Case notes
A 21-year-old woman with a history of myelodysplastic syndrome complained of a diminished urine stream. Four years earlier, the patient received myeloablative allogeneic bone marrow transplantation from an unrelated donor with 1 mismatched locus on the HLA-DR group. Subsequently, the patient experienced late extensive chronic graft-vs-host disease (GVHD) that affected the liver, oral mucosa, and eyes. In addition, she had secondary gonadal insufficiency, possibly because of the alkylating agent that had been administered for bone marrow transplantation. She was treated with cyclosporine to stabilize the GVHD over the duration. Because hormone replacement therapy was necessary as well, a combination of norgestrel and ethinyl estradiol, which is marketed in Japan as Planovar, was prescribed at a dosage of 10 mg/day for 21 days of each menstrual cycle.
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Physical examination disclosed an almost complete synechia of the vulva ( Figure 1 ). Surgical synechotomy revealed that the adhesion was limited to the external vulva; no intravaginal synechia was noted ( Figure 2 ).
