Botox treatment for Vaginismus: Is it safe? Does it work?

Recently the use of Botox for vaginismus has been a hot topic in some circles. Vaginismus is a condition that is sometimes described as uncontrollable muscle spasms that prevent women from being able to comfortably have vaginal intercourse or, sometimes, other forms of vaginal penetration including tampon use and gyn exams. (A difficulty with this description, however, is that vaginal spasms have not been found to be the most effective diagnostic predictors of vaginismus, and controversy continues to swirl around how vaginismus is similar to or different from other vaginal pain disorders.)

But on to Botox and what it has to do with vaginismus, since most people think of Botox as being used for cosmetic purposes as a facial injection. In fact, Botox has been used in many “off-label” ways – for example, research has shown that some healthcare providers have used it to effectively treat sweat gland disorders in the underarm and genital areas. It’s also been used to treat certain types of urge incontinence (peeing when one doesn’t intend to pee).

One of these off-label (read: not FDA approved) uses of Botox has been to treat vaginismus. In fact, there have been several studies in which researchers have examined the effectivess of Botox as a treatment for vaginismus and have found encouraging results with few problems/side effects.

That said, it’s important to remember that all cases of vaginal and vulvar pain are different, and that what works for one woman may not work for others. Botox is not approved by the FDA for specific treatment of vaginismus or vulvodynia, though there may be instances in which a woman and her healthcare provider discuss their options and choose to try Botox as a treatment. Also, I am not aware of any long term studies on the safety of using Botox in the genital area.

Whenever a woman finds that sex hurts, or that when she even tries to have sex it hurts, she should check in with her healthcare provider for a thorough gynecological exam. Meeting with a trained sex therapist is often advised, too, as some cases of vaginismus (and other genital pain problems) may improve with sex therapy. Some women who have been diagnosed with vaginismus find, for example, that using dilators in conjunction with information/guidance from a sex therapist helps them learn to have comfortable, pleasurable sex.

The bottom line is that we still have an enormous amount to learn about how to most effectively help women who experience vaginismus and other genital or sexual pain conditions. Learn more about vaginismus from the Vaginismus Awareness Network  and learn about vulvodynia (vulvar pain) from the National Vulvodynia Association.

About Dr. Debby Herbenick

Dr. Debby Herbenick

Dr. Debby Herbenick is a sex researcher at Indiana University, sexual health educator at The Kinsey Institute, columnist, and author of five books about sex and love. Learn more about her work at www.sexualhealth.indiana.edu.

  • http://www.plasticsurgerypa.com/ peter t pacik, md, facs

    I read this article with interest because of the work I do with vaginismus patients. I have a few comments that may be helpful to your readers:

    An important reference is the article written by:

    Shirin Ghazizadeh, MD, and Masoomeh Nikzad, MD. (2004). Botulinum Toxin in the Treatment of Refractory Vaginismus. Obstet Gynecol 104, 922-925.

    Single center pilot study, peer reviewed journal.

    Ghazizadeh and Nikzad2 from Iran reported on the use of botulinum toxin in the treatment of refractory vaginismus in 24 patients. In this study, Dysport (Botulinum Toxin A) 150-400 mIU (Ipsen Ltd, United Kingdom) was used. 23 patients were able to have vaginal examinations one week post procedure showing little or no vaginismus. One patient refused vaginal examination and did not attempt coitus. Of the 23 patients, 18 (75%) achieved satisfactory intercourse, 4 (17%) had mild pain and one patient was unable to have intercourse because of her husband’s impotence. A second dose of Dysport was needed on one patient. There were no recurrences during the 2-24 month follow-up period.

    It is important to differentiate between the various levels of vaginismus as described by Lamont. A level one patient has spasm that she can relax and would be suitable to work with counseling, dilators and PT. A level 4 vaginismus patient has extreme fear and will not allow any type of examination or any form of penetration including a tampon or even a Q tip. It is these patients that are especially suitable for treatment with Botox. All of the patients that I treat have a light anesthetic to make them more comfortable, and all level 4 patients demonstrate considerable spasm of a number of vaginal muscles even under anesthesia. Most of our patients have had 4-7 years of failed conservative therapy, yet are able to achieve intercourse in 2 weeks to one month after treatment with Botox. There have been no recurrences. One patient appears to have failed this treatment and I plan to re-treat her at no cost.

    This is a very important topic for these afflicted women and I’m happy that you have addressed these issues. Please let me know if I can be of further help.

    Peter T Pacik, MD FACS.

  • http://www.plasticsurgerypa.com peter t pacik, md, facs

    I read this article with interest because of the work I do with vaginismus patients. I have a few comments that may be helpful to your readers:

    An important reference is the article written by:

    Shirin Ghazizadeh, MD, and Masoomeh Nikzad, MD. (2004). Botulinum Toxin in the Treatment of Refractory Vaginismus. Obstet Gynecol 104, 922-925.

    Single center pilot study, peer reviewed journal.

