title: Botulinum toxin in the treatment of refractory vaginismus.
abstract: OBJECTIVE
  To investigate the efficacy of botulinum toxin injection to treat women with moderate and severe vaginismus.
  
  
  METHODS
  Twenty-four women referred to our clinic from February 2002 to February 2004 (mean age 25 years; range 19-34 years) with third- to fourth-degree vaginismus were recruited for this study. These women had previous unsuccessful treatments. Botulinum toxin (150-400 mIU) was injected into the puborectalis muscles in 3 sites on each side of the vagina.
  
  
  RESULTS
  Twenty-three patients (95.8%) had vaginal examinations 1 week postoperatively that showed little or no vaginismus, 18 (75%) achieved satisfactory intercourse after the first injection, 4 (16.7%) had mild pain, 1 was cured after a second injection, 1 patient refused vaginal examination and did not attempt to have coitus, and another had no coitus as a result of her husband's secondary impotence. The women were followed up for a mean of 12.3 months (range 2-24 months), and there were no cases of recurrence.
  
  
  CONCLUSIONS
  In refractory cases of vaginismus when conventional therapies have failed, local injection of botulinum toxin can be considered.
  
  
  METHODS
  III.
authors.affiliation: Department of Obstetrics and Gynecology, Tehran University of Medical Sciences, Vali-e Asr Reproductive Health Research Center, Tehran, Iran. shirin_ghazizadeh@yahoo.com
authors.forename: Shirin
authors.initials: S
authors.lastname: Ghazizadeh
authors.forename: Masoomeh
authors.initials: M
authors.lastname: Nikzad
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D020018:Sexual Dysfunctions, Psychological / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A