BACKGROUND Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has become a curative treatment modality for many patients with malignant hematologic diseases. Despite impressive advances in the management of allo-HSCT, graft vs. host disease (GvHD) is a frequent complication that significantly contributes to the morbidity and mortality associated with transplantation and is a significant obstacle to overcome. CASE An unusual case of hematocolpometra secondary to vaginal stenosis occurred as a manifestation of chronic GvHD. CONCLUSION Management of vaginal stenosis and stricture formation as a manifestation of chronic GvHD consists of surgery with lysis of adhesions. Return of anatomic distortion to normal is followed by vaginal dilatation. Later, local estrogen cream and sexual activity help to avoid further adhesion formation.