Vulvar and Vaginal Graft-Versus-Host Disease: prevalence and repercussions on vaginal microbiota

Allogeneic bone marrow transplantation (BMT) carries the risk of the donor's cells recognizing the recipient as abnormal, triggering Graft Versus Host Disease (GVHD). This study aimed to understand the prevalence and gynecological complications, including vaginal microbiota evaluation.

A descriptive cross-sectional study was carried out from December 2022 to October 2023. Post-allogeneic BMT patients underwent gynecological evaluation at the Assis Chateaubriand Maternity School in Fortaleza-Ceará, Brazil, composed of structured interview and physical examination, which included collection of fresh examination of vaginal content, gram bacterioscopy and cervicovaginal cytology.

A total of 22 patients between 21 and 61 years old (average: 38) were evaluated, with an average of 1028 (± 979) days post BMT. Of these patients, whether or not they had Vulvar and Vaginal Graft Versus Host Disease (VVGVHD), 15 reported various gynecological complaints (dryness being the most common). Of the total, twelve showed signs of genital atrophy on examination. A 45% prevalence of VVGVHD was found, with vulvar and vaginal involvement of 100% and 60%, respectively. Burning and dyspareunia symptoms were more prevalent in patients with VVGVHD than in those without it (p<0.05); there was no difference in Human Papillomavirus (HPV) induced lesions between the two groups. However, compared to the population not undergoing allogeneic BMT, these patients had a higher prevalence of induced HPV lesions and intermediate vaginal flora.

The findings described in the present work are consistent with other studies available in recent literature. In conclusion, VVGVHD is a potentially mutilating condition, with a significant prevalence among post-BMT patients.