Can numbing cream be used to treat dyspareunia (painful intercourse)?

Numbing Cream for Dyspareunia

For dyspareunia (painful intercourse), topical lidocaine applied to the vulvar vestibule before penetration is an effective treatment option, especially for women with superficial pain. 1

Understanding Dyspareunia

Dyspareunia affects approximately 10-20% of women in the US and can be categorized as:

• Superficial pain: Pain with attempted vaginal insertion
• Deep pain: Pain with deeper penetration

Women experiencing sexual pain are at increased risk for sexual dysfunction, relationship distress, diminished quality of life, anxiety, and depression 2.

Causes of Dyspareunia

Common causes include:

• Vaginal dryness/inadequate lubrication
• Vaginal atrophy (especially in menopausal women)
• Vulvodynia
• Pelvic floor dysfunction
• Vaginismus (involuntary pelvic floor muscle contraction)
• Endometriosis (typically causing deep pain)
• Postpartum issues

Treatment Algorithm

First-line treatments:

1. For vaginal dryness (most common cause):

   • Hormone-free lubricants and moisturizers are the first choice (e.g., water-based gel, hyaluronic acid gel) 3
   • Water-based lubricants should be used during all sexual activity
   • Moisturizers should be applied 2-3 times weekly for ongoing maintenance 4

2. If hormone-free measures are ineffective:

   • Consider low-dose estrogen-containing vaginal medication 3
   • Transdermal estrogen has lower risks compared to oral formulations 4
   • Note: Estrogen therapy is contraindicated in certain hormone-sensitive cancers 4

3. For superficial pain (especially with vestibular hypersensitivity):

   • Topical 4% aqueous lidocaine applied to the vulvar vestibule for 3 minutes before penetration can significantly reduce pain 1
   • In a randomized controlled trial, breast cancer survivors with severe dyspareunia reported a median pain score reduction from 8/10 to 1/10 with lidocaine use 1
   • 90% of participants reported comfortable penetration after lidocaine use, and 85% of prior abstainers resumed comfortable intimacy 1

Additional treatment options:

• Pelvic floor physical therapy for muscle tension or vaginismus 5
• Cognitive behavioral therapy for psychological components 5
• Vaginal dilators for gradual desensitization 2
• Topical analgesics beyond lidocaine 2

Important Considerations

• Location matters: Treatment should target whether the pain is superficial (entry) or deep 6
• Partner effects: No reports of penile numbness were found with lidocaine use 1
• Multifactorial approach: Since dyspareunia often has multiple contributing factors, combining treatments may be necessary 5

Cautions and Contraindications

• Always rule out underlying infections or pathology before symptomatic treatment
• For women with hormone-sensitive cancers, avoid estrogen-based treatments and focus on non-hormonal options 4
• If using lidocaine, ensure it's completely absorbed before penetration to avoid numbing the partner

Monitoring

• Regular follow-up is essential to assess symptom improvement
• Monitor for any abnormal vaginal bleeding, which would warrant further investigation 4
• Assess for improvement in sexual function and distress scores

Numbing cream (specifically 4% aqueous lidocaine) is a practical, evidence-based solution for superficial dyspareunia that can significantly improve comfort during intercourse and overall quality of life.