In this article, I will discuss a new treatment modality for painful penetration of the vagina or pain at the vaginal opening related to a condition called vaginismus (vaginal muscle spasms).
Vaginismus is a voluntary contraction of vaginal muscle on penetration. It is usually triggered by unpleasant sexual experience either due to forced sexual encounter or more commonly due to pain caused because of infection, vaginal dryness, a spasm or soreness in one of the vaginal muscles and glands or other medical conditions (for example, lichen sclerosis).
Once women experience such pain, the mind and body develop a conditioned response to penetration. The body learns to expect pain with vaginal penetration which causes the pelvic muscles to contract to protect against the potential pain. It is something that happens automatically. The problem is that tightening of these muscles actually causes more pain instead of protecting from pain. Even when the original cause of pain is no longer a present factor, a woman cannot help but contract their vaginal muscle on penetration.
Some women develop vaginismus after having a bad yeast infection or bladder infection, others are too scared of intercourse because of potential pregnancy or other reasons.
In the past, all we could offer for treatment of vaginismus was cognitive therapy and in other words psychological therapy and use of vaginal dilators. It is exciting that a new, effective treatment is now available for vaginismus which involves the use of botolinum toxin or botox. Injecting botox into the vaginal muscle stops the vagina from contracting and it amazingly breaks the vicious cycle. I still advise my patients to seek psychological support when dealing with vaginismus. The botox effect kicks in within 2 weeks. I advise my patients to start using vaginal dilators by themselves initially, and once they are comfortably inserting them into the vagina, they will use with their partner before proceeding to sexual intercourse.
This is a very satisfying condition to treat as we see great results with mostly just one injection.
Interestingly, the effect of botox does not usually wear off in vaginsimus as it does when it’s used in aesthetic medicine.