A solution for dyspareunia in breast cancer survivors: a randomized controlled study.

INTRODUCTION: Research has focused on vaginal atrophy as the cause of dyspareunia in postmenopausal women. This study explored whether penetrative pain was prevented after hypoestrogenic patients applied analgesic liquid to the vulvar vestibule.

METHODS: In a randomized controlled, double-blind trial, estrogen-deficient breast cancer survivors with severe penetrative dyspareunia applied either saline or 4% aqueous lidocaine to the vulvar vestibule for 3 minutes before vaginal penetration. After a 1-month blinded trial using diary documentation of twice-weekly tampon insertion or intercourse, all patients received lidocaine in an open-label trial for 2 months. The primary outcome was penetration pain (0-10 numeric rating scale). Secondary outcomes were sexual distress (Female Sexual Distress Scale, abnormal greater than 11) and resumption of intercourse. Comparisons were made with the Wilcoxon rank sum and Wilcoxon signed rank test, with significance set at P<.05.

RESULTS: Forty-six patients, screened to exclude pelvic muscle and organ pain, uniformly had severe vulvovaginal atrophy, dyspareunia (median pain 8/10, interquartile range 7-9), and elevated sexual distress scores (median 30.5, interquartile 23-37). Users of lidocaine had less intercourse pain in the blinded phase (median score 1.0 compared with saline 5.3, P=.015). After open-label lidocaine use, 37 of 41 (90%) reported comfortable penetration. Sexual distress had decreased (median 14, interquartile range 3-20, P<.001). Of 20 abstainers who completed the study, 17 (85%) had resumed penetrative intimacy. No partners complained of numbness.

CONCLUSION: Breast cancer survivors with severe menopausal dyspareunia associated with atrophy can have comfortable intercourse after applying topical liquid lidocaine to the vulvar vestibule before penetration.