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In females, the most frequent late effect manifesting as a genital complaint is vaginal–vulvar GVHD. It typically occurs around the 10th month post‐HCT and presents with vaginal pain, discomfort, and vaginal scarring [34]. As this late effect can be successfully treated with topical cyclosporine/steroids/estrogen therapies in the early stages, vaginal examinations at regular intervals (see Chapters 18 and 23) should be performed for early detection. Other late effects include cervical cancers, vaginal candidiasis, and herpes simplex infections.

In males, penile cGVHD is the most frequent genital late effect, which can result in Peyronie’s disease or phimosis [35].

Annual comprehensive dermatologic evaluations in both men and women should include complete genital assessments for genital cancers and cGVHD screening. The 2014 NIH cGVHD scoring system has been updated to reflect the complications in male genital tract [36].