How Botox Works

How, Why and How Often is
Botox Used to Treat Vaginismus?

Brief Summary:

How is Botox used for vaginismus?

Botox is injected under anesthesia using tiny needles. A medium sized dose of about 100 to 150 units is injected. The Botox is divided between the three important muscles of the vagina that can prevent penetration. More Botox is used in the entry muscle because it is this muscle that generally blocks penetration.

Why is Botox used for vaginismus?

Because it weakens the spastic vaginal muscles which are preventing penetration.

How often is Botox used in the treatment of vaginismus?

Generally only one treatment is needed even though Botox lasts only about four months. Once dilation is comfortable and intercourse is achieved, additional doses of Botox are rarely needed.

How is Botox Used to Treat Vaginismus?

Botox is injected superficially into the sides of the vagina using a tiny needle under anesthesia. It could easily be injected without anesthesia, as is routinely done when injecting other areas such as the face. There is generally so much fear and anxiety in vaginismus patients that any touch in the pelvic area is accompanied by major withdrawal, as occurs during a GYN exam. It is for this reason Botox is injected under anesthesia to make it more comfortable for the patient. The anesthesia is also necessary to permit progressive dilation to the larger dilators.

Botox is injected into all three vaginal muscles that may be responsible for the inability to have penetration, though the dose is divided to inject more Botox into those muscles that show greater spasm. This can be determined at the time of examination. Generally the entry muscle (bulbocavernosum) is noted to look like a tightly closed fist in the more severe vaginismus patients, and it is this muscle that receives a higher dose of Botox.

Only the side walls of the vagina are injected to help prevent incontinence. The areas around the urethra and rectum are avoided. This does not interfere with the treatment because the vaginal muscles encircle the vagina. Interfering with a portion of these muscles to contract results in muscles that can no longer go into spasm. They become softer more pliable muscles which can now be stretched with dilators. Once dilators are comfortable, transition to intercourse becomes fairly easy in most patients. Though there may be continued fear of penile penetration, an erect penis is more comfortable than the large dilators and patients quickly realize this as they make the transition to intercourse.

Why is Botox Used for Vaginismus?

Botox causes a weakening or paralysis of the targeted muscles depending on the dose used. The larger the muscle, the more Botox is used. For patients who have heavy frown lines between the eyes, Botox can be used in smaller doses so that some facial animation remains, or it can be used in a larger doses to completely eliminate any activity in this area. Similarly, the amount of Botox used in the vagina is determined on the basis of the degree of spasm and how many muscles are involved with the vaginismus process.

How Often is Botox Used to Treat Vaginismus?

Usually only one session of Botox injections are required for the treatment of vaginismus. Most patients do not need a second session once they are dilating and achieving intercourse. A number of factors seem to be important in this observation:

  • Dilating for a year keeps the muscles stretched and less likely to go back into spasm.
  • Achieving penetration with dilators and intercourse allows for a reduction of fear and anxiety which in turn seems to shut down the reflex that goes from the brain to the vagina causing spasm.

How Long Does Botox Stay in One’s System?

Botox lasts about four months and by six months any lingering effects of Botox disappear. By this time most patients have achieved pain free intercourse and continue to do so.

When Does Botox Become Effective?

The onset of Botox usually takes about two to five days. One is not aware when the Botox becomes effective. Despite this delayed onset, most patients are able to successfully dilate to the larger dilators immediately after the treatment because of the progressive dilation done in the operating room. As the Botox becomes effective, dilation continues to be easier.

Will I Know When the Botox Disappears?

Most patients are unaware of the subtle changes that take place as the Botox disappears. Vaginal contractions during orgasm improve, and there is more of a letdown with arousal.

How does Botox Work?

Botox works by blocking the chemical (acetylcholine) that goes from the nerve to the muscle, so the muscle is unable to contract. It does not cause numbness, only weakening of the injected muscles.

I Heard that Botox is a Toxin and Can Kill You.
Is this true?

Botox is a highly diluted toxin that has a long record of safety when used as directed and procured from Allergan, the company that manufactures this drug. Only FDA approved Botox is used. It is estimated that it would take about 200 vials of Botox to cause illness. Only one and a half vials (150 units) is used to treat vaginismus. I have used a great deal of Botox in the last fifteen years and feel it is one of the safest drugs I administer.

What are the Risks and Complications of Botox?

Botox, when properly used, is considered to be very safe and effective. Risks and complications are minimal. When Botox is used in the vagina it is best to avoid the areas near the urethra, bladder and rectum to avoid incontinence. It is for this reason that injections are given only along the side walls of the vagina. In over 140 patients treated with Botox for vaginismus through November, 2011, two patients developed minor stress incontinence losing a few drops of urine when straining. This disappeared after four months when the Botox wore off. Apart from this there were no other complications.

Other Important Considerations Using
Botox to Treat Vaginismus.

Botox in of itself is unlikely to cure vaginismus. The entire program of using Botox, dilation and close post procedure supervision are all important in achieving success. Our program is the only program in the United States that received FDA approval for the continued study of vaginismus treatment using the Botox program. The high rate of patient success speaks to the value of using the Botox program in almost any patient suffering from vaginismus, from milder cases to the more severe cases. Additionally, very little time is wasted in that progress is usually quick compared to other methods of treatment that often take years. An analysis of over 200 assessments in our practice showed that patients were under therapy for an average of 7+ years. This is far too long. One has but to read the agony these patients go though to understand the need for rapid diagnosis, and treatment that is quick and effective.

Botox is thought to be very safe and is a commonly injected drug throughout the world. There is no evidence of any long term problems and no evidence of any increase in miscarriages or congenital abnormalities in babies. The dose used is considered to be within safe limits.

For patients who continue to have relationship issues, continued fear of penile penetration or continued low libido, additional treatment by therapists is of great value.