Vaginal obliteration after total body irradiation and chemotherapy as treatment for acute myeloid leukemia

Although radiotherapy is an integral part in the management of certain type s of hematological malignancies, its effect on the reproductive system has been well documented. We report a rare complication where a patient had com plete vaginal obliteration after receiving a dose of total body irradiation (1575 cGy) as part of her treatment for acute myeloid leukemia. A 37-year- old married woman, G3P2, underwent high-dose cyclophosphamide accompanied b y high dose (1575 cGy) total body irradiation (TBI) as part of her treatmen t for acute myeloid leukemia (AML: ml) when she was 35 years of age. After TBI, the patient developed ovarian failure and amenorrhea, which was confir med by hormonal evaluation. Nevertheless, she did not receive any hormonal replacement therapy and stopped her sexual life for two years. Fortunately, no recurrence of AML was noted. The patient visited our clinic due to diff iculty in performing coitus. Physical examination showed a 2-cm short and b linded vaginal pouch. She initially received hormonal replacement therapy f ollowed by surgical correction via vaginoplasty and two months of dilatory replacement and frequent coitus with satisfactory result. To our limited kn owledge, vaginal obliteration as a complication of condition regimen has ne ver been reported before. In the present case report, it is unclear whether spontaneous vaginal obliteration resulted from chemotherapy, total body ir radiation, or another unknown cause such as a concomitant leukemic infiltra tion of the vaginal wall, severe bacterial and fungal infection before trea tment, or from any combination of the above. However, due to this case pres entation, we suggest that such patients must receive hormonal replacement t herapy and be encouraged to have a normal sexual life to avoid this possibl e problem. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.