Vaginismus and Botulinum Injections
Female sexual ‘dysfunction’ falls into four broad groups. These are:
- Lack of desire
- Difficulty with arousal
- Difficulty or complete inability to achieve orgasm and,
- Painful intercourse
In this hub, I am addressing the last one, namely painful intercourse and specifically pain during sex as a result of the condition vaginismus.
As you might have guessed (or already know), there are many different causes of pain during intercourse and vaginismus is just one of them. For a person affected by this problem, it is always advisable to bring this to the attention of a specialist for a thorough work up which will include a detailed history, careful examination, sometimes but not always involving an anaesthetic and, investigations which may be of the imaging type (scans) and microbiological to rule out pelvic infection. It is absolutely important to get the diagnosis right in any case of painful intercourse because management is completely dependent on this and, as you may expect, what works for one cause will be completely ineffective for another.
Vaginismus is a condition whereby the affected woman has markedly restricted and often complete inability to have any form of vaginal penetration. While this is most notable with regard to sexual intercourse, the affected person will have the same difficulty with insertion of any object such as a tampon or to undergo an examination which involves insertion of a finger or object into the vagina, regardless of size. For the purpose of this hub, we shall concentrate on the issues of difficulty with sex.
Primary and secondary vaginismus
As the names suggest, primary vaginismus is where the woman has never been able to engage in penetrative sexual intercourse. Primary vaginismus is the single biggest cause of unconsummated marriage. In secondary vaginismus, the problem develops after a period when the woman has had no difficulty with sexual intercourse. With secondary vaginismus, there is almost always a clearly identifiable trigger in the timeline. This could be a traumatic event, sexual abuse, childbirth, a major life change such as menopause etc.
What is going on?
Vaginismus is characterised by an involuntary tightening of pelvic floor muscles effectively shutting the vaginal canal. The vagina itself isn’t tight and there is no pain or discomfort at other times. The muscles surrounding the vagina function normally at all other times but go into a reflex tight knot at any attempt at penetration.
It is important to be aware that many women with vaginismus tend to have normal sexual desire and the arousal response is normal. However, once an attempt at vaginal penetration provokes this response, it inevitably creates a self-feeding vicious cycle. There is the original problem where the muscle contraction reflex is involuntary. This provokes pain and from that point on, the normal self-preservation reflex adds to the complexity of the situation. A subsequent attempt will be faced with anxiety about the anticipated pain and this becomes a self-fulfilling prophesy. Treatment will be necessary.
The good news for vaginismus sufferers is that this is one sexual dysfunction condition which is curable and long term success rates are impressive. What’s more; many treatment programs do not require medication or surgery. The mainstay of vaginismus treatment is behavioural therapy and desensitization exercises. There are several established programs for this and it is absolutely essential that a sufferer gets help from a recognised qualified expert. Suffice it to say here that even though any such program may take a few months to achieve the required results, there is ample data to show that success is often 100% and long-term.
Botulinum injections for vaginismus
The success rate of established vaginismus treatment programs is not in question and any patient with the condition should try those first before considering anything else. The impressive statistics are, however, meaningless and arguably a cruel irony for the small minority where they don’t work. It is for these women that there has been a significant amount of research on a possible role of botulinum toxin injections. Botulinum is used quite widely in the cosmetic industry where it is most popularly known by the brand name ‘Botox’. Botulinum injections are also widely used for a variety of medical conditions characterised by painful muscle spasms such as in upper motor neurone syndrome and cervical dystonia (neck and shoulders); intractable urinary incontinence due to overactive bladder, hyperhydrosis (excessive armpit sweating), prevention of chronic migraines and several others. Botulinum has been in use for an eye condition called blepharospasm (sustained repeated involuntary twitching or closing of eyelids) for over 25 years. It is, therefore, a product that has been widely deployed successfully for a number of medical conditions.
Several studies have shown that, for women where the standard therapy mentioned above has not been successful, botulinum injections may provide a cure. It is absolutely essential that botulinum injections are only resorted to after the sufferer has had the diagnosis confirmed and completed the behavioural therapy. What is quite encouraging is that patients treated with this do not require repeat injections a few months down the line as is the norm in other conditions. It is important that after the treatment the woman should be sexually active and this is where the psychological component of the treatment kicks in. The effect of Botulinum wears off after about 4 months. However, since the woman will have discovered that sex is not painful and is even highly pleasurable, the bracing herself for pain is replaced by anticipation of pleasure. The reflex tensing of muscles that tends to compound vaginismus will, as a result, not occur. The emergence of Botulinum injections as a treatment option for intractable vaginismus is a very important development indeed. It is, of course, essential to ensure the regulatory bodies in your country have approved it for this use before pursuing it.