What is GVHD of the vulva and vagina?

Chronic graft-versus-host disease (GVHD) of the vulva and vagina happens when donated cells a patient receives during a blood or marrow transplant (BMT) begin attacking these tissues. This type of GVHD can happen several months to several years   after transplant and most often affects the vulva (the outer part of the vagina) first, and then the vagina.

Chronic GVHD can affect the vulva and vagina, causing a range of symptoms that may impact comfort, intimacy and quality of life. Early treatment is important to help manage symptoms and prevent long-term complications.

• Feeling dry or gritty in the vaginal or vulvar area
• Itching or burning that may feel like a yeast infection
• Red or inflamed skin around the vulva or inside the vagina
• Pain when sitting, wearing tight clothing, urinating or having vaginal sex
• Small cracks, sores or open areas on the vulva or in the vagina
• Light bleeding after sex

• Vaginal discharge that may look yellow, green or different from usual
• Fused or stuck tissue in the vaginal area (called adhesions or synechiae)

To learn more about how GVHD can affect different parts of your body, view our full list of GVHD symptoms.

There are simple steps you can take to help relieve discomfort and prevent long-term issues. Always talk with your care team before starting any new treatment.

• Ask your doctor about estrogen therapy (pill, cream, ring or suppository) to ease dryness.
• Use water- or silicone-based vaginal moisturizers or lubricants with no dyes, perfumes or alcohol.
• Gently clean with warm water only. Avoid perfumed soaps, wipes or lotions, which can irritate sensitive skin.
• Wear soft, breathable cotton underwear. Avoid anything too tight, which can cause irritation.

• Check your vulva weekly for changes like redness, sores or swelling.
• Use a vaginal dilator or have vaginal sex 2–3 times a week if it doesn’t cause pain.
• Tell your doctor if sex becomes painful or if you notice discharge or bleeding.

• Your symptoms get worse.
• You have new symptoms in your vulva or vagina.
• You have a fever or other signs of an infection.
• It’s too painful to have vaginal sex or use a dilator.
• You have unexpected vaginal bleeding.

• Get a gynecologic exam about 3 months after transplant, then once a year, even if you don't have symptoms.
• See a gynecologist who has experience caring for people after transplant.
• Let your care team know if you notice new pain, odor or unusual discharge. These could be signs of infection.

Your doctor can check for GVHD with a simple pelvic exam. In some cases, they may take a small tissue sample (biopsy) to confirm the diagnosis.

If GVHD is found, treatment may include:

• Prescription creams or ointments with steroids to reduce inflammation
• Topical immunosuppressants like cyclosporine or tacrolimus—these may cause burning in some people
• Surgery in rare cases, if the vaginal opening becomes narrowed or closed

Talk with your care team to create a plan that works best for your body and your recovery.

NMDP^SM offers resources to help you navigate GVHD of the vulva and vagina and connect with people who understand your journey. Choose the support that’s right for you: