Gynecologic manifestations of Sjögren’s syndrome are an important, yet often overlooked, aspect of the disease. Even though vaginal dryness is a common occurrence during menopause, women with Sjögren’s syndrome report this symptom 2-3 times more often than comparably aged women without Sjögren’s syndrome. Vaginal atrophy develops during menopause as a consequence of a marked decline in serum levels of estrogen. The presence of Sjögren’s syndrome appears to aggravate the symptoms of vaginal atrophy. This may be manifested by thinning of the pubic hair, loss of vaginal rugae, decreased vaginal moisture, and narrowing of the vaginal introitus. As a consequence, women with vaginal atrophy may note vaginal burning or itching, pain with intercourse, and vaginal spotting or discharge. These symptoms may stem from other causes, such as vaginal infections, vaginal dermatoses (lichen planus or lichen sclerosis), and localized reactions to soaps, detergents, lubricants or sanitary napkins. Vaginal bleeding may also reflect the presence of certain gynecologic cancers. Accordingly, it is important that women with these symptoms be evaluated by a gynecologist.
The treatment of vaginal dryness in the setting of Sjögren’s syndrome includes the use of vaginal moisturizers, water soluble lubricants during sexual activity, and vaginal estrogen creams.