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Introduction Sexual dysfunction and fertility in women with systemic sclerosis (SSc) is an important health issue, adversely affecting self-esteem, well-being, and quality of life.Previous studies have mainly focused on the psychosocial aspects of the disease, while evidence regarding its effects on genital organs is limited.This study aimed to investigate the relationship between vaginal wall and mucosal thickness and sexual dysfunction in women with SSc.Material and Methods A total of 62 women fulfilling the 2013 ACR/EULAR classification criteria for SSc and 50 healthy controls were included.Vaginal wall thickness (proximal, middle, distal), vaginal mucosa thickness, and vaginal length were measured by transvaginal ultrasonography. The mean vaginal wall thickness was calculated as the average of three segments.Participants completed the Female Sexual Function Index (FSFI), SF-36, Beck Depression Inventory, and HAQ.Additionally, SSc patients were assessed with the five VAS of the sHAQ. An FSFI total score <19 was defined as sexual dysfunction.Results No differences were observed between SSc patients and controls in terms of age (50.8±8.4 vs. 48.7±7.7 years, p=0.166) or marital status. Vaginal ultrasonography revealed significantly thinner mean vaginal wall thickness (3.41±1.12 vs. 3.73±0.85, p=0.022), proximal (3.46±1.12 vs. 3.75±0.99, p=0.035), middle (3.31±1.26 vs. 3.63±0.97, p=0.032), and distal wall thickness (3.46±1.33 vs. 3.83±0.93, p=0.032), as well as mucosa thickness (1.60±0.59 vs. 1.86±0.61, p=0.018) in the SSc group. FSFI total scores were significantly lower in SSc women compared to controls (17.28±9.87 vs. 22.69±9.03, p=0.001). Domain analyses showed lower scores in desire (p=0.016), arousal (p=0.002), lubrication (p=0.006), orgasm (p=0.004), and satisfaction (p=0.006). SSc patients had higher depression scores (15.19±8.63 vs. 9.58±7.58, p<0.001) and significantly poorer SF-36 subdomains. Correlation analysis demonstrated positive associations between vaginal wall/mucosa thickness and FSFI total and domain scores. Among SSc patients with sexual dysfunction, mean (3.05 ± 1.01 vs. 3.75 ± 1.12, p=0.007), proximal (3.22 ± 1.06 vs. 3.68 ± 1.15, p=0.043), middle (2.97 ± 1.23 vs. 3.63 ± 1.23, p=0.012), distal wall thickness (2.94 ± 1.17 vs. 3.95 ± 1.30, p=0.001), and mucosa thickness (1.40 ± 0.52 vs. 1.78 ± 0.658, p=0.007) were significantly thinner compared to those without dysfunction. No significant differences were found in the control group.Conclusions This is, to our knowledge, the first study to evaluate vaginal wall and mucosal thickness by transvaginal ultrasonography in women with SSc. Our findings indicate that vaginal tissue thinning is associated with sexual dysfunction, suggesting that this method may serve as a novel objective tool for assessing sexual health in SSc.Abstract P.359 Table 1Sociodemographic characteristics, vaginal ukrasound measurements, questionnaire soores, and clinical features of SSc patients and controlsAbstract P.359 Table 2Corebtions between vagiral eltrasound mewurements and qesionnaire seones in women with Sse