Graft Versus Host Disease (GVHD) and Sex

Throughout February, we're looking at sex, relationships and fertility. Today, we wanted to give you a sneak peek at our upcoming booklet on blood cancer and sex. In this extract, you can learn more about how graft versus host disease (GVHD) - a common side effect of a stem cell transplant - can affect the genitals, and what you can do to treat it.

Patients may develop Graft Versus Host Disease (GVHD) after their transplant, and this can affect women and men in different ways. High dose steroids are often used to treat GVHD and these can also suppress the production of sex hormones, which may decrease a person’s sex drive.

Women and Genital GVHD

Chronic GVHD may affect your vaginal and genital area.  It may cause:

  • Vaginal burning
  • Vaginal tightness
  • Discomfort or pain with sexual intercourse
  • Abnormal vaginal discharge
  • Narrowing of the vagina
  • In severe cases, the vagina may become ulcerated

Women who have genital GVHD may have a decreased desire to have sex. They may find it difficult to achieve an orgasm and experience pain or bleeding during or after sex.

There are a few things that can be done to help prevent vaginal GVHD and its symptoms:

  • Avoid using chemical irritants when washing and try not to use perfumed lotions and soaps
  • Wear cotton underwear
  • If you have very sensitive skin, use a very mild detergent
  • Apply moisturisers to avoid dry skin
  • Vaginal lubricants can make sexual intercourse more comfortable. However, make sure they are water-based lubricants as oil-based lubricants can tear condoms.

If you get any symptoms of vaginal GVHD, such as vaginal burning, vaginal tightness, discomfort or pain with sexual intercourse and abnormal vaginal discharge, let your transplant team know immediately.

Men and Genital GVHD

Chronic GVHD may affect your penis and sexual function. It may cause:

  • A decreased desire to have sex
  • Redness/rash on your penis
  • Ulcers on the penis
  • Inflammation of the penis and/or scrotum
  • Narrowing of the urethra
  • An inability to ejaculate

If you experience any of these symptoms, it is important to let your transplant team know.

Treatments for genital GVHD may include some of the following medications:

  • Steroids are the most common treatment given
  • Calcineurin inhibitors are sometimes given as an alternative to avoid long term steroid use
  • Topical immuno-suppressants

Treatments for women

  • Oestrogen cream, capsules or release rings may be prescribed. This should be inserted into the vagina two to three times a week as prescribed. Oestrogen cream will help to increase the moisture and elasticity of the vagina.
  • The transplant team may encourage you to use vaginal dilators or sexual intercourse two to three times a week to help keep your vagina healthy. If you don’t currently have a partner, or you and your partner do not feel ready for sexual intercourse, then vaginal dilators should be inserted two to three times a week.
  • Hormone replacement therapy: Chemotherapy given as part of the transplant conditioning regimen can cause women to go through the menopause much earlier than usual.
    • Hormone replacement therapy may help to alleviate the symptoms of menopause, such as hot flushes, and it can help to increase sex drive.

Treatments for men

  • Testosterone may be prescribed – this may help to increase your libido
  • PDE-5 inhibitors – e.g. Viagra

If you experience any of these symptoms of GVHD, it is important to inform your medical team so that the appropriate treatments can be given.

Genital GVHD can be a difficult and uncomfortable subject to talk about; however, it is important to discuss any issues with your transplant team as genital GVHD can become severe if not treated and can have a devastating effect on quality of life.

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