Topical anesthetic (lidocaine-prilocaine) cream application before speculum examination in postmenopausal women

Abstract

Study objective: To evaluate the effectiveness of lidocaine-prilocaine (EMLA 5%) cream application to genital mucosa for reducing pain or discomfort associated with speculum examination in postmenopausal women.

Design: A randomized controlled study (Canadian Task Force classification I).

Setting: A university hospital.

Patients: One-hundred thirty-four postmenopausal women.

Interventions: The subjects were randomized to an EMLA cream group, a lubricant gel group, or a control group. General data was collected, including age, body weight, gravidity, parity, smoking habits, history of diabetes mellitus, previous gynecologic operations, dyspareunia, sexual activity, and duration of menopause. All patients were asked to score pain at 3 time points (insertion, dilation, and extraction of speculum) during the procedure using a visual analog scale. Pain intensity during speculum examination was compared between the groups.

Measurements and main results: There was no statistically significant difference between the EMLA cream, the lubricant gel, and the control groups in terms of age, weight, gravidity, parity, dyspareunia, duration of menopause, sexual activity, smoking habit, diabetes mellitus, previous vaginal and other gynecological procedures, vaginal length, and serum follicle-stimulating hormone and estradiol levels (p > .05). The pain scores obtained during all phases of speculum application were significantly lower in the EMLA group than in both the lubricant gel and the control groups (p < .001). Comparing the gel and the control groups, a lower pain score was observed in the former, except for the second phase of the examination (p < .001).

Conclusion: Topical application of EMLA 5% cream on genital mucosa of postmenopausal women before vaginal examination significantly reduces pain associated with speculum application.