in the vaginal area, except a gentle soap 2-3 times weekly- not daily. In addition, stop having sex for this period of time. Then, just give it some time to see if things clear up on their own.
Next, talk to your health provider about doing another exam to see if things are improving. If you had DIV, the cells may look healthier if you are healing. If no improvement, then discuss starting treatment, but only one prescription at a time so you don't get into another situation of not knowing what is helping/hurting. Lastly, if you do not feel that your provider is helping you, consider another opinion. However, if you trust and like her/him, sit down together and review where you are health and pain wise.
Best wishes for a good outcome. Sorry this is so long, but its a complicated topic.
Pelvic Inflammatory Disease (PID) is typically caused by a sexually transmitted bacterial infection such as gonorrhea (GC) or chlamydia (CT). Rarely, other microoragnanisms can lead to PID. Basically, if a person contracts GC or CT and it is not diagnosed and treated, the infection can spread upwards, from the vagina to the cervix and uterus and then the fallopian tubes and ovaries. As the bacteria spreads, it damages the reproductive tract-- tubes can get scarred and blocked; ovaries can get encased by scar tissue. The results can be ectopic pregnancy (pregnancy in the fallopian tube), chronic pelvic pain, or infertility due to the eggs not being released from the ovary or not being able to pass through the fallopian tubes.
PID symptoms typically come on pretty quickly. The infection can be silently present for months or even years, and then at some point if flares up. The woman can present with fever/chills, significant lower abdominal pain, and abnormal discharge. She will likely report pain with sexual activity.
Prevention: Obviously, you have to be sexually active to get an STD. To reduce risk if you are sexually active, use condoms all the time until both you and a monogamous partner get checked for infections. Then, don't have sex with anyone else.
Early diagnosis of GC and CT helps prevent PID. If you have had unprotected sex, have an exam. It is a very easy test, so don't hesitate to get checked. Same is true for males.
Treatment: antibiotics and then medical follow up to be sure the infection has cleared. There are some types of GC that are resistant to antibiotics, so you want to be sure you are cured.
Desquamative Inflammatory Vaginitis is a very uncommon disorder. Basically, it is a diagnosis made after other problems are ruled out. Symptoms include severe dyspareunia (pain with sex). Interestingly, the vaginal tissue appears to be atrophic, or thin and fragile (much like you might see in a postmenopausal woman that is not taking estrogen). However, the woman is usually still menstruating, so her vaginal tissue should look healthy and well-estrogenized. Vaginal stenosis, a narrowing of the vaginal opening, can occur. This causes further pain with intercourse.
I have had a few patients over the years who presented with these symptoms. In each case, we treated everything possible, but without success. We even increased the amount of estrogen in her pills.
What finally worked was to stop her birth control pills. We did this even though birth control pills usually don't cause problems with vaginal atrophy. These particular patients were on birth control pills that had plenty of estrogen for most people. They just happened to be women who made more estrogen on their own (when not on a pill). Symptoms completely resolved after a few months, and they never used hormonal contraception again.
I would suggest first that you reassess the situation. If you are on a pill and can use another contraceptive method, go of the pill for at least 2-3 months. Give it enough time that you start having regular periods for a few months. Don't use latex condoms, though, as some women are allegic to latex. You may just need to abstain from sex during this time.
Next, talk with your doctor about stopping all products. I have been to numerous GYN conferences, and there is always some expert talking about difficult to treat vaginal problems (does that give you an idea of how difficult these problems are?). They suggest, first and foremost, that if there are no untreated infections, stop ALL use of vaginal preparations, prescription and over-the-counter. No douching, no creams, gels, ointments of any kind, and no tampons or condoms (especially latex and those that have spermicide). Avoid soap in the vaginal area, except a gentle soap 2-3 times weekly- not daily. In addition, stop having sex for this period of time. Then, just give it some time to see if things clear up on their own.
Next, talk to your health provider about doing another exam to see if things are improving. If you had DIV, the cells may look healthier if you are healing. If no improvement, then discuss starting treatment, but only one prescription at a time so you don't get into another situation of not knowing what is helping/hurting. Lastly, if you do not feel that your provider is helping you, consider another opinion. However, if you trust and like her/him, sit down together and review where you are health and pain wise.
Best wishes for a good outcome. Sorry this is so long, but its a complicated topic.
source(s):
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1194531/
http://www.cdc.gov/std/PID/STDFact-PID.htm
30 years experience as an RN and a nurse midwife
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1194531/
http://www.cdc.gov/std/PID/STDFact-PID.htm
30 years experience as an RN and a nurse midwife
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