First Prize Paper Shows Solution for Painful Sex in Breast Cancer Survivors

A new study has detailed an effective treatment for dyspareunia, or painful intercourse, in estrogen-deficient breast cancer survivors. Awarded “First Prize,” this study was presented on Monday, April 28, 2014, at the 2014 ACOG Annual Clinical Meeting in Chicago.

Dyspareunia is a common complaint of many postmenopausal women, and estrogen can be an effective treatment. However, breast cancer survivors are warned not to use estrogen. So what might be an effective therapy for estrogen-deficient breast cancer survivors who experience severe penetrative dyspareunia?

First-author Martha Goetsch, MD, MPH, of the Oregon Health and Science University, Portland, and colleagues studied whether application of 4% aqueous lidocaine to the vulvar vestibule for 3 minutes before vaginal penetration was effective in reducing pain related to penetrative sex. The use of saline was used in a control group.

The study involved 46 women-all survivors of breast cancer-with severe vulvovaginal atrophy, dyspareunia (median pain, 8/10), and elevated sexual distress scores (median score, 30.5; an abnormal score is greater than 11). For one month, participants kept a diary documenting pain related to twice-weekly tampon insertion or intercourse; in this first phase, all of the participants were blinded as to whether they were using lidocaine or saline. After this first month, all patients received lidocaine for two months.

Women who used lidocaine in the first phase of the study had less pain related to intercourse than women who used saline (median pain score, 1.0 vs 5.3, respectively). In the second phase of the study, 37 (90%) of 41 women said that penetrative sex was “comfortable” using lidocaine. In addition, the median sexual distress score decreased from 30.5 to 14 (P<0.001).

Of 20 study women who completed the study but prior to the study had abstained from sex because it was too painful, 17 (85%) had resumed sexual intercourse. None of the women’s partners complained of experiencing numbness.

Goetsch suggested that perhaps ob/gyns should stop thinking of dyspareunia as an atrophy condition and start thinking about dyspareunia as a pain condition.