Can you apply topical lidocaine (local anesthetic) to a vaginal lesion near the vaginal opening?

From the Guidelines

Topical lidocaine can be applied to a vaginal lesion near the vaginal opening for temporary pain relief, as suggested by the American Society of Clinical Oncology clinical practice guideline adaptation of Cancer Care Ontario guideline 1. When applying topical lidocaine to a vaginal lesion, it is essential to follow proper instructions to minimize potential side effects.

• Common formulations include 2% or 5% lidocaine gel, ointment, or cream.
• Apply a small amount (pea-sized) to the affected area up to 3-4 times daily as needed for pain.
• Before application, gently clean and dry the area.
• Use a clean finger or cotton swab for application, and wash hands before and after. Lidocaine works by temporarily blocking nerve signals in the treated area, reducing pain sensation for approximately 1-2 hours per application, as noted in the context of managing genital symptoms and pain 1. However, it is crucial to be aware of potential side effects, which may include mild burning, stinging, or itching upon application.
• Discontinue use if you experience severe irritation, rash, or swelling. While lidocaine can provide symptomatic relief, it is essential to consult a healthcare provider about the underlying cause of the lesion, as proper diagnosis and treatment of the primary condition is necessary, and lidocaine can also be offered for persistent introital pain and dyspareunia, as per the guideline 1. Avoid using lidocaine for extended periods without medical supervision, and consider alternative treatments, such as lubricants, vaginal moisturizers, or low-dose vaginal estrogen, as recommended by the guideline for managing vaginal atrophy and related symptoms 1.

From the Research

Topical Lidocaine Application on Vaginal Lesions

• The application of topical lidocaine on vaginal lesions near the vaginal opening has been studied in various contexts, including pain relief during minor gynecological procedures and the treatment of human papillomavirus-related lesions 2, 3.
• A study published in the European journal of dermatology found that a lidocaine/prilocaine combination cream was effective in providing anesthesia for the treatment of human papillomavirus-related anogenital lesions, including those located on the vagina and vulva 2.
• Another study published in the Journal of minimally invasive gynecology found that topical application of lidocaine-prilocaine cream on genital mucosa significantly reduced pain associated with speculum examination in postmenopausal women 4.
• The use of topical lidocaine for pain relief during pessary removal and reinsertion has also been studied, with one trial finding that lidocaine hydrochloride 2% jelly did not significantly reduce pain compared to lubricating jelly 5.
• However, the study on lidocaine-prilocaine cream versus local infiltration anesthesia for pain relief during repair of perineal trauma after vaginal delivery found that topical lidocaine-prilocaine cream gave comparable results in reducing pain during perineal repair 6.

Key Findings

• Topical lidocaine can be effective in providing pain relief during minor gynecological procedures, including the treatment of vaginal lesions 2, 3.
• The application of lidocaine-prilocaine cream on genital mucosa can significantly reduce pain associated with speculum examination in postmenopausal women 4.
• The use of topical lidocaine for pain relief during pessary removal and reinsertion may not be significantly effective compared to lubricating jelly 5.
• Topical lidocaine-prilocaine cream can provide comparable pain relief to local infiltration anesthesia during perineal repair after vaginal delivery 6.