Overview
Vaginal dryness is a common yet often overlooked symptom in women with Sjögren’s. Research shows a higher prevalence of vaginal dryness in Sjögren’s patients compared to the general population. This symptom can significantly disrupt daily life and is often accompanied by dyspareunia (painful intercourse).
In some cases, chronic dyspareunia is the presenting symptom of Sjögren’s. Interestingly, even though vaginal dryness is prevalent, the vaginal microbiome in Sjögren’s patients has been found to be similar to that of healthy individuals.
Impact on Sexual Function
Sexual dysfunction is frequently reported by women with Sjögren’s and can be caused or worsened by vaginal dryness and pain. In addition, systemic symptoms such as fatigue, muscle pain, and joint pain can further affect sexual well-being.
Key statistics:
62% of Sjögren’s patients rate sexual activity as important.
68% report that their sexual function is negatively affected by Sjögren’s symptoms.
Sexual dysfunction in this context is linked to:
Anxiety and depression
Relationship dissatisfaction
Reduced quality of life
Causes of Vaginal Dryness
In healthy individuals, vaginal lubrication is supported by:
Transudate from a rich vascular network in the vaginal wall
Mucus produced by endocervical glands
For postmenopausal women, vaginal dryness is usually caused by decreased estrogen levels. In contrast, in Sjögren’s, dryness often begins before menopause, making it distinct and often more challenging to address.
Management and Treatment
Non-Hormonal Treatments
Treatment is based on the severity of symptoms and impact on quality of life. Non-hormonal, over-the-counter options include:
FemmePharma
Products with hyaluronic acid and vitamin E
Personal lubricants and moisturizers
Revaree (Bonafide)
Made with hyaluronic acid
Acts as a moisturizer and personal lubricant
Luvena (Laclede)
Probiotic-based moisturizers and lubricants
Includes vaginal rinse and feminine wipes
Replens
Bioadhesive moisturizers and lubricants
Options include Replens Moisture Restore Gel and Long-Lasting Moisturizer
K-Y Products
Water-soluble lubricants (e.g., K-Y Jelly, Liquid, Ultragel, True Feel, Liquibeads, Warming Jelly)
Note: Patients should consult their healthcare provider for guidance on product use.
Topical Estrogen Treatments
When menopause contributes to dryness and hormonal therapy is not contraindicated (e.g., in patients without estrogen-sensitive cancer), topical estrogen can be used.
Vaginal Estrogen Creams
Premarin cream
Estrace cream
Compounded vaginal estrogen
Vaginal Inserts (Estradiol-based)
Vagifem, Yuvafem: 10 mcg, used twice weekly
Imvexxy: 4 or 10 mcg, with initial loading dose
Intrarosa: 6.5 mg daily, contains prasterone (converted to estrogens and androgens)
Estring
A flexible vaginal ring that releases estrogen
Lasts for 3 months
Summary
Vaginal dryness is a significant but manageable symptom in women with Sjögren’s and is closely linked to sexual dysfunction and quality of life. Both non-hormonal and hormonal treatments are available to address this issue, and individualized care based on patient needs can lead to effective relief and improved well-being.
*excerpt/summary courtesy of The Sjögren's Book, Fifth Editionn, Daniel J. Wallace, MD
