Vulvovaginal Graft-Versus-Host Disease in an Australian Multidisciplinary Vulva Clinic

Objectives: Vulvovaginal graft-versus-host disease (vvGVHD) is an under-recognized complication of allogeneic stem cell transplantation (AlloSCT) associated with morbidity, including pain, sexual dysfunction, and quality-of-life impacts. Contemporary data on its frequency and management are limited. This study sought to determine the frequency of vvGVHD in a South Australian cohort, describe the affected population, evaluate the timing of screening relative to AlloSCT, and characterize management practices. Methods: A retrospective review of electronic medical records was conducted for patients attending a Vulvar multidisciplinary clinic in Adelaide, South Australia, from January 2020 to December 2024. Patients attending for screening or management of suspected or confirmed vvGVHD following AlloSCT were included. Demographic, transplant, clinical, and treatment data were analyzed descriptively. Results: A total of 1,688 encounters were screened, identifying 355 related to vvGVHD screening or management, corresponding to 51 patients. Of these, 31 patients (63.27%) developed any GVHD and 13 (26.53%) were diagnosed with vvGVHD. Median time to first specialist review was 440 days. Patients with vvGVHD were first reviewed at a median of 306 days, attending a mean of 11.85 clinic appointments. Nine of 13 patients (69.23%) were diagnosed at the first clinic review. Two had no prior documented GVHD elsewhere. All patients received topical intravaginal estrogen therapy, 84.61% received topical corticosteroids, and 46.15% received systemic hormonal therapy. Conclusions: vvGVHD was identified in one quarter of patients screened within this service. Diagnosis at first specialist review suggests delayed recognition and missed opportunities for earlier intervention. These findings support routine, standardized screening and earlier referral for vulvovaginal assessment following AlloSCT.