Sjogren's syndrome in women presenting with chronic dyspareunia

Objective To identify cases of Sjogren's syndrome among women with chronic dyspareunia who did not already have a diagnosed rheumatological disorder. Design Prospective recruitment over 12 months. Setting Tertiary referral service for the assessment of vulval disease. Participants Women with chronic dyspareunia who had musculoskeletal symptoms, Raynaud's phenomenon or symptoms of ocular or oral dryness. Methods The women underwent a Schirmer tear test and a comprehensive auto-antibody screen including latex fixation test for rheumatoid factor, antinuclear, anti-Ro, anti-La and anti-salivary duct antibodies. A labial salivary gland biopsy and vaginal biopsy were taken for routine histological analysis. Main outcome measures Cases of definite and probable Sjogren's syndrome were identified using the European criteria. Results Eleven women were assessed for features of Sjogren's syndrome. Four had definite primary Sjogren's syndrome, two had probable primary Sjogren's syndrome and one had probable secondary Sjogren's syndrome. Among these seven women the median duration of vaginal symptoms was seven years (range 0.25-20), of ocular symptoms was one year (range 0.25-2) and of oral symptoms was 1.5 years (range 0-6). In all but one woman dyspareunia presented before ocular or oral symptoms, often by many years. Conclusions Although well-recognised as a feature of established Sjogren's syndrome, this study emphasises that chronic dyspareunia can be a presenting feature in these women, antedating the emergence of ocular or oral symptoms by many years. Symptoms of ocular or oral dryness, Raynaud's phenomenon or musculoskeletal symptoms should be sought in women with chronic dyspareunia to identify those who merit further investigation.