Lidocaine (topical/vaginal)

Also known as: lidocaine, lignocaine, local anesthetic

Sexual Well-Being

In plain English

Lidocaine is a numbing medicine. Applied to sensitive genital tissue it can reduce pain during intercourse for some women with vulvar pain conditions. It is used topically/vaginally, often as part of a compounded suppository. Results vary, and it is one part of a broader treatment plan for sexual pain.

The science

Lidocaine is an amide local anesthetic that blocks voltage-gated sodium channels to reduce nerve conduction and pain sensation; topical application to the vulvar vestibule or vaginal tissue aims to reduce provoked pain (dyspareunia) in vulvodynia/vestibulodynia and pelvic pain. Randomized evidence is modest: in a placebo-controlled trial (Foster 2010) topical lidocaine (and oral desipramine) did not outperform placebo on the primary tampon-test outcome, although substantial pain reduction occurred across all arms and some patients derive symptomatic benefit; overnight topical lidocaine has supportive uncontrolled data. Systemic toxicity is unlikely with limited mucosal application but possible with large areas/high concentrations (CNS and cardiac effects); partner transfer/numbness can occur. Topical lidocaine is used within multimodal management of sexual pain; compounded vaginal suppository combinations are off-label formulations.

References

• Foster et al., Obstet Gynecol 2010 (topical lidocaine/oral desipramine for vulvodynia RCT)
• Abu El-Hamd, Arab J Urol 2013 (topical lidocaine among on-demand agents, RCT)