Martha F Goetsch1, Jeong Y Lim, Aaron B Caughey. 1. Departments of Obstetrics and Gynecology and Public Health & Preventative Medicine, Oregon Health & Science University, Portland, Oregon.
Abstract
OBJECTIVE: To locate sites of genital tenderness in breast cancer survivors not using estrogen who experience dyspareunia and to test the hypothesis that tenderness is limited to the vulvar vestibule rather than the vagina and is reversed by topical anesthetic. METHODS:Postmenopausal survivors of breast cancer with moderate and severe dyspareunia were recruited for an examination including randomization to a double-blind intervention using topical aqueous 4% lidocaine or normal saline for 3 minutes to the areas found to be tender. Comparisons of changes in patients' reported numerical rating scale values were made with the Wilcoxon rank-sum test with significance set at P<.05. RESULTS:Forty-nine patients aged 37-69 years (mean 55.6±8.6 years) had a median coital pain score of 8 (interquartile range 7-9, scale 0-10). On examination, all women had tenderness in the vulvar vestibule (worst site 4 o'clock median 6, 4-7). In addition, one had significant vaginal mucosal tenderness and two had pelvic floor myalgia. All had vulvovaginal atrophy with 86% having no intravaginal discharge. Aqueous lidocaine 4% reduced the vestibular tenderness of all painful sites. For example, pain at the worst site changed from a median of 5 (4-7) to 0 (0-1) as compared with saline placebo, which changed the worst site score from 6 (4-7) to 4 (3-6) (P<.001). After lidocaine application, speculum placement was nontender in the 47 without either myalgia or vaginal mucosal tenderness. CONCLUSION: In breast cancer survivors with dyspareunia, exquisite sensitivity was vestibular and reversible with aqueous lidocaine. Vaginal tenderness was rare despite severe atrophy. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01539317. LEVEL OF EVIDENCE: I.
RCT Entities:
OBJECTIVE: To locate sites of genital tenderness in breast cancer survivors not using estrogen who experience dyspareunia and to test the hypothesis that tenderness is limited to the vulvar vestibule rather than the vagina and is reversed by topical anesthetic. METHODS: Postmenopausal survivors of breast cancer with moderate and severe dyspareunia were recruited for an examination including randomization to a double-blind intervention using topical aqueous 4% lidocaine or normal saline for 3 minutes to the areas found to be tender. Comparisons of changes in patients' reported numerical rating scale values were made with the Wilcoxon rank-sum test with significance set at P<.05. RESULTS: Forty-nine patients aged 37-69 years (mean 55.6±8.6 years) had a median coital pain score of 8 (interquartile range 7-9, scale 0-10). On examination, all women had tenderness in the vulvar vestibule (worst site 4 o'clock median 6, 4-7). In addition, one had significant vaginal mucosal tenderness and two had pelvic floor myalgia. All had vulvovaginal atrophy with 86% having no intravaginal discharge. Aqueous lidocaine 4% reduced the vestibular tenderness of all painful sites. For example, pain at the worst site changed from a median of 5 (4-7) to 0 (0-1) as compared with saline placebo, which changed the worst site score from 6 (4-7) to 4 (3-6) (P<.001). After lidocaine application, speculum placement was nontender in the 47 without either myalgia or vaginal mucosal tenderness. CONCLUSION: In breast cancer survivors with dyspareunia, exquisite sensitivity was vestibular and reversible with aqueous lidocaine. Vaginal tenderness was rare despite severe atrophy. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01539317. LEVEL OF EVIDENCE: I.
Authors: Kathryn E Flynn; Jeanne Carter; Li Lin; Stacy T Lindau; Diana D Jeffery; Jennifer Barsky Reese; Bethanee J Schlosser; Kevin P Weinfurt Journal: Am J Obstet Gynecol Date: 2016-12-14 Impact factor: 8.661
Authors: Stefan Stefanovic; Markus Wallwiener; Uros Karic; Christoph Domschke; Luka Katic; Florin-Andrei Taran; Aleksandra Pesic; Andreas Hartkopf; Peyman Hadji; Martin Teufel; Florian Schuetz; Christof Sohn; Peter Fasching; Andreas Schneeweiss; Sara Brucker Journal: Support Care Cancer Date: 2016-10-17 Impact factor: 3.603
Authors: Candi C Bachour; Gloria A Bachmann; David C Foster; Jim Y Wan; Leslie A Rawlinson; Candace S Brown Journal: Clin Trials Date: 2016-08-11 Impact factor: 2.486
Authors: David C Foster; Megan L Falsetta; Collynn F Woeller; Stephen J Pollock; Kunchang Song; Adrienne Bonham; Constantine G Haidaris; Chris J Stodgell; Susan P Messing; Michael Iadarola; Richard P Phipps Journal: Pain Date: 2015-03 Impact factor: 7.926