Comment in:

Obstet Gynecol. 2004 Nov;104(5 Pt 1):913-4.

Botulinum toxin in the treatment of refractory vaginismus.

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

PMID: 15516379 [PubMed - indexed for MEDLINE]