By now, most people are familiar with Botox being used to smooth fine lines and wrinkles (think: crow’s feet, frown lines, and horizontal forehead lines, to name a few) and reverse signs of aging on the face. You may even know that the neurotoxin is used to treat migraines, quell hyperhidrosis (read: excessive sweating), and ease the pain associated with temporomandibular joint (a.k.a. TMJ) disorder. But did you know that botulinum toxin type A (the active ingredient in Botox®) can be used to treat vaginismus?

Vaginismus is a rare medical condition that causes involuntary vaginal muscle spasms. It can insert tampons and penetrative sex painful — and, in some cases, impossible. For some, it is a condition they have always had, while others can develop it later in life due to hormonal changes (i.e. menopause), emotional trauma, or no obvious reason at all.

Until recently, treatment often involved a combination of talking therapy sessions to address the emotional aspect of the condition and physical therapy and vaginal dilators to help the muscles adapt. The goal? Make intercourse possible or, at the very least, more comfortable. Now practitioners are using Botox® to paralyze the muscles that contract as a result of the condition with promising results.

Here, we outline everything you need to know about the procedure and hear from two patients about their experiences.

How Does Botox Treat Vaginismus?

Botox® is a brand name for BoNT-A, which is a neuromodulator that relaxes muscles when it is injected. It is used therapeutically to treat a number of medical conditions, as well as being used for cosmetic purposes. For vaginismus, Botox® is injected into the vaginal muscles that contract to cause pain and prevent penetration. By paralyzing the muscles, it effectively treats involuntary contractions — such as those experienced by people who have vaginismus. There are three main groups of muscles that can be affected by vaginismus, but Botox® is generally injected into the bulbospongiosus muscle (i.e. the muscle that surrounds the opening of the vagina).


The technique is based on the same principle as cosmetic Botox®. The product is injected into muscles that are contracting when they shouldn’t be. Your practitioner will establish which muscle groups are causing the pain and inject them accordingly. On average, 200 units of Botox® are used during a session.

While needles in the vulva may signal discomfort, procedure pain is rarely a factor. Vaginismus Botox® treatments are carried out under local or general anesthesia. For some patients, general anesthesia is the best option because the condition would make it difficult to inject the local anesthesia that is needed. Either way, the procedure is usually an outpatient procedure.

Generally speaking, it takes patients four to five days to recover from the procedure, and the full effects of Botox® are realized around one-week post-op. In some cases, the injection alone will be enough to allow for painless penetration. In other cases, the treatment will be combined with the use of dilators (to address physical discomfort) and therapy — in order to address the emotional issues that, of course, can’t be treated with a procedure alone.


More often than not, just one session is needed for patients to enjoy the full benefits of the procedure. This long-term relief occurs despite the fact that the Botox® only lasts three to five months — the initial treatment breaks the pain cycle associated with vaginismus. Once patients are able to have painless intercourse or penetration, the body tends to relax the muscles on its own. It is possible, however, to have multiple treatments, if results from the first procedure wear off over time.


Not all women with vaginismus are eligible for Botox treatment. Women who are allergic to albumin, botulinum toxin, or to any other component of the medication should not receive Botox treatment. In addition, if the patient has an ongoing infection at the proposed treatment site, treatment should be delayed until the infection has been resolved. Women with diseases of neuromuscular transmission or coagulopathy should also be excluded from treatment.

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