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TREATMENTS for Vaginismus: Pros & Cons
1. BOTULINUM TOXIN and Vaginismus
Botox is the trade mark name for a drug that uses one of the most poisonous naturally occurring substances in the world: Botulinum.
Its full name is Botulinum Toxin, a "neurotoxic protein produced by the bacterium Clostridium botulinum, the same toxin responsible for the disease 'botulism'.Though Botulinum Toxic Type A is highly toxic, it is used in minute doses to treat painful muscle spasms, but it's mainly used cosmetically as an anti-wrinkle filling or for lip jobs". (Retrieved from Wikipedia Oct 2006)
So far it has been tested as a treatment for vaginismus or for pelvic pain in only a few scientific studies (see below), with mixed results and some biasis and limitations.
Overall, we agree with the conclusions given in the Review of Nonurological uses of botulinum toxin in gynaecology (http://onlinetog.org/cgi/content/abstract/10/2/75 ):
"some of (these uses) are in their infancy and will require further research and clinical trials before they can be recommended in routine clinical practice "
We believe that at this stage it is unethical for practitioners to recommend Botulinum Toxic as a cure for Vaginismus as if it was a well established treatment for vaginismus. It is not and side-effects can be permanent.
So we urge you to consider whose interests they have in mind were practitioners to suggest you give it a try...
Studies on Botulinum and Vaginismus /Pelvic pain
(Click on the link to read the studies available online)1. 2004 Botulinum Toxin in the Treatment of Refractory Vaginismus
Authors: Shirin Ghazizadeh, MD and Masoomeh Nikzad, MD
2.
2005 Angus JM. Thomson, Sherin K. Jarvis, Meegan Lenart, Jason A. Abbott, Thierry G. Vancaillie The use of botulinum toxin type A (BOTOX®) as treatment for intractable chronic pelvic pain associated with spasm of the levator ani muscles
BJOG: An International Journal of Obstetrics and Gynaecology 112 (2), 247–249.
3. 2008 (Ongoing study) Botulinum Toxin Injection for Treatment of Vaginismus
(Comparison of Efficacy of 250 Units Versus 500 Units of Botulinum Toxin in the Treatment of Refractory Vaginismus )
( Dr Shirin Ghazizadeh ) Tehran University of Medical Sciences
Results of each study and our comments:
1. Twenty-three patients (95.8%) had vaginal examinations 1 week postoperatively that showed little or no vaginismus2. There was a significant reduction in pelvic floor pressure (centimeters of H2O) in the botulinum toxin type A group from baseline (49 versus 32; {chi}2=39.53, P<.001), with the placebo group also having lower pelvic floor muscle pressures (44 versus 39; {chi}2=19.85, P=.003).
3. Results not published yet
What had women in those studies tried first ?
1. "All patients had received different types of treatment, including behavior therapy techniques such as deep muscle relaxation exercises, anesthetic creams, and vaginal lubricants; 5 patients had history of surgery to incise the rigid hymen".Now, as you may know by now "deep muscle relaxation", "anesthetic creams", "vaginal lubricants" and hymenectomies are NOT typical treatments for vaginismus, they can just help speed up the process, so we believe it is quite misleading to say those women had received treatment which hadn't worked.
It would have been better to see women who had tried physical therapy with biofeedback, or tried graduated dilators together with behavioural psychotherapy.
Who knows how many of the women in this study would have treated their vaginismus through those established therapies and therefore without the Botolinum Toxin ?
We will never know but it is fair to assume that many would have.
2. "Women were not required to have had standard physical therapy for pelvic pain before inclusion".
Again, given how physical therapy is a really successful treatment for vaginismus, we will never know how many of those women would have shown reduced spasms and less painful sex after a course of physical therapy rather than after being injected with Botox.
The researchers themselves seem to realize the limit of their inclusion criteria when they recommend the following:
"The importance of physical therapy is recognized and recommended as first-line therapy for women with chronic pelvic pain due to pelvic floor myalgia."
More critical comments on the studies on Botulinum Toxic and Vaginismus
* SAMPLE.
In each study, the sample was quite small (less than 60 women).
* BIASES.
There are reasons to be cautious. The Australian study (nr. 2) was sponsored by Allergan, the company producing Botox.
Read their Financial Disclosure:
"This study was sponsored by an unrestricted educational grant from Allergan Australia. One author (S. K. Jarvis) received partial salary for the conduct of the study. No author holds stock or options in Allergan, or any parent or subsidiary company. Two authors (J. A. Abbott and S. K. Jarvis) have received or will receive company sponsorship to present the results of this study at international meetings".
* SIDE EFFECTS (Retrieved from the Australian study: http://www.greenjournal.org/cgi/reprint/108/4/915)
"Notable events and serious complications occurred in four women in the botulinum toxin type A group, two of whom became pregnant during the study period, one of whom had urinary stress incontinence on several occasions, and one of whom had urge and stress urinary incontinence, flatus, and fecal incontinence intermittently for 4 months. No woman in the placebo group had a serious or notable complication"
* PLACEBO RESPONSE
"The trial observed a placebo response as well" Ms. Jarvis said. "That's quite common when you use botulinum toxin type A to treat pain."
(Source: http://www.medscape.com/viewarticle/516570)
Ms. Jarvis noted reduced sexual discomfort with both botulinum toxin type A and placebo.
