title: Early Diagnosis of Labial Fusion in Women After Allogeneic Hematopoietic Cell Transplant Enables Outpatient Treatment.
abstract: OBJECTIVE
  The aim of the study was to describe the presentation and successful treatment of labial fusion in women after allogeneic hematopoietic cell transplantation (HCT).
  
  
  METHODS
  During routine posttransplant gynecologic evaluation, labial fusion was identified in 5 female patients. Clinical data were collected regarding underlying disease, transplant regimen, genital symptoms, systemic sites of chronic graft-versus-host disease (cGvHD) and treatment, and follow-up.
  
  
  RESULTS
  At presentation, women had a median age of 40 years (range = 35-50) and were 23-month to 8-year post-HCT. Four of the 5 patients with labial fusion had evidence of active cGvHD; 3 patients had severe sclerotic cGvHD, and 1 patient had bronchiolitis obliterans. One had rheumatoid arthritis and had recently stopped taking etanercept, but had no sites of cGvHD. One patient presented with only a pinpoint opening for passage of urine. Her complete labial fusion was lysed under general anesthesia. Three of the 4 others presented with dyspareunia. Their labia were fused between the clitoris and urethra narrowing the vaginal opening without obstructing the urethra. These labial adhesions were successfully lysed during an office procedure. Once the labial mucosa healed, the patients applied topical clobetasol and estrogen to prevent reagglutination. On follow-up, 1 month to 1 year later, all women were significantly improved.
  
  
  CONCLUSIONS
  These patients highlight the importance of asking women who have undergone allogeneic HCT, especially those with severe cGvHD, about dyspareunia and dysuria. Those with genital symptoms warrant referral to a gynecologist. These cases illustrate that labial fusion, if diagnosed early enough, may be treated successfully with an office procedure and medical therapy.
authors.affiliation: 1Hematology Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD; 2Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD; 3Intramural Office of Rare Diseases, Office of the Director, National Institutes of Health, Bethesda, MD; 4Community Health Center Zagreb East, Department of Gynecology, Zagreb, Croatia; 5Graft-versus-Host and Autoimmunity Unit, Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; 6Molecular and Clinical Hematology Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD; and 7Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
authors.forename: Claire
authors.initials: C
authors.lastname: Scrivani
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Merideth
authors.forename: Tajana
authors.initials: T
authors.lastname: Klepac Pulanic
authors.forename: Steven
authors.initials: S
authors.lastname: Pavletic
authors.forename: Richard W
authors.initials: RW
authors.lastname: Childs
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Hsieh
authors.forename: Pamela
authors.initials: P
authors.lastname: Stratton
mesh_terms: D000328:Adult; D042241:Early Diagnosis; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D014184:Transplantation, Homologous / Q000009:adverse effects*; D014845:Vulvar Diseases / Q000175:diagnosis* / Q000628:therapy*