Departments of Obstetrics and Gynecology and Public Health & Preventative Medicine, Oregon Health & Science University, Portland, Oregon.
Obstet Gynecol. 2014 Jun;123(6):1231-1236. doi: 10.1097/AOG.0000000000000283.
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.
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.
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.
In breast cancer survivors with dyspareunia, exquisite sensitivity was vestibular and reversible with aqueous lidocaine. Vaginal tenderness was rare despite severe atrophy.
ClinicalTrials.gov, www.clinicaltrials.gov, NCT01539317.
I.
定位经历性交困难且不使用雌激素的乳腺癌幸存者的生殖器敏感部位，并验证以下假设：即这种敏感局限于外阴前庭，而非阴道，且可通过局部麻醉逆转。
患有中度至重度性交困难的绝经后乳腺癌幸存者参与了一项检查，包括随机分配至双盲干预组，用 4%利多卡因水溶液或生理盐水对发现的敏感部位进行 3 分钟的局部涂抹。采用 Wilcoxon 秩和检验比较患者报告的数字评定量表评分的变化，以 P<.05 为差异有统计学意义。
49 名年龄 37-69 岁（平均 55.6±8.6 岁）的患者性交疼痛评分中位数为 8（四分位间距 7-9，评分 0-10）。体格检查时，所有女性外阴前庭均有压痛（最痛点 4 点钟方向，中位数 6，范围 4-7）。此外，1 名患者有明显的阴道黏膜压痛，2 名患者有盆底肌痛。所有患者均有外阴阴道萎缩，86%的患者无阴道分泌物。4%的利多卡因水溶液减轻了所有疼痛部位的外阴前庭压痛。例如，最痛点疼痛从 5（4-7）降至 0（0-1），而生理盐水安慰剂组最痛点评分从 6（4-7）降至 4（3-6）（P<.001）。利多卡因涂抹后，47 名无肌痛或阴道黏膜压痛的患者进行窥器检查时无触痛。
在有性交困难的乳腺癌幸存者中，外阴前庭高度敏感，可用利多卡因水溶液逆转。尽管严重萎缩，但阴道压痛罕见。
ClinicalTrials.gov，www.clinicaltrials.gov，NCT01539317。
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