Sexual health in women

Sexual health problems are a typical scleroderma symptom for women. Most women with vulval and vaginal problems find them difficult to discuss. Be reassured that these difficulties are common - you are not alone.

Vaginal dryness

'Sjögrens syndrome' or 'sicca syndrome' often accompanies systemic sclerosis. This causes dryness of the mucous membranes, typically leading to dry eyes and a dry mouth. The vagina can also be affected, and with less lubrication during arousal, sex can be uncomfortable, or even painful.

This is the usual reason for vaginal dryness in women with scleroderma.

However, it is important to exclude other causes such as the menopause or local infection as different treatments may be helpful for these. Occasionally the problem can be caused by other conditions such as lichen sclerosis et atrophicus that resembles morphoea - a type of localised scleroderma. Your GP or local well woman clinic will be able to help arrange the right tests and treatments for you.

Treatment for dryness caused by Sjögrens syndrome:

  • Vaginal lubricants, such as KY jelly, Aquagel, Replens or Senselle, are completely harmless, and can be bought without prescription at any chemist.
  • Try to relax. If you are expecting intercourse to be painful, your vaginal muscles will instinctively tense up and intercourse will then be even more difficult. Find something relaxing that works for you.
  • Local anaesthetic jelly can help. Apply it to the vaginal entrance about ten minutes before intercourse so that you can feel confident that it will not be painful. 2% lignocaine antiseptic gel comes in single-use sachets (on prescription) and is safe to use.
  • Smooth plastic dilators can open up the vaginal entrance and help you regain your confidence for the real thing. They come in a series of sizes, to enable you to improve things gradually. These are called “Amielle Trainers" and you may find it helpful to look at the manufacturer's website.
  • Operations on the vaginal entrance are occasionally appropriate, but this is not usually helpful for women with systemic sclerosis, as the scar tissue from the operation wound would make things even more uncomfortable. If you would like advice on this, ask to be referred to a gynaecologist.

If simple remedies have not proved helpful, you may need more help. Larger hospital gynaecology departments will have a “Vulval Clinic" where they can investigate the problem in more detail and consider the use of steroid ointments. You can ask your doctor for a referral to this.

Remember to be patient. If you have a problem that has been building up over a few years, it may need some time and care to correct it – but there are always ways of making things better.

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