title: Successful use of botulinum toxin type a in the treatment of refractory postoperative dyspareunia.
abstract: BACKGROUND
  Refractory dyspareunia presents a challenging therapeutic dilemma.
  
  
  METHODS
  A woman with defecatory dysfunction and dyspareunia presented with stage 2 prolapse. She underwent laparoscopic and vaginal pelvic floor reconstruction with excision of endometriosis. The patient experienced increased dyspareunia and de novo vaginismus postoperatively that were refractory to trigger point injections, physical therapy, and medical and surgical management. She underwent botulinum toxin type A injections into her levator ani muscles, which allowed her to have sexual intercourse again after 2 years of apareunia with no recurrence of pain for 12 months.
  
  
  CONCLUSIONS
  Injecting botulinum toxin into the levator ani muscles shows promise for postoperative patients who develop vaginismus and do not respond to conservative therapy.
authors.affiliation: Female Pelvic Medicine & Reconstructive Pelvic Surgery and Minimally Invasive Surgery, Department of Gynecology & Obstetrics, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Park
authors.forename: Marie Fidela R
authors.initials: MFR
authors.lastname: Paraiso
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D004414:Dyspareunia / Q000188:drug therapy* / Q000209:etiology*; D004715:Endometriosis / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D017773:Pelvic Floor / Q000601:surgery; D011183:Postoperative Complications; D020047:Rectocele / Q000601:surgery; D014596:Uterine Prolapse / Q000601:surgery; D052065:Vaginismus / Q000188:drug therapy* / Q000209:etiology
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A