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Botulinum Toxin in the Treatment of Refractory Vaginismus

Ghazizadeh, Shirin MD; Nikzad, Masoomeh MD

doi: 10.1097/01.AOG.0000141441.41178.6b
Original Research

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.


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:

Received January 10, 2004. Received in revised form June 16, 2004. Accepted June 24, 2004.

© 2004 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.