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
Local injection of botulinum toxin into the paravaginal muscles can successfully treat refractory cases of 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: firstname.lastname@example.org..
Received January 10, 2004. Received in revised form June 16, 2004. Accepted June 24, 2004.