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Botulinum Toxin in the Treatment of Refractory Vaginismus

From the Department of Obstetrics and Gynecology, Tehran University of Medical Sciences, Vali-e Asr Reproductive Health Research Center, Tehran, Iran.

Address reprint requests to: Shirin Ghazizadeh, Tehran University of Medical Sciences, Vali-e-Asr Reproductive Health Research Center, Keshavarz Boulevard, Tehran, Iran 14197; e-mail: shirin_ghazizadeh{at}yahoo.com..

OBJECTIVE: To investigate the efficacy of botulinum toxin injection to treat women with moderate and severe vaginismus.

METHODS: Twenty-four women referred to our clinic from February 2002 to February 2004 (mean age 25 years; range 19–34 years) with third- to fourth-degree vaginismus were recruited for this study. These women had previous unsuccessful treatments. Botulinum toxin (150–400 mIU) was injected into the puborectalis muscles in 3 sites on each side of the vagina.

RESULTS: Twenty-three patients (95.8%) had vaginal examinations 1 week postoperatively that showed little or no vaginismus, 18 (75%) achieved satisfactory intercourse after the first injection, 4 (16.7%) had mild pain, 1 was cured after a second injection, 1 patient refused vaginal examination and did not attempt to have coitus, and another had no coitus as a result of her husband's secondary impotence. The women were followed up for a mean of 12.3 months (range 2–24 months), and there were no cases of recurrence.

CONCLUSION: In refractory cases of vaginismus when conventional therapies have failed, local injection of botulinum toxin can be considered.

LEVEL OF EVIDENCE: III

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