Management of Clitoral Discomfort with Testosterone Cream

Alternative Application Sites and Formulations

Applying testosterone cream to less sensitive vaginal areas is recommended if the goal is local vaginal therapy, as intravaginal testosterone cream has been shown safe and effective for vaginal atrophy when applied internally rather than externally, according to the National Comprehensive Cancer Network 1, 2
Vaginal DHEA (prasterone) may be considered as an alternative androgen therapy, as it has demonstrated improvements in sexual function with potentially fewer local side effects, as suggested by the National Comprehensive Cancer Network 1, 2
Vaginal estrogen may be more appropriate if the primary concern is vaginal atrophy rather than sexual desire, as recommended by the National Comprehensive Cancer Network 1, 2

Topical lidocaine may be applied to the affected area for persistent discomfort, as it has been shown effective for vulvar and introital pain in multiple studies, according to the Journal of Clinical Oncology 3, 2
Vaginal moisturizers or lubricants may be used to reduce friction and irritation, as recommended by the National Comprehensive Cancer Network 1, 2
Pelvic physical therapy can address underlying pelvic floor dysfunction that may be contributing to discomfort, as suggested by the National Comprehensive Cancer Network 1, 2, 5
Cognitive behavioral therapy has proven effective for sexual dysfunction and associated distress, according to the National Comprehensive Cancer Network 6, 7, 5

Use caution in patients on aromatase inhibitor therapy if considering DHEA, as it increases circulating androgens that may impact AI activity, as recommended by the National Comprehensive Cancer Network 1, 2
Patients with hormone-sensitive cancers require thorough discussion of risks and benefits before any hormonal therapy, as suggested by the National Comprehensive Cancer Network and the Journal of Clinical Oncology 1, 3, 4

Refer to a sexual health specialist or gynecologist if symptoms persist despite discontinuation, alternative therapies are needed but uncertainty exists about appropriate options, or underlying pelvic floor dysfunction is suspected, as recommended by the National Comprehensive Cancer Network 1, 2, 5