SJOGRENS-SYNDROME IN WOMEN PRESENTING WITH CHRONIC DYSPAREUNIA

Objective To identify cases of Sjogren's syndrome among women with chr onic dyspareunia who did not already have a diagnosed rheumatological disorder. Design Prospective recruitment over 12 months. Setting Terti ary referral service for the assessment of vulval disease. Participant s Women with chronic dyspareunia who had musculoskeletal symptoms, Ray naud's phenomenon or symptoms of ocular or oral dryness. Methods The w omen underwent a Schirmer tear test and a comprehensive auto-antibody screen including latex fixation test for rheumatoid factor, antinuclea r, anti-Ro, anti-La and anti-salivary duct antibodies. A labial saliva ry gland biopsy and vaginal biopsy were taken for routine histological analysis. Main outcome measures Cases of definite and probable Sjogre n's syndrome were identified using the European criteria. Results Elev en women were assessed for features of Sjogren's syndrome. Four had de finite primary Sjogren's syndrome, two had probable primary Sjogren's syndrome and one had probable secondary Sjogren's syndrome. Among thes e 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 dyspare unia presented before ocular or oral symptoms, often by many years. Co nclusions Although well-recognised as a feature of established Sjogren 's syndrome, this study emphasises that chronic dyspareunia can be a p resenting feature in these women, antedating the emergence of ocular o r oral symptoms by many years. Symptoms of ocular or oral dryness, Ray naud's phenomenon or musculoskeletal symptoms should be sought in wome n with chronic dyspareunia to identify those who merit further investi gation.