A practical solution may be topical lidocaine application.
Dyspareunia is common among breast cancer survivors. It’s thought to be caused by low estrogen levels that dry out vaginal and labial tissue and result in pain upon penetration. To address this problem, researchers at Oregon Health & Science University in Portland explored the effectiveness of a topical analgesic liquid.
In the randomized, controlled, double-blind trial, estrogen-deficient breast cancer survivors with severe penetrative dyspareunia applied either saline or a 4% aqueous lidocaine topical solution to the vulvar vestibule for 3 minutes before vaginal penetration. After a 1-month blinded trial of patient-assessed twice-per-week tampon insertion or intercourse, all women received lidocaine for 2 months in an open-label trial. The primary outcome was patient-related assessment of penetration pain on a 0 to 10 scale. Secondary outcomes were sexual distress (measured using the Female Sexual Distress Scale), sexual function (measured using the Sexual Function Questionnaire), and resumption of intercourse.
The 46 women, who were screened to exclude those with pelvic muscle and organ pain, uniformly had clinical evidence of severe vulvovaginal atrophy, dyspareunia (median pain score 8 on 10-point scale), increased sexual distress scores (median 30.5; distress is present if score is >11), and abnormal sexual function.
Women who used lidocaine reported less pain during intercourse in the blinded phase (median score of 1.0 compared with saline score of 5.3). After open-label lidocaine use, 37 (90%) of 41 reported comfortable penetration. Sexual distress decreased significantly (median score, 14), and sexual function improved in all but one domain. Of 20 prior abstainers from intercourse who completed the study, 17 (85%) had resumed comfortable penetrative intimacy. No partners reported penile numbness.
The researchers concluded that breast cancer survivors with menopausal dyspareunia can have comfortable intercourse after applying liquid lidocaine to the vulvar vestibule before penetration. This is an easy, cost-effective measure that may enhance sexual intimacy for these women.
Goetsch MF, Lim JY, & Caughey AB. A practical solution for dyspareunia in breast cancer survivors: a randomized controlled trial. Journal of Clinical Oncology 2015; Published online before print July 27, 2015, doi: 10.1200/JCO.2014.60.7366