Table 4.

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