There are two prominent mechanisms involved in the production of intravaginal moisture. In the sexually unstimulated state, bacteria, mainly lactobacilli, metabolise glycogen in the vaginal epithelium to produce water and lactic acid the latter maintains the intravaginal pH at about 4.5. The normally substantial increase in intravaginal moisture that occurs during sexual arousal is the result of transudation through the vaginal epithelium, a so-called sweating response. The cause of vaginal dryness in Sjogren's syndrome has not been adequately explained. Sjogren's syndrome is common but its prevalence in the general population is unknown.
All diagnostic criteria are empirical and representative of the investigator's opinion.
In this case the combination of keratoconjunctivitis sicca, xerostomia and a positive rheumatoid factor were considered to represent Sjogren's syndrome, and no other cause of vaginal dryness was apparent. The management of eye and oral dryness in Sjogren's syndrome has been well described 9 but little attention has been paid to the relief of vaginal dryness that causes dyspareunia. Local moisturising cream and lubricating jelly provide some benefit and have a role to play. Because oestrogen deficiency may worsen the preexisting condition in postmenopausal women, local or systemic oestrogen replacement may also be helpful. At present, however, the symptom of vaginal dryness is not well understood there is a need for the development of a longer-acting treatment.