"Muscle needling (without injection) is reported to decrease muscle spasm—an effect commonly associated with acupuncture.19 In addition, desensitizing trigger points is demonstrated to relieve muscle spasm and pain.20 The repeated measurement of pelvic floor pressures by perineometry using a relax/contract model is standard physical therapy for pelvic floor spasm in our department. Women in the placebo group who had not been through this program may have used this approach as a means of reducing pain."
Exactly.. So some of the women who felt better may have felt so because of the physical therapy they received and the counselling too, to prepare them for the injections.
How Botulinum works for vag.
As a treatment for vaginismus, Botulinum is usually injected into the pelvic floor muscles, intravaginally, so just inside the vagina and once inside the skin, it hardens, causing the muscles it is injected in to become unable to move, so the PC muscles will be unable to clench tightly and that will allow women to be able to have almost immediate penetration/insertions.Usually few rounds of injections are needed.
Each round may consist of one or more injections.
The price for full treatment may be around 800$ or more, but it varies.
Some women have reported being able to have intercourse almost straight after the first injections, others reported the need to still use dilators, at least for a while.
What does not seem clear is which women Botox could help.
If the problem is mainly physical and your vagina goes into spasms when you try intercourse, if you have other muscle problems or problems with your tendons etc, then Botox may be a good last resort for you if everything else failed.
But if you have other issues, with your partner or parents, issues with previous abuse or traumatic experiences where your vagina or parts of your body were involved and you felt invaded, and if you don't know your vulva or don't have a positive approach to sexuality in general, then it's unlikely that Botox will be a solution to your vaginismus.
We feel that there is still a lot to be researched in this field, so please just be very informed before making up your mind, and if you're not desperate (and why should one be?), we would recommend waiting a few years and more conclusive studies before taking your chances with botox for vaginismus. Anyway, these are some of the main pros and cons we have gathered so far.
If you want to talk about this topic with women who've tried it, or if you tried it and want to share your experience, you may want to join one of the biggest forums on Botox our there (that we're aware of) and add your experience there.
BOTOX FORUM: www.cosmeticenhancementsforum.com
BOTOX: Pros
# Botox is usually the treatment chosen by women who find it impossible to self-treat themselves and dilate or who tried many other treatments unsuccessfully. It is rarely a first-choice treatment.
# Botox is not meant to directly solve vaginismus, but to help you with the dilation treatment by helping you to make the first transition to dilators easier, so the muscles will learn that it's not painful to insert something and then you can go on inserting the other ones on your own.
#Its effects are not permanent, so you will have to repeat the injection if needed, but during that time, it can make it possible for you to use dilators or to have pain free intercourse, then your body may again understand the important lesson that it’s possible to insert something painlessly in the vagina so you may no longer need a second injection.
# You can go through the treatments under sedation (general or local anaesthesia) so it can be painless (but add risks associated with anaesthesia)
BOTOX: Cons
* The idea of having an injection inside the vagina can be very scary and intolerable for women with primary vaginismus. The injections is painful and if you should decide to have it under anesthesia, there are risks associated with it, however minor, that you may want to consider.
The idea can actually sound pretty scary for these women's partner too. A guy we recently approached gasped at hearing that her partner may have had to be injected inside her vagina to fix vaginismus and he said out loud "How invasive!!! I'd rather not have intercourse all my life rather than having her go through that!".
* Although it is medically refined and approved by the FDA, (though not as a cure for vag. in many countries) it is still questionable whether it is essential to insert such a poisonous substance in our vagina when there are other methods that work fine and are risk-free. (If dilating doesn't work the first time round, we'd recommend trying to solve other underlying issues and then try again maybe after a few months or following year.)
* Botox at first may seem like an attractive prospect. It’s just one injection and the same night you could try have pain free sex. However, Botox doesn't deal with any of the issues or fears that caused your vaginismus in the first place, with partners, with body-image, with your upbringing and view of sex.
So when it wears off (as it is likely to after a few weeks), your vaginismus or those issues will still remain.
* Its effects are not permanent so you may have to repeat the injections after a while but its side effects instead will be permanent, if you have any. The most serious one being the paralysis of the wrong muscle and/or an allergic reaction..
* It’s yet not legal in some countries as a cure for vaginismus. According to our knowledge, in the UK for instance Botox is not yet licensed for use in the treatment of vaginismus.
* (Retreived from www.fda.gov )
* Bad side effects found when Botox was used to treat women with pelvi pain (Retrieved from: http://www.greenjournal.org/cgi/reprint/108/4/915)
"Notable events and serious complications occurred in four women in the botulinum toxin type A group, two of whom became pregnant during the study period, one of whom had urinary stress incontinence on several occasions, and one of whom had urge and stress urinary incontinence, flatus, and fecal incontinence intermittently for 4 months. No woman in the placebo group had a serious or notable complication"
** "Injections usually have to be repeated, as the effects usually only last about three to four months, although sometimes they can last over a year. Because of this, up to 10 percent of patients eventually develop antibodies to the toxin; this is more likely in patients who receive higher doses at more frequent intervals. Therefore, the makers of the biologic recommend that its dosage be kept as low as possible." by Luba Vangelova, Md.
** "Petition to the FDA requesting regulatory action concerning the possible spread of botulinum toxin (Botox, Myobloc) from the site of injection to other parts of the body"
Published by Public Citizen’s Health Research Group(www.citizen.org) (23 January 2008)
| 1. BOTOX | 2. HYMENECTOMY | 3. HYPNOSIS |
| 4. PHYSICAL THERAPY | 5. GRADUAL DESENSITIZATION a.k.a. DILATING |
6. PRIVATE CLINICS |
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