An End to Painful Sex After Chemo? New Treatment Shows Promise

Patient Expert

Of all the breast cancer treatment side effects women experience, the potentially most distressing and life-altering is also the one least talked about: painful sex. There's been no good solution for this disheartening situation – until now.

Dyspareunia. It's an abstract-looking medical term for a condition many breast cancer survivors endure that's hardly abstract, if you experience it:

Painful sex.

You've been through treatment for breast cancer. It's been a long haul: surgery, maybe reconstruction, chemo, radiation, hormone therapy. Each of those has its own challenging side effects, from surgery's rehab to radiation burns to the joint pain and weight gain of hormone therapy.

But chemotherapy, with its associated nausea, hair loss, throat pain, fatigue, numbness, and assorted other side effects, is probably the toughest.

Chemo wins the title hands down: worst breast cancer treatment.

And once chemo's over, the fun's just beginning. Women can experience years – indeed, a lifetime – of lasting side effects. Toes and fingers may remain numb. Eyes may burn, hot flashes may leave you soaking every night, and your mind may never be the same again: chemobrain, anyone?

Chemo-induced menopause comes with nasty side effects.

Chemotherapy often puts a pre-menopausal woman into menopause: suddenly and viciously. As the woman's reproductive system shuts down—a victim of chemo's harsh drugs—she experiences some or all of the menopausal side effects healthy women go through, from mood swings to weight gain to hot flashes. Not over the course of months or years, but within weeks.

And let's not forget that elephant in the corner, the side effect everyone hates and no one talks about...

Painful intercourse.

Menopause is marked by a loss of circulating estrogen in the blood. This female sex hormone is responsible, in large part, for a woman's libido and, just as important, her physical capacity to enjoy sex.

Without estrogen, soft tissues in the vulva and vagina dry up and shrink; in medical parlance, they atrophy. And when this happens, what was once an enjoyable experience becomes unbearably painful.

Healthy women take HRT for relief.

Women who haven't had breast cancer often reach out to their doctors for hormone replacement therapy (HRT) to fight the ravages of menopause, including painful sex. HRT's goal is to elevate the level of female sex hormones – in effect, to replicate pre-menopausal hormone levels, thus reducing the side effects that result from the natural reduction of hormones during menopause. And HRT is an effective treatment.

So why can't breast cancer survivors use HRT?

Some can. But about 80 percent of breast cancer survivors are HR+ (hormone responsive positive), meaning they have a type of cancer that requires female sex hormones to grow – chiefly estrogen. Thus eliminating as much estrogen from the system as possible effectively lowers the risk of a breast cancer recurrence.

Adding MORE estrogen via HRT gives any hidden cancer cells something to feed on. Not a good option.

HR+ breast cancer survivors are left between a rock and a hard place: treat hormone-related side effects (including painful sex) at the risk of a cancer recurrence; or suffer through the side effects (including painful sex) forever.

Quality vs. quantity of life: it's a tough one.

A simple solution for painful intercourse.

Suddenly, though, there's hope on the horizon for at least one of cancer treatment's miserable side effects. A team of researchers has come up with a seemingly simple solution for painful intercourse: lidocaine, a topical anesthetic regularly used to numb pain.

You may already have experienced lidocaine: some dentists apply it before administering a Novocain injection. It's also used for minor surgery: think removal of a deep splinter.

Researchers at Oregon Health and Science University undertook a small study that had breast cancer survivors with dyspareunia apply a liquid lidocaine compress to the "vulvar vestibule" for three minutes, prior to having intercourse

The result? The lidocaine treatment was a resounding success. Women who'd reported intercourse earning a score of 8 out of 10 on the pain index said that the lidocaine reduced their pain to an easy 1.

Breast cancer survivors were able to enjoy sex again.

In addition, according to the study, "Of 20 prior abstainers from intercourse who completed the study, 17 (85 percent) had resumed comfortable penetrative intimacy. No partners reported penile numbness."

Have you given up sex as a result of pain?

Then ask your doctor about lidocaine. Since the study results were just published in late July, your doctor might not be aware of this treatment. But it's worth a discussion, right?

After all, making love shouldn't be a casualty of the cancer war.

See more helpful articles:

Female Sex Hormones: What They Do and Why It Matters

A Guide to Survivorship: Life After Treatment

Breast Cancer Drugs: Preventing Cancer (and Sex, Too)

Tamoxifiend (aka Tamoxifen): Life Saver, Sex Life Slayer


Martha, Goetsch. "Journal of Clinical Oncology." A Practical Solution for Dyspareunia in Breast Cancer Survivors: A Randomized Controlled Trial. 2015. Accessed August 15, 2015.

"Lidocaine May Help Ease Painful Intercourse After Breast Cancer Treatment." July 30, 2015. Accessed August 15, 2015.

Breast cancer survivor and award-winning author PJ Hamel_, a long-time contributor to the HealthCentral community, counsels women with breast cancer through the volunteer program at her local hospital. She founded and manages a large and active online survivor support network. _