Background Primary Sjögren's syndrome (pSS) is a chronic and disabling disease, characterized by sicca symptoms of the eyes and mouth as well as fatigue. Besides these well-known symptoms, multiple studies have shown that women with pSS often experience complaints of vaginal dryness and dyspareunia.
Objectives To compare sexual functioning and sexual distress between women with pSS and healthy controls, and to identify parameters that predict sexual dysfunctioning in women with pSS.
Methods 46 women with pSS according to the AECG criteria (mean age 46.3±10.5) and 43 age-matched healthy controls (mean age 44.4±11.3) were included. Median disease duration of the patients was 7 years (interquartile range 4-14). Participants completed a self-administered questionnaire, which included the Female Sexual Function Index (FSFI), Female Sexual Distress Scale (FSDS), RAND-36 item health survey (RAND-36), Hospital Anxiety and Depression Scale (HADS), Multidimensional Fatigue Index (MFI) and Maudsley Marital Questionnaire (MMQ). In patients, disease activity was recorded with the EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI) and EULAR Sjögren's Disease Activity Index (ESSDAI).
Results Women with pSS had a significantly lower FSFI total score compared to healthy controls (median 20.6 vs. 30.3, p<0.001), and experienced more sexual dysfunctioning in the domains of desire, arousal, orgasm, lubrication and pain (figure). Furthermore, pSS patients experienced more sexual distress according to the FSDS (median 7 vs. 4, p<0.05) and reported more frequently that they had been sexually inactive in the past four weeks than healthy controls (24% vs. 7%, p<0.05). In total, 67% of the patients never talked about sexual problems with their rheumatologist.
Sexual dysfunctioning correlated significantly with depressive symptoms (HADS), higher ESSPRI score, more symptoms of fatigue (MFI), lower mental quality of life (RAND-36) and relationship dissatisfaction (MMQ). Furthermore, sexual dysfunctioning correlated significantly with higher ESSDAI score only in premenopausal patients.
Conclusions Sexual dysfunctioning is an important symptom and leads to psychological distress in women with pSS. Symptoms of depression and higher disease activity are associated with sexual dysfunctioning. When treating pSS, this aspect of the disease should not be overlooked. More research is needed to obtain knowledge on the pathogenesis of vaginal sicca symptoms in pSS and the best treatment for this complaint.
Disclosure of Interest None declared