Novel management of vaginal chronic graft-versus-host disease causing haematometra and haematocolpos.

Genital chronic graft-versus-host disease (GVHD) in women posthaematopoietic cell transplantation may cause vaginal mucosal sclerosis. Human papillomavirus (HPV) reactivation, also common post-transplantation, limits local immunosuppressive, but not oestrogen treatment. A 36-year-old nulliparous woman developed coincidental genital chronic GVHD and HPV 22 months after transplant for aplastic anaemia. Topical immunosuppression for GVHD led to an eruption of warts successfully treated with laser surgery and cone biopsy. She maintained normal ovarian function and used extended cycle combined hormonal contraception. A vaginal oestrogen ring used continuously limited most scarring for 8 years. Progressive apical vaginal scarring obstructed menstrual flow leading to haematocolpos and haematometra. Normal anatomy was restored with a cruciate incision in the cervicovaginal scar performed during menses. When HPV disease limits use of topical immunosuppression in women with vaginal GVHD, the local scar-reducing effect of a vaginal oestrogen ring is limited, and surgery may be needed and can be successful in treating haematocolpos.This study was registered in ClinicalTrials.gov with trial registration number of NCT00003838. I, Pamela Stratton, The Corresponding Author has the right to grant and do so grant on behalf of all Contributors a licence to all intellectual property rights for all content within the submitted case report or as later submitted (which includes without limitation any diagrams photographs, other illustrative material, video, film or any other material howsoever submitted by any of the Contributors at any time and related to this article) other than as agreed with the BMJ Publishing Group Ltd) (“BMJ”)) has the right to grant on behalf of all Contributors and does grant on behalf of all Contributors , a licence to BMJ in any media known now or created in the future, and permit this case report (if accepted) to be published on BMJ Case Reports website and /or within any other BMJ products in any media and to be fully exploited within the remit of the licence which has been read.