Can Sjögren's Syndrome Cause Genital Symptoms in Males?
Yes, Sjögren's syndrome can cause genital symptoms in males, though this manifestation is less commonly recognized than in females. While the hallmark features of Sjögren's syndrome are dry eyes and dry mouth, the disease affects multiple exocrine glands and mucosal surfaces throughout the body, including the genital area in both sexes 1, 2.
Documented Genital Manifestations in Males
The evidence for male genital involvement in Sjögren's syndrome is primarily indirect but clinically relevant:
Mucosal dryness can theoretically affect the urogenital mucosa in males, similar to how it affects other mucosal surfaces, though this is less extensively documented than in females 1, 3
Systemic manifestations including peripheral neuropathy (numbness, changed sensation, or burning pain) can affect the genital region as part of the broader neurological involvement seen in Sjögren's syndrome 1
The disease is characterized by lymphocytic infiltration of exocrine glands throughout the body, with potential for multiple organ involvement beyond just the lacrimal and salivary glands 4, 3
Clinical Context and Differential Diagnosis
A critical caveat: If a male patient presents with genital symptoms, particularly involving the penis, you must consider lichen sclerosus as a primary differential diagnosis rather than assuming it is directly related to Sjögren's syndrome. Lichen sclerosus in males commonly affects the glans penis, coronal sulcus, frenulum, and prepuce, presenting with porcelain-white lesions and can cause urinary symptoms 5. This is a distinct autoimmune condition that requires different management.
Comparison to Female Manifestations
The evidence is much stronger for female genital involvement:
Vaginal dryness causing painful intercourse is a well-documented systemic manifestation in women with Sjögren's syndrome 1, 6
Female patients experience vaginal and vulvar dryness and dyspareunia at significantly higher rates, particularly in primary Sjögren's syndrome 7
These gynecological symptoms can strongly alter quality of life both physically and psychologically 6, 7
Practical Clinical Approach
When evaluating a male patient with suspected Sjögren's syndrome and genital symptoms:
Document the specific nature of symptoms: dryness, pain, burning, neurological symptoms, or structural changes 1
Perform careful examination to distinguish between mucosal dryness related to Sjögren's syndrome versus lichen sclerosus or other dermatological conditions 5
Co-management with rheumatology is essential for any patient with confirmed or suspected Sjögren's syndrome due to potential systemic complications 1, 4
Consider serological testing including anti-SSA/Ro antibody, anti-SSB/La antibody, ANA, and rheumatoid factor if Sjögren's syndrome is suspected 1, 2
Important Limitations
The medical literature has a significant gap regarding male genital manifestations of Sjögren's syndrome specifically. Most research focuses on female patients, given the 20:1 female-to-male ratio of the disease 1, 4. The symptoms described in males are extrapolated from the understanding that Sjögren's syndrome affects all mucosal surfaces and exocrine glands, but specific studies documenting male genital involvement are lacking in the provided evidence.