Botox-type drug helpful for vaginal spasm disorder

About one woman in every 100 may suffer from vaginismus, a painful condition in which muscles around the vagina go into involuntary spasm with little or no provocation.

About 10 percent of women with vaginismus are not helped by conventional therapy - which can include lubricants and anesthetic creams, anti-anxiety drugs, and Kegel exercises - but now Iranian researchers have come up with an alternative in such cases.

Local injection of botulinum toxin - better known as Botox - is an effective and safe way to treat vaginismus that has not responded to other treatments, report Drs. Shirin Ghazizdeh and M. Nikzad of the Vali-e Asr Reproductive Health Research Center in Tehran.

The researchers tested botulinum toxin injections in 24 women with severe vaginismus that had not been cured with previous treatment. The women were injected in three sites in muscles on either side of the vagina while under light sedation.

The participants were followed-up a week later, and then for up to 24 months after the procedure.

One patient refused a vaginal exam the week after the procedure, but the other 23 who were examined had little or no vaginismus at that point, the investigators report in the medical journal Obstetrics and Gynecology.

Eighteen of the patients were able to have intercourse successfully after the first injection. Four reported some pain with intercourse, and one reported being cured after a second series of injections. One woman was not able to attempt intercourse with her husband due to his secondary impotence.

None of the patients experienced a return of vaginismus, and all said they would recommend the injections for others with the condition.

While the botulinum toxin treatment is effective, Ghazizdeh and Nikzad recommend that patients try other treatments first.

"Botulinum toxin may be appropriate therapy for patients with vaginismus who have failed to respond to conventional therapies," the researchers conclude. "However, therapy with botulinum toxin should be considered experimental and ideally administered as part of clinical trials."

SOURCE: Obstetrics and Gynecology, November 2004.