Noncongenital Vaginal Obliteration: Surgical Restoration of Vaginal Patency for GVHD

Abstract

SettingGenital graft-versus-host disease (GVHD) is a known possible complication of bone marrow transplant (BMT). This condition can lead to vaginal obliteration, affecting sexual performance and quality of life. ObjectivesTo provide a brief overview of non-congenital causes of vaginal obliteration and stenosis, discuss a unique case of vaginal agglutination in a patient who developed genital GVHD after receiving a BMT, and present the steps of a laparoscopic total hysterectomy and lysis of vaginal adhesions that successfully restored vaginal patency without the need for grafting. Design and InterventionsThis video gives an overview of non-congenital causes of vaginal obliteration with a focus on genital GVHD. We discuss the clinical course of a 54-year-old female with history of acute monocytic leukemia treated with chemotherapy and a BMT. She subsequently developed genital GVHD with complete vaginal obliteration, precluding penetrative intercourse and causing pain, discomfort, and decreased quality of life. We present a combined laparoscopic and vaginal surgical procedure that allowed for the creation of a neovagina with a normal length and caliber. While grafting is sometimes necessary due to inflammation and scarring, we were able to avoid a graft by using a combined laparoscopic and vaginal approach, followed by restoration of continuity between the unaffected upper and lower vaginal tissues. ConclusionGVHD can be quite debilitating for patients. A combined surgical approach is a feasible option for patients with complex pathology not amenable to simple transvaginal adhesiolysis. Surgical restoration of the vagina does not necessarily require the use of a graft if the anatomy is reestablished successfully.