Intralesional Bleomycin for Genital Lymphedema-Associated Lymphatic Malformations and Lymphorrhea

Female genital lymphedema may occur secondary to lower-limb lymphedema following lymphadenectomy for gynecologic cancer. It is often characterized by genital lymphatic vesicles (acquired lymphatic malformations) and lymphorrhea, which are frequently overlooked but can markedly impair quality of life.

To evaluate the efficacy of intralesional bleomycin sclerotherapy for lymphatic malformations and lymphorrhea associated with genital lymphedema.

We retrospectively reviewed patients treated with intralesional bleomycin sclerotherapy between June 2022 and June 2025. Outcomes were assessed by changes in the number of lymphatic vesicles and patient-reported symptoms during a median follow-up of 9 months. Treatment-related complications were also recorded.

A significant reduction in lymphatic vesicles was observed, with the median number decreasing from 11 (range 6-33) before treatment to 2 (range 0-6) after treatment (p<0.01). Twelve patients (54.5%) achieved complete resolution of lymphatic leakage, nine (41%) reported marked improvement, and one (4.5%) reported partial improvement. Minor complications included intralesional hemorrhage and transient hyperpigmentation.

Intralesional bleomycin sclerotherapy appears to be a safe and effective minimally invasive treatment option for genital lymphedema-associated lymphatic malformations and lymphorrhea. This study provides additional clinical evidence for the management of this underrecognized complication of genital lymphedema.

Special Topics. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .