#68 : Effect of Botulinum Toxin in the Treatment of Refractory Vaginismus

Abstract

Background: Vaginismus is a body’s automatic reaction to the fear of some or all types of vaginal penetration. Whenever penetration is attempted, the vaginal muscles tighten up on their own. It can range from mildly uncomfortable to almost impossible penetration. Hence, we need to pay more attention to the multidimensionality of this disorder’s biological, psychological, and social dimensions and its treatment. Objective: To see the efficacy of botulinum injection in success rate of treatment of vaginismus were counselling sessions and using different method of dilatation failed. Methods: It was a case control study conducted at tertiary care hospital from January 2021 to December 2022. 120 women were recruited, 50 with vaginismus and 70 were without vaginismus. Females diagnosed with moderate to severe vaginismus who failed to respond to counseling sessions and use of dilators was included. A designed questionnaire was used for data collection and entered in SPSS version 25. The Chi-square test was used to compare categorical variables. The level of significance was 5%. Results: The mean age of women and duration of marriage was 28.4±2.63 and 4.16±1.36 years. Women who suffered with vaginismus were depressed. 28(56%) couple had good relationship and good communication after marriage. 41(82.0%) women were not sexually abused. Out of 50 couples, 23(46%) had excellent sexual knowledge. Before injection Botox examination under anesthesia was done, there was no local pathology, 17(34%) could admit one finger and 33(66%) could admit two fingers. A significant relationship was found between case control with outcome after Botulinum injection (p-value=0.00). The success rate of this treatment was 74%. Conclusion: Botulinum toxin blocks release of acetylcholine, inhibiting neuromuscular transmission and leading to muscle paralysis. This therapy intensely relieved the inappropriate spasms, allowing resumption of intercourse.