    Ghazizadeh and Nikzad2 from Iran reported on the use of botulinum toxin in the treatment of refractory vaginismus in 24 patients. In this study, Dysport (Botulinum Toxin A) 150-400 mIU (Ipsen Ltd, United Kingdom) was used. 23 patients were able to have vaginal examinations one week post procedure showing little or no vaginismus. One patient refused vaginal examination and did not attempt coitus. Of the 23 patients, 18 (75%) achieved satisfactory intercourse, 4 (17%) had mild pain and one patient was unable to have intercourse because of her husband’s impotence. A second dose of Dysport was needed on one patient. There were no recurrences during the 2-24 month follow-up period.

    It is important to differentiate between the various levels of vaginismus as described by Lamont. A level one patient has spasm that she can relax and would be suitable to work with counseling, dilators and PT. A level 4 vaginismus patient has extreme fear and will not allow any type of examination or any form of penetration including a tampon or even a Q tip. It is these patients that are especially suitable for treatment with Botox. All of the patients that I treat have a light anesthetic to make them more comfortable, and all level 4 patients demonstrate considerable spasm of a number of vaginal muscles even under anesthesia. Most of our patients have had 4-7 years of failed conservative therapy, yet are able to achieve intercourse in 2 weeks to one month after treatment with Botox. There have been no recurrences. One patient appears to have failed this treatment and I plan to re-treat her at no cost.

    This is a very important topic for these afflicted women and I’m happy that you have addressed these issues. Please let me know if I can be of further help.

    Peter T Pacik, MD FACS.

  • Debby

    Thank you for sharing your thoughts and experiences, Dr. Pacik. It was nice to meet you at SSSS.

  • Debby

    Thank you for sharing your thoughts and experiences, Dr. Pacik. It was nice to meet you at SSSS.

  • http://www.plasticsurgerypa.com/ peter t pacik, md, facs

    I enjoyed meeting you also and will once again pursue the idea of inflatable dilators.

  • http://www.plasticsurgerypa.com peter t pacik, md, facs

    I enjoyed meeting you also and will once again pursue the idea of inflatable dilators.

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  • http://www.plasticsurgerypa.com Peter T. Pacik, MD, FACS

    Hi Debby
    I thought I would give you an update since my last comment.
    I received FDA approval to continue my studies using Botox for vaginismus. Currently I have treated 67 patients with a 90+% cure rate and no complications (5 years).
    The approved pilot study is for the treatment of 30 patients (we are recruiting at present) who are in good health, ages 20-40 with primary vaginismus. This will be an extension of the treatment protocol currently in place.
    The approval is for the injections of intravaginal Botox and progressive dilation done under anesthesia and 3 days of post procedure counseling which includes the use of dilators and sex counseling to transition to intercourse. FDA approval is a major step in bringing awareness to vaginismus.
    I will be doing a 2 hour continuing education course at SSSS in November.
    Best
    Peter T. Pacik, MD, FACS

  • Peter T. Pacik, MD, FACS

    I thought I would add a comment about vaginal spasm:
    Most of my treated patients have the more severe form of vaginismus (level 3-”5″. At the advice of some of my patients I added a level 5 to indicate a visceral reaction to a GYN exam such as light headedness, shaking, nausea, etc.)
    All of my patients are examined under anesthesia because this seems to be the most humane way of delivering the injections and performing progressive dilation. As they are induced I do an external exam as well as a digital exam to determine where the spasm resides. This helps me determine where I should place the Botox. My more severe cases of vaginismus all have significant vaginal spasm, so much so that often I am barely unable to insert my finger. The less severe cases often have increased muscle tone, but I would not call this spasm.
    There is debate in the literature whether these patients have vaginal spasm, but there is little doubt from the many patients I have examined that spasm is present.
    Marion Sims described this in 1861. His article makes for very interesting reading (see ref). I’ll send you a copy.
    Ref: Sims, JS. On Vaginismus Transactions. Obstetrical Society of London 1861; 3:356-367
    Thanks for posting.
    Best
    Peter T. Pacik, MD, FACS

  • Peter T. Pacik, MD, FACS

    I would like to add that sex therapy is often very helpful for my patients after their vaginismus has been treated. Many have preexisting relationship problems that benefit from the advice of a sex counselor. Others have yet to find their sexual comfort and are sexually immature making progression to intercourse more difficult. A certified sex counselor has the expertise to help these couples and allow for a smoother transition to the joys of a sexual partnership.
    Peter T. Pacik, MD, FACS

  • Ptpacik

    Our FDA approved study is now well underway and this gives patients an opportunity to have the treatment at reduced costs. Our office can help with considerable information about this.
    We continue to have a permanent cure rate of 90+% and have had no complications from the treatment during the past 5 years. Most of the patients we treat are the more severe forms of vaginismus who have been refractory to other treatments.
    The study allows us to collect detailed information about the causes and cure of vaginismus and this data will be published in the future.
    Our patients have become advocates for other women with vaginismus and are very willing to speak to prospective patients.
    Please speak to Gloria or Ellen at 1 800 640 0290 for more information or email us at info@plasticsurgerypa.com