Vaginal outflow tract obstruction by graft-versus-host reaction

Abstract

Summary:We describe a 25-year-old patient suffering from vaginal outflow obstruction which presented as secondary amenorrhea during hormone replacement therapy. The patient had undergone bone marrow transplantation for acute myelocytic leukemia, which caused ovarian failure. Oral mucositis associated with a chronic GVH reaction also occurred. For 3 years she was treated with HRT and had regular menses which gradually ceased and were associated with dyspareunia and abdominal cramps. Abdominal US examination demonstrated hematocolpus. Sonography guided adhesiolysis of a dense vaginal obstruction allowed free drainage with histologic confirmation of a graft-versus-host reaction. The possibility of vaginal stricture or obstruction should be considered in all patients after BMT who suffer from graft-versus-host disease. Keywords: graft-versus-host disease; gynecological complications; vaginal obstruction Secondary amenorrhea occurs in the majority of patients treated with high-dose radiochemotherapy followed by bone marrow transplantation (BMT), as a result of ovarian failure. 1,2 Ovarian failure rate is influenced by the patients' age at the time of chemotherapy, by the type of the primary disease and by the chemotherapy regimen given. 3 Since many of the patients are young women during their reproductive years, hormone replacement therapy (HRT) is usually recommended. 4 Menstruation induced by HRT shows that chemotherapy or BMT does not affect the endometrium.We describe a case of secondary amenorrhea in a young woman who suffered from chronic GVH after BMT. For 3 years she had HRT-induced menstruation that gradually ceased combined with the appearance of dyspareunia and period cramps. Case reportA 25-year-old female patient presented with secondary amenorrhea of 6 months duration, dyspareunia and abdomi-

Clinical guidelines for gynecologic care after hematopoietic SCT. Report from the international consensus project on clinical practice in chronic GVHD

“…Patients, who are sexually active, may recognize symptoms earlier. Female genital cGVHD causing complete vaginal obstruction resulting in hematocolpos or hematometra can manifest as cyclic pain and amenorrhea in women taking HT 34,35 or as difficulty while voiding in case of vulvar adhesions.…”

Female genital tract graft-versus-host disease: incidence, risk factors and recommendations for management

“…The majority of published case reports are skewed to the advanced stenosing lesions requiring surgical therapy. 2,3 As genital tract GVHD impacts on quality of life, sexual function and relationship dynamics, early recognition and treatment are an important part of post transplant management. In the late-1990s, we initiated a programme to standardize detection, grading of severity and management of female genital tract GVHD.…”

Penile lichen sclerosus after allogeneic stem cell transplantation

“…Oral microstomia and fibrosis of the oesophagus and vagina are well‐known complications of cGVHD 6,7 8 and phimosis, 6 without histopathological confirmation, have also been reported previously.…”