Gynecology and Sjogren's Syndrome

Yep. I used the same picture yesterday. Read on to see why. 

I received an email from a reader after yesterday's post. Although she appreciated the information about new insurance options for those that have been denied coverage, what she really wanted to know was: Where can I get a copy of the article about gynecological aspects of Sjogren's syndrome shown in the picture?

The story can be found in the September 2011 issue of The Moisture Seekers, published by the Sjogren's Syndrome Foundation. Members of the SSF receive every issue. Joining is easy and can be done online.

The topic of gynecological aspects of Sjogren's is an important one, but one that is very poorly understood. Recently, the Johns Hopkins Jerome Greene Sjogren's Syndrome Center has established a clinic dedicated to the gynecological problems of women with Sjs. Here's a few excerpts from this excellent article, written by Thomas Grader-Beck, MD and Anne Burke, MD, MPH:

Vaginal dryness has long been recognized as a manifestation of SS. There are few studies that address this symptom, but they suggest that vaginal dryness is frequent among women with SS. About a third of pre-menopausal SS patients are affected by vaginal dryness; this increases to 75 percent in the postmenopausal period. While vaginal, oral, and ocular dryness may coexist in the same woman, their severity may not correlate. In many cases, the vaginal dryness may be more severe than oral or eye dryness. Vaginal dryness also may occur before the onset of oral and ocular dryness in women with SS. Vaginal dryness may help to identify Sjogren's patients who have the characteristic autoantibodies (anti-Ro/La) but lack eye and mouth symptoms. Along with vaginal dryness, patients frequently complain about itching (pruritus) that can be debilitating.
     Patients with Sjogren's syndrome have a high frequency of dyspareunia (pain during intercourse). In a study of premenopausal women, 40 percent with SS complained of dyspareunia in contrast to only 3% without SS. Postmenopausal women with SS also have a higher frequency of dyspareunia than their healthy counterparts. 

The article goes on to note that the mechanisms that cause vaginal dryness and the resulting problems are very poorly understood. Unlike the eyes and mouth, there are no glands which provide lubrication within the vaginal tissue itself.

Therapy is frustratingly limited to few treatments at this time, and include topical estrogens and vaginal moisturizers. Read this:

As of yet, there is no definitive treatment for the vaginal symptoms of SS. Since there is inflammation in vaginal tissues of women with vaginal sicca due to SS, the question arises whether women may benefit from anti-inflammatory therapy, in particular in the premenopausal period. There currently is no information available in this regard. 

The Johns Hopkins Jerome L. Greene Sjogren's Syndrome Center has initiated two studies to better understand this difficult issue. You can read more about the Johns Hopkins Center and it's ongoing studies here.