When Vaginal Dryness Is Linked to an Immune System Disorder

Mary Rojas presented problems with dry eyes, mouth, nose and skin after her 50th birthday. Doctors diagnosed Sjögren's syndrome associated with arthritis, which had been in remission for more than a decade.

Since then, the Madrid resident said she experiences occasional episodes of peeling eyelid skin, gritty sensation in the eyes, dry tongue and nasal burning with subsequent bleeding.

When the immune system is compromised by Sjögren's syndrome, the body's mucous membranes and salivary and lacrimal glands become chronically inflamed. As a result, this systemic autoimmune disease causes dryness in different areas of the body including the mouth, eyes, skin, nose, throat and vagina.

Despite being one of the most important symptoms, vaginal dryness is often overlooked, according to the Johns Hopkins Jerome L. Greene Sjögren's Center in Baltimore. Women with Sjögren's syndrome report this symptom two to three times more often than women of a comparable age without the disorder, according to the center.

Sjögren's can be a primary condition without other disorders or secondary when related to another medical condition, such as rheumatoid arthritis, scleroderma, lupus, sclerosis and other connective tissue diseases. In both primary and secondary cases, the fluid reduction is caused when the immune system mistakenly attacks the secretory glands.

The symptoms of Sjögren's syndrome

At the time of her diagnosis, Rojas began to have vaginal dryness and discomfort during intercourse. Her gynecologist and rheumatologist indicated that in addition to menopause, the symptoms were a common problem among women with this autoimmune disease.

Women with vaginal dryness and primary Sjögren's have impaired vaginal health, sexual dysfunction and an "increased lymphocytic infiltration in the vaginal lamina propria," according to a 2020 study published in the Oxford Academic journal Rheumatology.

The consequences of vaginal dryness generate discomfort in the daily lives of women with Sjögren's syndrome, as well as pain during intercourse, said Jolien F. van Nimwegen, M.D., Ph.D., the study's lead author and rheumatology resident in the department of rheumatology and clinical immunology at the University Medical Center Groningen in the Netherlands.

The life of women with Sjögren's is influenced by a number of symptoms, such as dry mouth, disabling fatigue and pain in joints and muscles. Gynecologically, some women experience irritation, burning and/or pain, and spotting or light bleeding may occur due to the dryness of the vaginal tissues and subsequent friction, said Kiarra King, M.D., a board-certified OB-GYN based in Chicago.

"In our previous study...we saw a significant decrease in female sexual function in patients with primary Sjögren's syndrome," van Nimwegen said. "Women with Sjögren’s syndrome experience more problems regarding lubrication of the vagina and pain during intercourse, but also, sexual desire, arousal and the ability to orgasm are affected."

Who is afflicted with Sjögren's syndrome?

In the United States, between 1 and 4 million people are affected by this condition, according to data managed by the National Institute of Dental and Craniofacial Research. Sjögren's impairs all ethnicities and races, with an increase in the female population and people older than 50. Women are nine times more likely to have Sjögren's syndrome than men.

Vaginal dryness in women with and without Sjögren's

"In our study from 2020, participants were examined by a gynecologist which looked at several aspects of vaginal health, such as fluid secretion, moisture, bleeding tendency and elasticity of the vaginal mucosa," van Nimwegen said.

The analysis of these aspects was compared with results from women without the syndrome to assess the impairment of vaginal health and the cause of the dryness.

For the trial, researchers took biopsies of each participant's vagina. The data revealed more inflammatory immune cells in the vaginal mucosa and also fewer smooth muscle cells in women with Sjögren's syndrome.

"[This] may indicate that there is a problem with the blood vessels which produce vaginal fluid," van Nimwegen said.

Although the findings may be related to poor vaginal lubrication, further research is needed to confirm this possibility, she added.

Vaginal dryness in postmenopausal women with and without Sjögren's syndrome is linked to hormonal changes that lead to atrophic vaginitis.

"However, in Sjögren's syndrome, women often develop vaginal dryness at an earlier age, sometimes even around the age of 20," van Nimwegen said.

No signs of atrophic vaginitis were found in the women who participated in the study. Therefore, the researchers believe that hormone replacement is probably not part of an effective treatment for premenopausal women with Sjögren's syndrome.

"As we found increased inflammation in the vagina, it is possible that therapies that reduce inflammation could improve vaginal and sexual health," van Nimwegen said.

Ongoing trials are evaluating these treatments and their effects.

What methods can help control dryness?

Sjögren's syndrome has no cure, but there are treatments to help alleviate symptoms and restore lost moisture in the mouth, eyes, vagina and other body parts.

When Rojas sought treatment to mitigate the discomfort caused by vaginal dryness, she was prescribed some body creams, artificial tears and vaginal moisturizers to help her regain lost moisture.

"Patients would ideally be under the care of their primary physician and/or rheumatologist for their Sjögren's syndrome. However, if vaginal dryness is present, a consultation with an OB-GYN may be fitting," King said.

Some of the treatments for patients with Sjögren's include artificial tears, use of sunglasses, salivary stimulants, skin moisturizers, eye ointments and environmental humidifiers. Meanwhile, for women with gynecological symptoms, vaginal moisturizers and lubricants would be a mainstay of therapy, King said.

"I recommend that all of my patients, regardless of a Sjogren's diagnosis, wear a breathable fabric for their underwear, use mild soaps/body washes that are free of dyes and perfumes, and avoid douching," she said.

Both experts recommended drinking water regularly, maintaining a balanced diet, exercising regularly, not smoking, maintaining good oral hygiene, reducing alcohol consumption, and keeping up with regular medical appointments with your rheumatologist, gynecologist, ophthalmologist and dentist.