As a greater number of patients are living beyond a cancer diagnosis, the management of health issues related to the persistent and late effects of cancer treatment is important and essential to long-term improvements in health. 

Sexual dysfunction, which includes lack of desire, negative body image, depression and anxiety, and genital pain, is one of the most common complaints of breast cancer survivors. With 46% of post-treatment cancer survivors who responded to a 2006 LIVESTRONG survey reporting changes in sexual function and 71% of them not receiving post-treatment care for their sexual concerns, the topic of sexual health continues to be difficult for patients to discuss with their healthcare team. 

The development of sexual difficulties in women from cancer treatment can be multifactorial, resulting from a decrease in estrogen, changes in body image, vaginal shortening, pelvic adhesions, and disruption of pelvic nerves. The reduction of circulating estrogen caused by chemotherapy and endocrine therapies can lead to decreased blood flow to the vulvar and vaginal tissue, decreased vaginal and cervical secretions, and decreased elasticity and thinning of the vaginal mucosa, resulting in penetrative pain and fear of pain with sexual activity. 

A new study explored whether topical lidocaine prior to sexual intercourse reduces penetration pain. The researchers conducted a phase II, randomized, placebo-controlled study involving 46 postmenopausal breast cancer survivors with documented vulvovaginal atrophy, painful genitalia during sexual intercourse, high sexual distress scores, or abnormal sexual dysfunction. Patients applied either saline or 4% aqueous lidocaine compresses three minutes prior to twice-weekly vaginal intercourse or tampon insertion. Afterward, patients participated in a two-month, open-label trial during which they received lidocaine. The primary outcome was patient-reported penetration pain and secondary assessment of sexual function and distress. 

Patients in the blinded trial experienced significantly less pain during intercourse with a median score of 1 out of 10 compared with the saline score of 5.3 out of 10. In the open-label portion of the trial, 90% of patients reported comfortable penetration. Scores of sexual distress also decreased with lidocaine use. Almost 50% of patients abstained from sexual relations before using lidocaine; 85% of them resumed sexual intercourse after using lidocaine. None of their partners reported penile numbness. 

Although a larger trial will need to be conducted to confirm the findings, this simple approach could be used to help patients who are presently experiencing sexual distress.