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Home |  Pregnancy overview |  Reproductive Health | Complications | Labor & Birth

One of the forms of treatment that is increasingly being recognised as an effective alternative to the traditional methods is the use of Botulinum toxin injections.

What is Botulinum toxin?

Botulinum toxin is a naturally occurring protein produced by a common bacteria called Clostridium botulinum (hence the name). The protein is highly toxic to the nervous system. However, in minute amounts, it has been used for therapeutic purposes for over one hundred years.

In the western world, Botulinum toxin is mainly known for its role in cosmetic procedures used to prevent wrinkles of the face or to smoothen so-called frown-lines. Most people will know it by its trade name of ‘Botox’ or, to a lesser extent, Dysport. In 2007, in the United States alone, there were over 4.6 million ‘Botox’ procedures.

What is not so well-known is the fact that Botulinum toxin has been extensively employed medically in treating a wide range of muscular disorders including:

• Strabismus (squint),
• Cervical dystonia (muscle spasms),
• Blepharospasm (abnormal eyelid tics),
• Overactive urinary bladder
• Axillary hyperhidrosis (excessive armpit sweating)

...and several others.

In the last few years, Botulinum toxin injections treatment has been increasingly resorted to for treating vaginismus and quite impressive results reported. There have also been properly conducted studies which have shown that, where traditional methods to treat vaginismus have failed, this appears to work successfully.

Botulinum toxin type A is injected in small doses of between 250 to 500 units into the affected pelvic floor muscle, usually the pubo-coccygeus. A few days after the treatment, the woman can and should be able to insert a tampon or a dilator without feeling any pain. Whilst that will be a good sign; it is painless intercourse that constitutes success. She should be encouraged and it is important that she should try that as soon as possible after the treatment. Ideally, the partner should be involved every step of the way since the woman will inevitably be anxious on that first post-treatment attempt.

It is important for the woman to be aware that the effect of the injection does gradually wear off. However, what has been observed is that, if after the first injection, the pain associated with intercourse disappears, and if she keeps sexually active, having penetrative coitus several times a week, the problem tends to stay away permanently. This is because the brain re-learns the new situation where sex is associated with pleasure rather than pain as was the case before. The reflex contraction of the pelvic floor muscles which was the original underlying problem does not therefore happen. Some women, however, will need to have repeat injections, usually every 4 - 6 months.

Preparation:

It is absolutely crucial for the doctor to conclusively rule out other causes of painful intercourse such as a thick hymen, vulvodynia, vestibulitis etc (discussed on previous page) before resorting to botulinum toxin. A careful examination of the external genitalia will easily establish this. If botulinum injections are used where the underlying cause is these other conditions, it is guaranteed not to work. That is sure to worsen the anguish of the long-suffering patient.

Success and safety:

Reported series of treatment show very encouraging levels of success as measured by successful painless penetrative sexual intercourse.

Botulinum toxin, used appropriately and in the minute doses used medically, is quite safe. Reported side-effects include headache, focal transient paralysis, difficulty swallowing (dysphagia) and flu-like symptoms.

Where all else has failed, for a woman suffering from this quite distressing condition, Botulinum toxin injection should be given serious consideration.

Confirming the diagnosis:

This test is simple but quite essential and reliable. It can also be performed by the partner if the patient so prefers:

Run two fingers lightly over the skin covering the inner thighs and the lower two-thirds of the external genitalia (avoid the clitoris). This should produce a normal touch sensation or a ticklish sensation.

If there is vague burning or any other form of discomfort on this test, the diagnosis of vaginismus is most probably wrong. Botulinum injections are unlikely to work in this case.

Test should be confined to this area

Management of vaginismus using Botulinum injections