Sjögren's syndrome in women presenting with chronic dyspareunia

Abstract

Objective To identify cases of Sjogren's syndrome among women with chronic dyspareunia who did not Design Prospective recruitment over 12 months.Setting Tertiary referral service for the assessment of vulva1 disease.Participants Women with chronic dyspareunia who had musculoskeletal symptoms, Raynaud's phenomenon or symptoms of ocular or oral dryness. MethodsThe women underwent a Schirmer tear test and a comprehensive auto-antibody screen including latex fixation test for rheumatoid factor, antinuclear, anti-Ro, anti-La and anti-salivary duct antibodies. A labial salivary gland biopsy and vaginal biopsy were taken for routine histological analysis.Main outcome measures Cases of definite and probable Sjogren's syndrome were identified using the European criteria.Results Eleven women were assessed for features of Sjogren's syndrome. Four had definite primary Sjogren's syndrome, two had probable primary Sjogren's syndrome and one had probable secondary Sjogren's syndrome. Among these seven women the median duration of vaginal symptoms was seven years (range 0-25-20), of ocular symptoms was one year (range 0.25-2) and of oral symptoms was 1.5 years (range 0-6). In all but one woman dyspareunia presented before ocular or oral symptoms, often by many years.Conclusions Although well-recognised as a feature of established Sj ogren's syndrome, this study emphasises that chronic dyspareunia can be a presenting feature in these women, antedating the emergence of ocular or oral symptoms by many years. Symptoms of ocular or oral dryness, Raynaud's phenomenon or musculoskeletal symptoms should be sought in women with chronic dyspareunia to identify those who merit further investigation.already have a diagnosed rheumatological disorder.

Non‐Infective Cutaneous Conditions of the Vulva

“…In a case-control study of 36 women with 43 controls, 61% of the patients with Sjögren's syndrome described dyspareunia and 55% vaginal dryness, compared with 39% and 33% of controls respectively (Marchesoni et al 1995). In a study of patients presenting with dyspareunia who also complained of musculoskeletal symptoms, four of the 11 were found to have primary Sjögren's syndrome with positive antibodies and salivary gland histology (Mulherin et al 1997). It was noted that the vaginal symptoms seemed to predate the ocular and oral symptoms by many months.…”

Reproduction and gynaecological manifestations in women with primary Sjögren's syndrome: a case‐control study

“…Few studies have addressed gynaecological problems and fertility in pSS (2,3) as compared to other connective tissue diseases such as systemic lupus erythematosus (SLE) (4). Vaginal dryness and dyspareuni have been shown to be common and early manifestations of pSS (5). In the present case-control study, we have studied gynaecological aspects and fertility in women with pSS.…”

Sexual Dysfunction among Women with Connective Tissue Disease

“…Dyspareunia, pain with sexual intercourse, occurs more commonly in postmenopausal women due to estrogen deficiency that leads to vaginal atrophy. In SS, there is a disproportionately higher rate of dyspareunia reported among premenopausal women [26]. Skopouli et al reported that 40% of premenopausal SS patients reported dyspareunia compared to 3% among a healthy control population [24].…”

“…The prevalence of dyspareunia among women with SS ranges from 40-69% [24][25][26][27]. Dyspareunia, pain with sexual intercourse, occurs more commonly in postmenopausal women due to estrogen deficiency that leads to vaginal atrophy.…”