title: Pelvic floor dysfunction in female Sjögren's syndrome: an 8-year audit.
abstract: OBJECTIVE
  The classic triad of dry eyes, mouth and vagina is known to most gynaecologists as pathognomonic of Sjögren's syndrome, but rheumatologists seldom consider vaginal symptoms. Our hypothesis was that women with Sjögren's syndrome would have an increased likelihood of postoperative voiding dysfunction, severe vaginal stenosis or poor response to anticholinergics compared with the general urogynaecology patient.
  
  
  METHODS
  All patients with Sjögren's syndrome were prospectively recorded from July 2007 to June 2015. Presenting complaint, pelvic examination findings, previous/subsequent pelvic surgery, voiding dysfunction and response to anticholinergics were noted. The denominator, all new urogynaecology patients, was prospectively recorded.
  
  
  RESULTS
  Fifteen patients were identified over 8 years (0.5 % of 2794 new presentations). Of the seven patients who had previously undergone surgery elsewhere, all had demonstrable pelvic tissue fibrosis; five had such severe fibrosis that no speculum could be passed. Anticholinergic medications were completely intolerable in 10/11 (91 %) women, and severe postoperative voiding dysfunction occurred in 6/9 (67 %) women. Only 2/15 (13 %) women were unaffected by fibrosis, postoperative voiding dysfunction or intolerance to anticholinergics.
  
  
  CONCLUSIONS
  This audit demonstrates a substantial risk of vaginal stenosis, postoperative voiding dysfunction or severe intolerance to anticholinergics in women with Sjögren's syndrome.
authors.affiliation: University of New South Wales, Sydney, Australia.|Pelvic Floor Unit, St George Hospital, Sydney, Australia.
authors.forename: Aaron K
authors.initials: AK
authors.lastname: Budden
authors.affiliation: University of New South Wales, Sydney, Australia.|Pelvic Floor Unit, St George Hospital, Sydney, Australia.
authors.forename: Nèvine I D
authors.initials: NI
authors.lastname: Te West
authors.affiliation: University of New South Wales, Sydney, Australia.|Department of Rheumatology, St George Hospital, Sydney, Australia.
authors.forename: Allan D
authors.initials: AD
authors.lastname: Sturgess
authors.affiliation: University of New South Wales, Sydney, Australia. k.moore@unsw.edu.au.|Pelvic Floor Unit, St George Hospital, Sydney, Australia. k.moore@unsw.edu.au.|Department of Urogynaecology, School of Women's and Children's Health, St George Hospital, Level 1, WR Pitney Clinical Sciences Building, Short Street, Kogarah, NSW, 2217, Australia. k.moore@unsw.edu.au.
authors.forename: Kate H
authors.initials: KH
authors.lastname: Moore
mesh_terms: D000368:Aged; D018680:Cholinergic Antagonists / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000209:etiology; D004361:Drug Tolerance; D005260:Female; D006801:Humans; D008485:Medical Audit; D008875:Middle Aged; D017773:Pelvic Floor / Q000503:physiopathology / Q000601:surgery*; D059952:Pelvic Floor Disorders / Q000209:etiology* / Q000628:therapy; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D012307:Risk Factors; D012859:Sjogren's Syndrome / Q000150:complications* / Q000503:physiopathology; D014555:Urination Disorders / Q000209:etiology; D014621:Vagina / Q000601:surgery
chemical_list: D018680:Cholinergic Antagonists
keywords: Fibrosis; Incontinence; Pelvic floor; Sjögren’s syndrome