Vulvar pain, often described as chronic discomfort or a burning sensation in the external genital area, is a common and distressing issue. The pain can significantly impact daily activities, exercise, and sexual function. Topical lidocaine cream or ointment is frequently utilized as a targeted, localized approach to manage this discomfort. This medication offers temporary relief by directly addressing the nerve signals that transmit pain from the affected vulvar tissues, allowing for activities that might otherwise be too painful.
Understanding How Lidocaine Cream Works
Lidocaine is classified as an amide-type local anesthetic, meaning it works specifically to interrupt the transmission of pain signals directly at the site of application. Its pharmacological action involves stabilizing the neuronal membrane of nerve cells. The drug achieves this effect by blocking the voltage-gated sodium channels present along the nerve cell membrane.
When lidocaine is absorbed, its molecules enter the nerve cell and bind to these internal sodium channels, locking them in an inactivated state. This blockage prevents the rapid influx of sodium ions required for the nerve to generate an electrical impulse, or action potential. By stopping the nerve from “firing,” lidocaine effectively prevents the pain signal from traveling up to the brain, providing temporary numbness.
Topical lidocaine is available in various strengths and formulations. Over-the-counter (OTC) products typically contain up to 4% lidocaine, while prescription-strength formulations, most commonly 5%, are often used for chronic vulvar pain conditions. An ointment base is generally preferred over a cream for the vulva, since creams may contain preservatives that can cause stinging or irritation on sensitive mucosal tissue. The ointment also often provides a longer-lasting effect because it adheres better to the skin surface.
Conditions Appropriate for Treatment
Lidocaine cream or ointment is frequently prescribed for specific types of vulvar pain, particularly localized provoked vulvodynia, which involves pain concentrated at the vaginal opening, or vestibule. It is also used for managing dyspareunia (painful intercourse), as well as pain that follows certain surgical procedures or biopsies. The temporary numbing effect helps desensitize the hypersensitive nerve endings that contribute to the chronic pain experience.
Application Instructions
For application, a small, pea-sized amount of the prescribed ointment is typically sufficient to cover the localized area of discomfort. The medication should be applied directly to the painful spot, such as the vaginal vestibule, and should not be inserted deep into the vagina. Using a clean finger or a cotton swab ensures precise targeting of the medication to the affected tissue.
The timing of application is important, particularly when used to facilitate activities like sexual intercourse or physical therapy. It is usually recommended to apply the lidocaine about 10 to 30 minutes before the anticipated activity to allow adequate time for the anesthetic effect to take hold. After this waiting period, any excess product should be gently wiped away with a clean tissue before proceeding.
Wiping off the excess is especially important if condoms are being used, as the oil in certain ointment bases can degrade the latex, compromising the barrier. Depending on the condition, frequency can range from use as needed before activities to up to three or four times daily, or even nightly for a defined period. Always wash hands thoroughly with soap and water both before and immediately after applying the medication to prevent accidental transfer to other sensitive areas.
Recognizing Side Effects and Systemic Warnings
While topical lidocaine is generally well-tolerated, users may experience minor, localized side effects. Common reactions at the application site include temporary, mild burning, stinging, or itching, which often subside quickly as the numbing effect begins. Some individuals may also notice localized redness or a change in skin color in the treated area. These local effects are usually temporary and indicate the medication is beginning to work.
A more serious concern is the risk of systemic absorption, which occurs when too much lidocaine enters the bloodstream. This is a rare event, but the risk increases if a large amount is applied, if it is used too frequently, or if it is applied to broken or inflamed skin. Signs of systemic toxicity affect the central nervous and cardiovascular systems and require immediate medical attention.
Key signs of toxicity include neurological symptoms such as lightheadedness, dizziness, confusion, ringing in the ears (tinnitus), or a metallic taste in the mouth. Cardiovascular signs can manifest as an irregular or unusually slow heartbeat. If any of these systemic symptoms occur, the application must be stopped immediately, and a healthcare provider should be contacted. Consulting with a healthcare professional is advisable if pain persists or if any concerning side effects develop.