Botox Is One of the Treatments That Can Help Vaginismus Symptoms

Published in Verywell

By Elizabeth Boskey, PhD | Updated on February 29, 2024
✓  Medically reviewed by Sanaz Ghazal, MD, modified by Dr M Krishna, Consultant Pain Medicine (as per his practice)

Vaginismus is a condition where a person’s vagina painfully contracts in a way that prevents penetration during sex. These contractions are involuntary. In other words, someone who has vaginismus isn’t trying to contract their vaginal muscles.

The contractions can make any attempt at penetration painful or impossible. They can also be painful on their own.

Botox (botulinum toxin) can be injected into the muscles affected by vaginismus to treat the condition. It works by relaxing the muscles, effectively paralyzing the muscles and preventing them from contracting. Botox is often combined with other therapeutic methods, such as the use of dilators, tube-shaped devices made of plastic or silicone that are inserted to gently stretch the vagina.

This article discusses the use of Botox for vaginismus, what to expect when receiving it, and other alternative therapies that can help.

Using Botox for Vaginismus

Botox, short for botulinum toxin, can be used to treat vaginismus. While Botox is commonly used to reduce facial lines, it’s also used to treat some chronic pain conditions, such as headaches and bladder pain.

Botox paralyzes the muscles into which it is injected. This prevents them from contracting—either consciously or unconsciously. Reducing tension in the problematic muscles also reduces pain.

Botox is not usually the first line of treatment for vaginismus. However, for those unable to undergo other vaginismus treatments, Botox treatment can have a positive effect.

Using Botox to treat vaginismus involves several injections of the drug. Botox is injected into multiple areas of the bulbospongiosus muscle. This is the muscle that wraps around the entrance to the vagina. Additional injections may be used to relax other muscles if they are contributing to the vaginal spasms.

Botox treatment is usually not done on its own. Instead, it is often combined with psychotherapy and the use of dilators so that people can become comfortable with penetration.

The Botox injection lasts for between two and four months. However, the effects of the treatment may last longer than that. This is likely due to a combination of anxiety reduction and retraining of the muscles. Botox provides the initial relaxation and lack of pain on penetration that allows the body to become used to the sensations without tensing up.

Side effects of Botox treatment are possible. In a 2017 study, out of 177 patients, three developed mild temporary stress urinary incontinence, two experienced a short period of blurry vision, and one had temporary excessive vaginal dryness. All side effects resolved within four months.

How Effective Is It?

A 2018 review of studies looked at several clinical trials investigating Botox as a treatment for vaginismus. In one study, Botox injections were used in 24 women with vaginismus. Patients were monitored for a year. About 95% showed less resistance to vaginal exams and 75% had satisfactory sexual satisfaction after the first injection.

Another case looked at 13 women with vaginismus. Eight of the patients received Botox injections while the other five received saline solution injections. After three months, all of the Botox patients reported that their sexual lives became possible or satisfactory. The control group that received saline didn’t see any improvements.

A 2022 study looked at 99 patients who received Botox injections for vaginismus. Some were given 150 units of botulinum toxin and some were given 200 units. Significant improvements were seen in both groups, but there wasn’t a significant difference between those who received low-dose and high-dose Botox.

What to Expect When Receiving Botox

You may receive a Botox injection for vaginismus in a surgery centre or your doctor’s office. It may be performed under general anaesthesia or local anaesthesia, depending on your provider’s recommendation, so that you won’t feel any pain.

While you’re under anaesthesia, Botox will be injected into the pelvic floor muscles. It’s an outpatient procedure and typically takes about 30 minutes.

You may feel sore for a few days after the injection.

How Long It Takes to Work

The Botox will take effect completely one week later, and you’ll be able to follow your provider’s instructions on using dilators. After about three months, the Botox will have worn off, but you should feel more comfortable with vaginal penetration. Most people will only need the procedure done once to notice a difference.

Other Vaginismus Treatments

In addition to Botox, there are several other common therapies for vaginismus. These include other forms of injections, physical therapy, systematic desensitization to the stress of penetration, hypnotherapy, and cognitive behavioural therapy.

Systematic desensitization uses dilators to increase an individual’s ability to tolerate penetration. The graded vaginal dilators are used to slowly stretch the vaginal muscles.

Cognitive behavioural therapy, for both individuals and couples, generally uses a treatment manual. It can be used as part of individual or group therapy. To date, the evidence for how well this works is mixed. Some people appear to be helped by these therapies. However, the studies are often small and of low quality.

Interestingly, one study found that the effectiveness of different forms of treatment was unrelated to the cause of vaginismus. Cases of vaginismus associated with both medical and psychological triggers responded similarly well to both medical and psychological therapies. This suggests that focusing on treating the painful contractions vaginismus causes may sometimes be more helpful than trying to identify their causes.

Summary

Botox injections can be used for vaginismus to help decrease painful contractions and make vaginal penetration possible. Your doctor will perform the injections while you’re awake, under local anaesthesia. After the Botox takes effect, your provider will also instruct you on how to use dilators to become comfortable with penetration.

Research has shown positive results for the procedure. Most patients are more comfortable with vaginal penetration even after the Botox wears off after three months.

9 Sources: 

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Helmi ZR. Comparative study of 150 vs. 200 units of botulinum toxin as treatment for vaginismus. Rev Bras Ginecol Obstet. 2022;44(09):854-865. doi:10.1055/s-0042-1751287

Pacik PT, Geletta S. Vaginismus treatment: clinical trials follow up 241 patients. Sexual Medicine. 2017;5(2):e114-e123. doi:10.1016/j.esxm.2017.02.002

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At Pain Spa, Dr Krishna is very experienced in performing Botox injections for vaginismus. Please email us at clinic@painspa.co.uk if you are interested in having a consultation with Dr Krishna.