Yellow Discharge and Burning That Isn't Yeast or BV: Desquamative Inflammatory Vaginitis
Intimate HealthArticleIf you've been treated again and again for yeast or BV and still have heavy yellow-green discharge, redness and painful sex, ask about desquamative inflammatory vaginitis. It's often missed, half of women in one large series were past menopause, and most improved quickly with topical prescription treatment, though many needed ongoing maintenance.
Heavy yellow or greenish discharge, redness, burning and painful sex usually get treated as yeast or bacterial vaginosis (BV). When the treatments don’t work, or the symptoms keep coming back, another cause is worth considering: desquamative inflammatory vaginitis (DIV).
What it is
DIV is a long-lasting inflammation of the vagina and the vulvar entrance (vestibule) that causes a rash-like redness and pus-like discharge.1 It’s frequently unrecognized.1
In a university vaginitis clinic’s series of 98 women with DIV:1
- The average age was about 49, and half were past menopause.
- All had vaginal inflammation, and 72% had redness at the vaginal opening.
How it’s diagnosed
A clinician examines the vagina and looks at a discharge sample under a microscope (a wet mount). Tests for yeast, BV, trichomoniasis and other infections help rule out look-alikes. Our guides to telling yeast, BV and UTIs apart, trichomoniasis follow-up and what’s normal for discharge explain related conditions.
Treatment and what to expect
In that series, prescription vaginal clindamycin cream (2%) or hydrocortisone (10%) relieved symptoms in 86% of women, usually within about 3 weeks.1
But it often comes back:1
- About a third relapsed within 6 weeks of stopping.
- At one year, about a quarter were cured.
- More than half were symptom-free but needed ongoing maintenance treatment.
The authors described DIV as a chronic inflammatory condition that responds well to topical anti-inflammatory therapy, though long-term maintenance is often required.1
Questions to ask
- Could this be DIV rather than repeat yeast or BV?
- Can you look at a discharge sample under the microscope today?
- What maintenance plan should I follow if it improves?
- Should vaginal estrogen be part of the plan after menopause?
Our guide to vaginal estrogen safety evidence covers that option.
Try: “I’ve been treated for yeast three times this year, but the yellow discharge and burning keep coming back. Could this be desquamative inflammatory vaginitis?”
Down There, Decoded includes a Down-There Log and a See script for appointments. Use them to record each treatment you’ve tried and how your symptoms responded. Explore the intimate-health playbook.
This article is for general educational purposes only and is not medical advice. It isn't a substitute for diagnosis or treatment from a qualified healthcare professional who knows your health history. Please don't ignore professional advice or delay getting care because of something you read here. Bleeding after menopause, fever with pelvic pain, or sores and lumps should be examined promptly. If you think you may be having a medical emergency, call 911 or your local emergency number right away. This article discusses a medical condition and published research. Girl Playbook does not endorse any specific product, test, or provider.
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Sources
The research behind this article, in the order it’s cited. How we source our articles.
- Obstetrics and Gynecology (abstract via Europe PMC), 2011Prognosis and treatment of desquamative inflammatory vaginitis (opens in a new tab)abcdef
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