title: Different treatment modalities for refractory vaginismus in western Saudi Arabia.
abstract: BACKGROUND
  Although vaginismus is a common sexual dysfunction in Saudi Arabia, there are limited data concerning the treatment modalities associated with patients with symptoms of vaginismus.
  
  
  OBJECTIVE
  This study is aimed to evaluate the presentation and different modalities of management in patients with severe refractory vaginismus in western Saudi Arabia.
  
  
  METHODS
  Successful penetrative sexual intercourse suggesting that common elements of the therapies used were successful.
  
  
  METHODS
  A retrospective study of patients presenting with severe refractory vaginismus treated in Jeddah, Saudi Arabia. The subjects were 15 women with third to fourth degree vaginismus who presented to King Abdulazziz University Hospital between January 1, 2008 and January 1, 2009.
  
  
  RESULTS
  The mean age of the participants was 23 years. The mean duration of marriage before seeking medical advice was 12 months. Six patients had undergone conventional therapy successfully. The other six cases, four of which had a previous history of treatment failure, and two who were unresponsive to 4 months of conventional therapy were offered botulinum toxin type A. Five patients who received the Botox therapy had satisfactory intercourse on the same day of the treatment. One patient required a repeat injection after 2 months for recurrent vaginismus. Three of the 15 patients refused the treatment as they were already divorced and had only come in to exclude organic causes for their condition.
  
  
  CONCLUSIONS
  Vaginismus is an overlooked topic in conservative societies such as Saudi Arabia. For most patients, not knowing who to confide in or where to turn to plays a major role in the under diagnosis of vaginismus. Conventional therapy proved effective in mild and moderate cases, while botulinum toxin has a more rapid effect and was thus more effective in severe cases.
authors.affiliation: King Abdulaziz University, Obstetrics and Gynecology Department, Jeddah, Saudi Arabia. fageeh.wafa@gmail.com
authors.forename: Wafa M K
authors.initials: WM
authors.lastname: Fageeh
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D003431:Cross-Cultural Comparison; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D019233:Retreatment; D012189:Retrospective Studies; D012529:Saudi Arabia; D017211:Treatment Failure; D052065:Vaginismus / Q000188:drug therapy* / Q000453:epidemiology; D055815:Young Adult
chemical_list: D019274:Botulinum Toxins, Type A