Vaginismus is a disorder that is characterized by the involuntary tightening of the vagina. Also know as genitor-pelvic pain or penetration disorder, vaginismus is a painful condition that causes discomfort and tightening to the point that penetration—whether during intercourse, the insertion of sanitary products such as tampons, or the insertion of a speculum during a pelvic exam—becomes impossible. Vaginismus can negatively impact the patient’s quality of life, not just because of the physical pain and discomfort, but also because of the inability to engage intimately with partners. There are two recognized types of vaginismus: primary vaginismus and secondary vaginismus.
Causes and symptoms of vaginismus
Physically, the involuntary tightening of the vagina that is associated with vaginismus is caused by spasms or contractions of the pelvis floor muscles. Primary vaginismus and secondary vaginismus have slightly differing causes and symptoms. Primary vaginismus is diagnosed in patients who have never experienced intercourse that is pain-free, because the muscle contractions have always occurred. Patients with primary vaginismus are more likely to have difficulty with other activities that require penetration, such as tampon use and gynecological exams. Secondary vaginismus differs from primary vaginismus in that it develops later. A patient may once have been able to engage in penetrative activities without pain or involuntary contraction, but no longer. This type of vaginismus can be caused by a number of different issues, both physical and non-physical. These causes include medical conditions such as urinary tract infections, yeast infections, cysts, cancer, or more. Secondary vaginismus may also be caused by childbirth or age-related changes like menopause, as well as short-term discomfort such as inadequate vaginal lubrication, abuse, pelvic trauma, or as a side effect of medication.
The pain experienced by primary and secondary vaginismus varies, but symptoms include:
- Stinging or burning during sex;
- Difficulty or inability to penetrate due to pain or discomfort during entry of penis or other objects;
- Ongoing discomfort or pain during sex after experiencing childbirth, STDs, hysterectomy, menopause, yeast or urinary infections, or other medical issues;
- Ongoing pain during sex with no known origin or obvious cause;
- Difficulty undergoing gynecological or pelvic exam;
- Difficulty inserting tampons;
- Spasms in other muscles in the body, such as in the legs or lower back;
- Difficulty breathing or cessation of breath during attempts at intercourse;
- Ongoing avoidance of intercourse due to pain and/or failure to engage sexually.
How does Botox for vaginismus work?
Botox is a neuroblocker that is made of botulinum toxin A. Upon injection into a muscle, Botox interrupts the chemical signals that are sent between the brain and the muscle that instructs the muscle to contract. This effectively causes a temporary paralysis of the injected muscle. When used in the treatment of vaginismus, Botox injections weaken or temporarily paralyze the muscles that are involuntarily contracting and causing discomfort. With Botox treatment, the vagina is able to relax, making penetration possible and pain-free.
What is treatment like?
Botox is used to treat many medical symptoms and conditions and is always injected directly into the muscles in or around the area where the issue originates. Botox treatment for vaginismus typically involves three injection sites in different vaginal muscles. Depending on the severity of the condition, these injections will be administered either under anesthetic or sedation. The muscles that receive the injections are the side walls of the vagina and the entry muscle. Once the muscles have been injected, a dilator will be inserted into the vagina, and the size of the dilator will be gradually increased—sometimes over a matter of a few days—in order to encourage the vaginal muscles to relax further and get them more comfortable with penetration. The patient will eventually be able to transition from dilators to intercourse comfortably, in some cases with the addition of sex counseling. The dose of Botox is usually pretty low, with only 100 to 200 units being used, though this depends on the severity of the condition.
How long does Botox for vaginismus last?
Most Botox treatments require repeated injections, as the effects of the neuroblocker itself only lasts between three to four months. However, when it comes to treating vaginismus, only one treatment session with Botox is typically required. Once the body and mind have realized that penetration can take place without pain, then the cycle of pain is broken, and the body no longer anticipates pain thereby ceasing the involuntary contractions. Once the patient is able to experience pain-free intercourse or penetration, it is rare that any additional Botox injections will be needed. Botox for vaginismus has been found to be very effective, with studies reporting that Botox injections for vaginismus are effective in approximately 90% of patients. However, it is important that patients receive Botox injections only from licensed and experienced medical professionals.