From the Guidelines
Vaginal dryness in Sjögren's syndrome should be managed with topical treatments, prioritizing over-the-counter vaginal moisturizers and lubricants, due to their efficacy and minimal systemic absorption, as recommended by recent guidelines 1.
Management of Vaginal Dryness
To manage vaginal dryness in Sjögren's syndrome, the following steps can be taken:
- Start with over-the-counter vaginal moisturizers like Replens or K-Y Liquibeads, used 2-3 times weekly to maintain vaginal moisture.
- For sexual activity, use water-based lubricants such as K-Y Jelly or Astroglide for temporary relief.
- If these measures are insufficient, consider prescription options including low-dose vaginal estrogen therapy, such as Vagifem tablets (10 mcg estradiol, inserted twice weekly), Estring (silicone ring replaced every 3 months), or Estrace cream (0.5-1 g applied 1-3 times weekly), which have minimal systemic absorption, making them safer than oral hormone therapy 1.
Additional Considerations
- For severe cases, the doctor might consider prescribing ospemifene (Osphena), a selective estrogen receptor modulator taken orally at 60 mg daily.
- Staying well-hydrated, avoiding irritating soaps in the genital area, and wearing cotton underwear can help manage symptoms.
- Regular follow-up with the healthcare provider is important to monitor effectiveness and adjust treatment as needed, especially since Sjögren's syndrome is a chronic condition that may require ongoing management of vaginal dryness.
Guideline Recommendations
The European League Against Rheumatism (EULAR) recommendations for the management of Sjögren's syndrome emphasize the importance of topical and systemic therapies in relieving symptoms, including vaginal dryness 1. While the guidelines do not specifically address vaginal dryness, they highlight the need for a rational therapeutic approach to managing Sjögren's syndrome, which can be applied to the treatment of vaginal dryness.
Recent Studies
A recent study on dry eye syndrome preferred practice pattern provides insight into the management of Sjögren's syndrome, although it does not directly address vaginal dryness 1. The study emphasizes the importance of evaluating patients with Sjögren's syndrome for symptoms of discomfort and visual disturbance, as well as determining the relative contribution of aqueous production deficiency and evaporative loss of tear volume. While this study focuses on dry eye syndrome, its recommendations on tear supplementation and stabilization, control of inflammation, and possible stimulation of tear production can be applied to the management of vaginal dryness in Sjögren's syndrome.
From the Research
Vaginal Dryness in Sjögren's Syndrome
- Vaginal dryness is a common symptom in women with Sjögren's syndrome, as reported in a study published in 1994 2.
- A study published in 2024 found that vaginal biopsies from patients with primary Sjögren's syndrome showed increased interferon signaling, which may contribute to inflammation of the vaginal wall and vaginal dryness 3.
- Another study published in 2020 found that women with primary Sjögren's syndrome had impaired vaginal health and increased lymphocytic infiltration in the vagina compared to controls, which may be caused by vascular dysfunction induced by IFN-mediated pathways 4.
Prevalence of Vaginal Dryness
- A study published in 1995 found that 55% of patients with primary Sjögren's syndrome reported vaginal dryness, compared to 33% of healthy controls 5.
- The same study found that 61% of patients with primary Sjögren's syndrome reported dyspareunia, compared to 39% of healthy controls 5.
Treatment Options
- A systematic review published in 2021 found that hyaluronic acid is a promising treatment for vulvovaginal atrophy and vaginal dryness, with moisturizing properties and potential benefits for women with contraindications to estrogen therapy 6.
Pathophysiology
- The exact mechanisms of vaginal dryness in Sjögren's syndrome are not fully understood, but studies suggest that it may be related to inflammation, immune dysfunction, and vascular dysfunction 3, 4.
- Increased interferon signaling and lymphocytic infiltration in the vagina may contribute to the development of vaginal dryness in patients with primary Sjögren's syndrome 3, 4.