title: Botulinum neurotoxin type A injections for vaginismus secondary to vulvar vestibulitis syndrome.
abstract: OBJECTIVE
  To investigate whether botulinum neurotoxin type A improves vaginismus and study its efficacy with repeated treatments.
  
  
  METHODS
  Outpatients were referred because standard cognitive-behavioral and medical treatment for vaginismus and vulvar vestibular syndrome failed. From this group, we prospectively recruited consecutive women (n=39) whose diagnostic electromyogram (EMG) recordings from the levator ani muscle showed hyperactivity at rest and reduced inhibition during straining. These women were followed for a mean (+/-standard deviation) of 105 (+/-50) weeks. Recruited patients underwent repeated cycles of botulinum neurotoxin type A injected into the levator ani under EMG guidance and EMG monitoring thereafter. At enrollment and 4 weeks after each cycle, women were asked about sexual intercourse; underwent EMG evaluation and examinations to grade vaginal resistance according to Lamont; and completed a visual analog scale (VAS) for pain, the Female Sexual Function Index Scale, a quality-of-life questionnaire (Short-Form 12 Health Survey), and bowel and bladder symptom assessment.
  
  
  RESULTS
  At 4 weeks after the first botulinum neurotoxin type A cycle, the primary outcome measures (the possibility of having sexual intercourse, and levator ani EMG hyperactivity) both improved, as did the secondary outcomes, Lamont scores, VAS, Female Sexual Function Index Scales, Short-Form 12 Health Survey, and bowel-bladder symptoms. These benefits persisted through later cycles. When follow-up ended, 63.2% of the patients completely recovered from vaginismus and vulvar vestibular syndrome, 15.4% still needed reinjections (censored), and 15.4% had dropped out.
  
  
  CONCLUSIONS
  Botulinum neurotoxin type A is an effective treatment option for vaginismus secondary to vulvar vestibular syndrome refractory to standard cognitive-behavioral and medical management. After patients received botulinum neurotoxin type A, their sexual activity improved and reinjections provided sustained benefits.
  
  
  METHODS
  III.
authors.affiliation: From the Department of Neurological Sciences and Vision, Section of Clinical Neurology, University of Verona, Italy; Departments of Neurology and Management Control, ULSS15 Cittadella Hospital, Padua, Italy; and Centre of Gynaecology and Medical Sexuology, San Raffaele Resnati Hospital, Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Bertolasi
authors.forename: Emma
authors.initials: E
authors.lastname: Frasson
authors.forename: Jee Yun
authors.initials: JY
authors.lastname: Cappelletti
authors.forename: Silvana
authors.initials: S
authors.lastname: Vicentini
authors.forename: Monia
authors.initials: M
authors.lastname: Bordignon
authors.forename: Alessandra
authors.initials: A
authors.lastname: Graziottin
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D003075:Coitus; D004414:Dyspareunia / Q000188:drug therapy; D004576:Electromyography; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D007410:Intestinal Diseases / Q000188:drug therapy; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D017773:Pelvic Floor / Q000503:physiopathology; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014555:Urination Disorders / Q000188:drug therapy; D052065:Vaginismus / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D054515:Vulvar Vestibulitis / Q000150:complications*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A