How do you manage severe vaginal dryness and vulvodynia refractory to topical lubricants in patients with Sjogren's syndrome?  

Exclude candida, vestibular gland blockage, and lichen sclerosis.First-line treatment option is vaginal estrogens (cream, ring) or low-dose systemic estrogen (tablet, patch).Second-line options include vaginal DHEA or vaginal testosterone.The severe vaginal dryness in Sjogren's is associated with ly...