Goetsch Martha F, Lim Jeong Y, Caughey Aaron B
All authors: Oregon Health & Science University, Portland, OR.
J Clin Oncol. 2015 Oct 20;33(30):3394-400. doi: 10.1200/JCO.2014.60.7366. Epub 2015 Jul 27.
Dyspareunia is common in breast cancer survivors because of low estrogen. This study explored whether dyspareunia is introital pain, preventable with analgesic liquid.
In a randomized, controlled, double-blind trial, estrogen-deficient breast cancer survivors with severe penetrative dyspareunia applied either saline or 4% aqueous lidocaine to the vulvar vestibule for 3 minutes before vaginal penetration. After a 1-month blinded trial of patient-assessed twice-per-week tampon insertion or intercourse, all patients received lidocaine for 2 months in an open-label trial. The primary outcome was patient-related assessment of penetration pain on a scale of zero to 10. Secondary outcomes were sexual distress (Female Sexual Distress Scale), sexual function (Sexual Function Questionnaire), and resumption of intercourse. Comparisons were made with the Mann-Whitney U and Wilcoxon signed rank test with significance set at P < .05.
In all, 46 patients, screened to exclude those with pelvic muscle and organ pain, uniformly had clinical evidence of severe vulvovaginal atrophy, dyspareunia (median pain score, 8 of 10; interquartile range [IQR], 7 to 9), increased sexual distress scores (median, 30.5; IQR, 23 to 37; abnormal, > 11), and abnormal sexual function. Users of lidocaine reported less pain during intercourse in the blinded phase (median score of 1.0 compared with saline score of 5.3; P = .007). After open-label lidocaine use, 37 (90%) of 41 reported comfortable penetration. Sexual distress decreased (median score, 14; IQR, 3 to 20; P < .001), and sexual function improved in all but one domain. Of 20 prior abstainers from intercourse who completed the study, 17 (85%) had resumed comfortable penetrative intimacy. No partners reported penile numbness.
Breast cancer survivors with menopausal dyspareunia can have comfortable intercourse after applying liquid lidocaine compresses to the vulvar vestibule before penetration.
由于雌激素水平低，性交困难在乳腺癌幸存者中很常见。本研究探讨性交困难是否为阴道口疼痛，以及止痛液能否预防。
在一项随机、对照、双盲试验中，患有严重插入式性交困难的雌激素缺乏型乳腺癌幸存者在阴道插入前，将生理盐水或4%利多卡因水溶液涂抹于外阴前庭3分钟。在为期1个月的双盲试验中，患者每周评估两次棉塞插入或性交情况，之后所有患者在开放标签试验中接受2个月的利多卡因治疗。主要结局是患者对插入疼痛的评估，范围为0至10分。次要结局包括性困扰（女性性困扰量表）、性功能（性功能问卷）以及恢复性交情况。采用Mann-Whitney U检验和Wilcoxon符号秩检验进行比较，显著性设定为P < 0.05。
总共46例经筛查排除盆腔肌肉和器官疼痛的患者，均有严重外阴阴道萎缩、性交困难（疼痛评分中位数为10分中的8分；四分位间距[IQR]为7至9分）、性困扰评分增加（中位数为30.5；IQR为23至37；异常，> 11）以及性功能异常的临床证据。利多卡因使用者在双盲阶段报告性交时疼痛较轻（中位数评分为1.0，而生理盐水评分为5.3；P = 0.007）。在开放标签使用利多卡因后，41例患者中有37例（90%）报告插入舒适。性困扰减轻（中位数评分，14；IQR，3至20；P < 0.001），除一个领域外，性功能在所有方面均有改善。在完成研究的20例之前避免性交的患者中，17例（85%）恢复了舒适的插入式亲密关系。没有伴侣报告阴茎麻木。
患有绝经后性交困难的乳腺癌幸存者在插入前对外阴前庭应用利多卡因液敷后可进行舒适的性交。
