Some breast cancer treatments, such as chemotherapy and ovarian shut down, can bring on menopause more abruptly than it would happen otherwise. Sexual intercourse may be uncomfortable or even painful for women in early-onset menopause because dramatically lower amounts of estrogen in the body can cause vaginal dryness.
Doctors call painful intercourse “dyspareunia.”
A small, proof-of-concept study has found that applying a liquid lidocaine compress to the area where the vulva meets with the vagina (the vulvar vestibule) can make intercourse comfortable again for many women.
The research was published online on July 27, 2015 by the Journal of Clinical Oncology. Read the abstract of “A Practical Solution for Dyspareunia in Breast Cancer Survivors: A Randomized Controlled Trial.”
Lidocaine is a local anesthetic that numbs the area to which it is applied.
Proof-of-concept studies are small and used to show that a concept could work as intended and is safe.
The study involved 43 postmenopausal women who had been treated for breast cancer and had been having moderately or severely painful sexual intercourse for at least 6 months. The women were all in long-term, stable heterosexual relationships and had not used any estrogen products, including hormone replacement therapy, for at least 4 months.
All the women had previously used artificial lubricants, and 13 of the women also had tried some type of vaginal moisturizer, but still had pain during sex. About half of the women (20) had stopped having sex because of the pain. On a scale of 1 to 10, the average pain score during sex for the women was an 8.
The researchers randomly assigned the women to one of two month-long treatment groups. For 3 minutes before penetration by either their partner’s penis or a tampon:
- half the women applied a 4% lidocaine compress to the vulvar vestibule
- the other half of the women applied a placebo saltwater compress to the vulvar vestibule
The women agreed to attempt to have sex or insert a tampon 2 times per week and record their pain scores in a diary. All the women also were given a silicone lubricant to use during sex.
After the month was up, women who were applying lidocaine before sex and using the silicone lubricant reported much less pain -- a pain score of 1 -- during sex than women who were applying saltwater and using the silicone lubricant before sex -- a pain score of 5.3. This difference in pain was statistically significant, which means that it was likely due to the difference in treatment and not just because of chance.
After the month was up, all the women in the study were given lidocaine compresses for 2 months and told to use them the same way as the original group. At the end of the 2 months:
- 90% of the women said sex was comfortable for them
- 17 of the 20 women who said they had stopped having sex because of pain had started having sex again
- none of the women’s partners said their penises felt numb
“The physical and psychological consequences for the more than 2.8 million breast cancer survivors in the U.S. are very real and often misunderstood, or not treated," said Martha F. Goetsch, M.D., M.P.H., adjunct assistant professor in the Oregon Health & Science University Department of Obstetrics and Gynecology and the study's lead author. "This noninvasive treatment will offer distinct help in alleviating the physical -- and quite frankly the emotional -- pain associated with sexual intercourse, making sexual function more enjoyable and fulfilling for them and their partner."
The results of this study are extremely promising and may offer a solution for many women who find sexual intercourse painful.
Still, the results don’t apply to everyone who has painful sex. Applying a lidocaine compress to the vulvar vestibule won’t help women who have muscle pain during sex. The lidocaine compress also won’t help women who have trouble reaching orgasm, have a lack of desire, or have pain inside the vagina.
If you find sex painful, you might want to ask your doctor about this study and see if your sexual pain could be helped by a lidocaine compress.
For more information on sex during and after breast cancer treatment, visit the Breastcancer.org Sex and Intimacy pages. Our monthly Sex Matters blog, by Michael Krychman, M.D., a sexual medicine gynecologist and certified sexual therapist, also discusses physical and psychological issues that can affect sexuality and offers practical tips on how to have better sex during and after breast cancer treatment.
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