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Dyspareunia associated with genitourinary syndrome of menopause (GSM) is common in menopausal women, but conventional treatment with low-dose vaginal estrogen is contraindicated in breast cancer survivors. In a double-blind trial, 46 breast cancer survivors (mean age, 55) with GSM and severe penetrative dyspareunia localized to the vulvar vestibule and extinguishable with topical lidocaine were randomized to 1 month of 4% aqueous lidocaine or saline applied to vulvar vestibular tissue for 3 minutes prior to vaginal penetration. All participants were supplied with silicone-based lubricant. In an open-label trial extension, all participants used lidocaine for 2 months. Pain scores were reported on a scale of 0 to 10.
At baseline, median report…