Vaginismus & Vaginal Botulism Toxin

Vaginismus is a condition characterized by involuntary spasms of the vaginal muscles, resulting in pain during sexual intercourse, tampon insertion, and even sitting. Historically, vaginismus has been poorly addressed in medicine. Treatment often involves the use of vaginal dilators and pelvic floor physiotherapy to gradually stretch the opening of the vagina. However, this approach lacks a proper diagnosis of the underlying cause of vaginismus.

There are various reasons why vaginismus may occur. One common cause is a tight hymen in younger women. While some hymens are stretchy and easily break, others can be fibrous and resistant to dilation, causing pain during intercourse or dilation attempts. It is important to note that a tight hymen is not the sole cause of vaginismus. Traumatic sexual experiences, vaginal deliveries, deep vaginal pain (often associated with endometriosis), scoliosis, or pelvic asymmetry due to accidents can also contribute to vaginismus. In cases of pelvic asymmetry, tight lower back and piriformis muscles can lead to spasms in the vagina, which are typically more pronounced on one side.

Regardless of the cause, vaginismus often requires intervention. Dr. Jessup utilises vaginal botulism toxin injections to release the involuntary muscle spasms. Vaginal botulism toxin can be administered either in the clinic rooms with local anaesthesia or in a theatre setting under general anaesthesia. Once the underlying cause of vaginismus has been addressed, a single course of vaginal botulism toxin is usually sufficient to release the spasms and provide long-lasting relief, even after the botulism toxin has worn off. The vaginal muscles can then move normally without spasm and without pain. However, some women with highly hypertrophied vaginal muscles may require a larger amount of botulism toxin or a second procedure.

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