Using Botox to Treat Vaginismus

Vaginismus is a condition where a person's vagina painfully contracts in a way that prevents penetration. These contractions are involuntary. In other words, someone who has vaginismus isn't trying to contract their vaginal muscles. Instead, those muscles contract on their own. This contraction often makes any attempt at penetration—with fingers, a penis, or a sex toy—painful or impossible. The contractions of vaginismus can also be painful on their own. They can make it impossible to undergo a gynecological exam.

Botox needles and bottles close up
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Doctors don't fully understand why people develop vaginismus. It is more common in women who have experienced sexual assaults and other traumas. It is also more common in individuals who have had a strict sexual upbringing. In other words, for some people there seems to be a connection between vaginismus and fear or anxiety about sex. However, there are also physical causes of vaginismus. Vaginismus can also be associated with a variety of medical conditions that can lead to pain during penetration. These include certain STDs and pelvic health problems as well as the natural changes associated with menopause.

Historically, research has suggested that medical and psychological treatments work similarly for people with vaginismus. This does not mean that vaginismus is "all in someone's head." What it means is that some of the body's reactions to pain and anxiety can be altered through behavioral techniques. Often, psychological treatments for vaginismus are provided by sex therapists or other sexual health professionals. However, general work on anxiety reduction can be helpful in some circumstances where vaginismus is relatively mild.

Using Botox for Vaginismus

One exciting area of sexual health research is in using Botox to treat vaginismus. Botox is commonly thought of as a vanity drug, due to its use for reducing facial lines. However, Botox, short for botulinum toxin, is also used to treat a number of chronic pain conditions. This is because Botox paralyzes the muscles into which it is injected. This prevents them from contracting—either consciously or unconsciously. That's why Botox is useful for preventing wrinkles—people can't move their faces. It's also why it's used for chronic pain conditions like TMJ (jaw pain), headaches, bladder pain, and vaginismus. Reducing tension in the problematic muscles also reduces pain.

Botox can cause significant side effects. Therefore, it is not usually the first line of treatment for vaginismus. However, some individuals are unwilling or unable to undergo other vaginismus treatments. For them, Botox treatment can have a positive effect. Using Botox to treat vaginismus involves several injections of the drug. Botox is injected into multiple areas of the bulbospongiosus muscle. This is the muscle that wraps around the entrance to the vagina. Additional injections may be used to relax other muscles if they are contributing to the vaginal spasms.

Botox treatment is usually not done on its own. Instead, it is often combined with psychotherapy and the use of dilators so that people can become comfortable with penetration. The Botox injections last for between 2 and 4 months. However, the effects of the treatment may last longer than that. This is likely due to a combination of anxiety reduction and retraining of the muscles. The Botox provides the initial relaxation and lack of pain on penetration that allows the body to become used to the sensations without tensing up.

Side effects of using Botox to treat vaginismus can include urinary incontinence and blurry vision.

Other Vaginismus Treatments

In addition to Botox, there are several other common therapies for vaginismus. These include other forms of injections, physical therapy, systematic desensitization to the stress of penetration, hypnotherapy, and cognitive behavioral therapy. Systematic desensitization uses dilators to slowly increase an individual's ability to tolerate penetration. This can either be done by a physician or by the patient, under the verbal direction of a physician or therapist.

Cognitive behavioral therapy, for both individuals and couples, generally uses a treatment manual. It can be used as part of individual or group therapy. To date, the evidence for the efficacy of these treatments is mixed. Some people appear to be helped by these therapies. However, the studies are often small and of low quality.

Interestingly, one study found that the cause of vaginismus does not necessarily relate to how effective different forms of treatment are. Cases of vaginismus associated with both medical and psychological triggers responded similarly well to both medical and psychological therapies. This suggests that focusing on treating the painful contractions vaginismus causes may sometimes be more helpful than trying to identify their causes.

A Word From Verywell

If you experience pain during sex, it can be difficult to find help. Not all doctors are comfortable talking about sexual health problems. Nor are all people comfortable talking to their doctors. One option is seeking out a sexual health specialist. This could be either a medical doctor or behavioral health professional. Specialists are not only good sources of information. They are also skilled at helping people get comfortable discussing the often uncomfortable topic of sex.

People are sometimes worried about what sex therapy entails. It's not hands-on work. Instead, sex therapists provide education about the body and how people can become more functional sexually. This can include homework exercises done alone or with a sexual partner. When seeing a sex therapist, usually you will also be sent to a medical doctor to explore any medical issues that may be contributing to your pain. The doctor and sex therapist can then work together to help you resolve your concerns.

There's a truth that isn't said often enough. Sex shouldn't be something that you dread because of pain. Pain is a sign that there's something that needs to be happening differently. Sometimes it's just changing positions or adding lubricants. Other times improvement will take more work. Just know that there are things that can be done to help make sex less painful and more enjoyable. If that's something you want, reach out to a professional. Making any necessary changes isn't always easy. However, they can be extremely rewarding.

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Harish T, Muliyala K, Murthy P. Successful management of vaginismus: An eclectic approach. Indian J Psychiatry. 53(2):154-5. doi:10.4103/0019-5545.82548

  2. Cleveland Clinic. Vaginismus.

  3. Heim LJ. Evaluation and differential diagnosis of dyspareuniaAmerican Family Physician. 63(8):1535-1545.

  4. Cleveland Clinic. Vaginismus: management and treatment.

  5. Sandrini G, De icco R, Tassorelli C, Smania N, Tamburin S. Botulinum neurotoxin type A for the treatment of pain: not just in migraine and trigeminal neuralgia. J Headache Pain. 18(1):38. doi:10.1186/s10194-017-0744-z

  6. Pacik PT, Geletta S. Vaginismus Treatment: Clinical Trials Follow Up 241 Patients. Sex Med. 5(2):e114-e123. doi:10.1016/j.esxm.2017.02.002

  7. Cleveland Clinic. How is vaginismus treated?

  8. Şafak Öztürk C, Arkar H. Effect of cognitive behavioral therapy on sexual Satisfaction, marital adjustment, and levels of depression and anxiety symptoms in couples with vaginismus. Turk Psikiyatri Derg. 28(3):172-180.

  9. Ramli M, Nora M, Roszaman R, Hatta S. Vaginismus and subfertility: case reports on the association observed in clinical practice. Malays Fam Physician. 7(1):24-7.

Additional Reading

By Elizabeth Boskey, PhD
Elizabeth Boskey, PhD, MPH, CHES, is a social worker, adjunct lecturer, and expert writer in the field of sexually transmitted diseases.