Hysteroscopic management of cervicovaginal adhesions presenting as long-term sequelae of vulvovaginal graft-versus-host disease

BackgroundVulvovaginal graft-versus-host disease (GVHD) is an underdiagnosed and poorly recognized complication of HSCT1,2. We aim to present hysteroscopic management of cervicovaginal dense adhesions developed as a long-term sequelae of vulvovaginal GVHD in a 16-years-old girl who has Diamond-Blackfan Anemia. The institutional review board approval was obtained.CaseA 16-years-old girl presented with pelvic pain for last 2 months. Her previous history was significant for Diamond-Blackfan anemia and having HSCT 10 years ago. She was started on pubertal induction 3 years ago and she had been receiving E2 replacement with cyclic progesterone for the last 6 months without having any menstrual bleeding. Perineal inspection revealed the absence of an external vaginal opening. Abdominal ultrasonography revealed a relatively small uterus with a thin endometrial lining and some fluid collections in the cervical canal and vagina. The topical steroid with vaginal dilation were tried first. Since adequate vaginal patency could not be achieved, hysteroscopic lysis of the adhesions was performed under general anesthesia.ConclusionThe possible late effects of GVHD on the genital organs should be remembered, since adolescents may underreport the genital symptoms1-3. Office hysteroscopy is a method that can be used safely in opening the vaginal and cervical synechia in a patient with late effects of GVHD. Vulvovaginal graft-versus-host disease (GVHD) is an underdiagnosed and poorly recognized complication of HSCT1,2. We aim to present hysteroscopic management of cervicovaginal dense adhesions developed as a long-term sequelae of vulvovaginal GVHD in a 16-years-old girl who has Diamond-Blackfan Anemia. The institutional review board approval was obtained. A 16-years-old girl presented with pelvic pain for last 2 months. Her previous history was significant for Diamond-Blackfan anemia and having HSCT 10 years ago. She was started on pubertal induction 3 years ago and she had been receiving E2 replacement with cyclic progesterone for the last 6 months without having any menstrual bleeding. Perineal inspection revealed the absence of an external vaginal opening. Abdominal ultrasonography revealed a relatively small uterus with a thin endometrial lining and some fluid collections in the cervical canal and vagina. The topical steroid with vaginal dilation were tried first. Since adequate vaginal patency could not be achieved, hysteroscopic lysis of the adhesions was performed under general anesthesia. The possible late effects of GVHD on the genital organs should be remembered, since adolescents may underreport the genital symptoms1-3. Office hysteroscopy is a method that can be used safely in opening the vaginal and cervical synechia in a patient with late effects of GVHD.