Supportive care recommendations for vulvar and vaginal chronic GVHD
| Vulvar discomfort |
| Avoid mechanical and chemical irritants Cleanse genital area with warm water, allow air circulation, and wipe front to back Sparing use of simple emollients to vulva Water-based lubricants |
| Vulvovaginal symptoms due to low estrogen status |
| Topical estrogen with or without dilator therapy |
| Topical therapy for vulvovaginal GVHD |
| High- and ultra-high-potency corticosteroids ○ Clobetasol gel 0.05% (vagina) ○ Betamethasone dipropionate augmented gel (vagina) or ointment (vulva) ○ Tacrolimus ointment 0.1% (vulva) |
| Surgical therapy |
| Surgery for strictures |
| Vulvar discomfort |
| Avoid mechanical and chemical irritants Cleanse genital area with warm water, allow air circulation, and wipe front to back Sparing use of simple emollients to vulva Water-based lubricants |
| Vulvovaginal symptoms due to low estrogen status |
| Topical estrogen with or without dilator therapy |
| Topical therapy for vulvovaginal GVHD |
| High- and ultra-high-potency corticosteroids ○ Clobetasol gel 0.05% (vagina) ○ Betamethasone dipropionate augmented gel (vagina) or ointment (vulva) ○ Tacrolimus ointment 0.1% (vulva) |
| Surgical therapy |
| Surgery for strictures |