Scientific Literature-The Science of Botox for Vaginismus

The Science of Botox for Vaginismus

The use of Botox was first described in a case report by Brin, 1997, for the treatment of secondary vaginismus. Since then a number of articles have appeared in the scientific literature suggesting the use of Botox as a treatment for vaginismus. These articles are referenced below.

Botox as a treatment for vaginismus makes sense in that Botox is well known to interfere with muscular activity. Botox is one of the most commonly used drugs throughout the world and has a high level of safety when used correctly. A number of products containing weakened botulinum toxin A are available of which Botox is one of the more commonly used products. When Botox is injected into overactive muscles, these muscles are unable to contract.

An important breakthrough was the publication by Pacik showing that when Botox injections for vaginismus were combined with dilators, the success rate was improved from about 70% to well over 90%. This is actually a simple concept in that the Botox weakens the overactive muscles while dilators stretch the muscles in their weakened state. Once the patient overcomes her fear and anxiety, she is able to achieve intercourse and continue dilating as needed for about the first year. In this way repeat Botox injections are not needed, even though Botox lasts only about four months.


Brin MF, Vapnek JM. Treatment of vaginismus with botulinum toxin injections. (1997). Lancet. 349: 252-253.

Shafik A, El-Sibai O. Vaginismus: results of treatment with botulinum toxin. (2000) J Obstet Gynaecol. 20:300-2

Shirin Ghazizadeh, MD, and Masoomeh Nikzad, MD. (2004). Botulinum Toxin in the Treatment of Refractory Vaginismus. Obstet Gynecol 104, 922-925.

Abbott JA, Jarvis SK, Lyons SD, Thomson A, Vancaille TG. Botulinum toxin type A for chronic pain and pelvic floor spasm in women: a randomized controlled trial. (2006) Obstet Gynecol. 108:915-923.

Bertolasi L, Frasson E, Cappelletti J, Botulinum Neurotoxin A Injections for Vaginismus Secondary to Vulvar Vestibulitis Syndrome. Obstet. and Gynecol. 114:1008, 2009.

Pacik PT. Botox Treatment for Vaginismus. (2009) Plastic & Reconstructive Surgery, 124:455e-456e

Pacik PT. Book: When Sex Seems Impossible. Stories of Vaginismus & How You Can Achieve Intimacy, Odyne Publishing 2010

Pacik, PT. Vaginismus: Review of Current Concepts and Treatment Using Botox Injections, Bupivacaine Injections, and Progressive Dilation with the Patient Under Anesthesia (2011) Aesth Plast Surg. DOI 10.1007/s00266-011-9737-5

Pacik, P. Vaginismus. Treatment with Intravaginal Botox and Dilation Under Anesthesia. A Prospective Study of 70 Consecutive Patients. J Sex Med 2011;8(suppl. 2):64 Citation: (2011) Proceedings from the 10th Annual Meeting of the International Society for the Study of Women’s Sexual Health. Scottsdale, AZ. February 10-13, 2011. The Journal of Sexual Medicine, 8:56-77, doi: 10.1111/j.1743-6109.2010.02249_4.x