Vulvovaginal Graft-versus-Host Disease Affects One in Four Women After Stem Cell Transplants

Women who undergo allogeneic haematopoietic stem cell transplantation frequently develop vulvovaginal graft-versus-host disease (GvHD), a poorly recognised complication that often appears late and can be severe. In a retrospective, observational, single-centre study conducted at the Centre Henri Becquerel in Rouen, France, researchers reviewed the records of all women transplanted since 2017 who had attended at least one gynaecological consultation, with data collected between April 2023 and April 2024.

Among the 110 patients analysed, vulvovaginal GvHD was identified in 25.5 percent of cases. The condition, in which donor immune cells attack the recipient’s vulvovaginal tissue, most often had a late onset and presented in severe forms, underscoring how frequently it escapes diagnosis during routine post-transplant care.

Treatment, delivered mainly as topical therapy with systemic treatment reserved for more severe cases, led to clinical improvement or complete resolution in 65.4 percent of the affected women. The authors argue that the burden of disease justifies systematic and individualised gynaecological follow-up after allogeneic transplantation.

The study also evaluated other gynaecological sequelae of transplantation. Rates of human papillomavirus positivity and cervical cytological abnormalities were not significantly increased after transplantation, a finding that may reassure clinicians monitoring cervical health in this population.

Menometrorrhagia, or prolonged and excessive uterine bleeding, was observed in 6.5 percent of patients. Among women younger than 40 years, premature ovarian insufficiency occurred in 53.3 percent, a substantial endocrine finding reported by the study, although the research documented its frequency rather than establishing its cause.

Sexual dysfunction emerged as markedly more common among women with vulvovaginal GvHD than among those without it. Vaginal dryness was reported by 57.1 percent of these patients compared with 28.8 percent of those without the condition, a difference that reached statistical significance (p = 0.014).

Dyspareunia, or painful intercourse, showed an even starker contrast, affecting 73.9 percent of women with vulvovaginal GvHD versus 26.2 percent of those without (p < 0.001). These associations suggest that the condition has a considerable impact on quality of life beyond its direct physical manifestations.

The authors conclude that vulvovaginal GvHD and other gynaecological complications after allogeneic haematopoietic stem cell transplantation remain under-estimated and warrant closer clinical attention. As a retrospective, single-centre analysis restricted to women who attended gynaecological consultations, the study’s findings reflect that selected population, but the high observed prevalence and severity of vulvovaginal GvHD highlight the value of dedicated gynaecological assessment in post-transplant follow-up.

Subject of Research: Gynaecological complications and vulvovaginal graft-versus-host disease after allogeneic haematopoietic stem cell transplantation

Article Title: Gynaecological complications and vulvovaginal graft-versus-host disease after allogeneic haematopoietic stem cell transplantation: a retrospective study

Article References: Plaziat, M., Georgescu, D., Rives, N., Jardin, F., Petrovic, C.-H., Ottaviani, M., Drouyer, A., & Jorda, P. (2026). Gynaecological complications and vulvovaginal graft-versus-host disease after allogeneic haematopoietic stem cell transplantation: a retrospective study. Supportive Care in Cancer, 34(11), Article 1146. https://doi.org/10.1007/s00520-026-11392-5

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11392-5

Keywords: allogeneic HSCT, graft-versus-host disease, vulvovaginal GvHD, gynaecological complications, premature ovarian insufficiency, sexual dysfunction, HPV, haematological malignancies, retrospective study, supportive care, Gynaecological, complications