Comparative Study of 150 vs. 200 Units of Botulinum Toxin as Treatment for Vaginismus

Abstract

Objective To comparatively evaluate the outcome of treatment with 150 versus 200 units (U) of botulinum toxin in achieving pain-free intercourse and relieving muscle contraction in order to allow gynecological examination. Methods In this comparative prospective observational study, 99 patients with vaginismus were treated with botulinum toxin injections from September 2016 to August 2021. Diagnosis and grading of vaginismus severity were assessed using a Female Sexual Function Index (FSFI) questionnaire. Under local or general anesthesia, botulinum toxin diluted with preservative-free saline (150 U and 200 U) was injected into, above, and below the right and left bulbospongiosus muscle and the lateral submucosal areas of the introitus and perineal body using an insulin syringe. Patients were recalled after 2 weeks, and the postoperative outcome was recorded using a similar preoperative questionnaire. Results Overall, the mean age of patients was 30.2 years. The baseline and clinical characteristics were comparable between the 2 groups (p > 0.05). Significant improvements were seen in the pain and anxiety scores of finger penetration, dilator use, intercourse, and cotton swab in individual groups. The intergroup comparisons between 150 U and 200 U of Botox were not statistically significant (p > 0.05). Conclusion Low-dose Botox (150 U) is equally effective as high dose Botox injections (200 U) in vaginismus patients. Therefore, Botox-150 U can be used to treat vaginismus as an alternative to high doses of the same substance.

Botulinum Toxin for the Management of Pelvic Floor Tension Myalgia and Persistent Pelvic Pain

“…com/AOG/D419). 13,[34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] Prospective data showed significant improvements in patient-reported outcomes after botulinum toxin in all studies. Of the eight studies that reported the non-patient-reported outcomes of vaginal manometry or physical examination findings, seven reported significant improvements in vaginal pressure or pelvic floor hypertonicity at clinical examination.…”

“…Qualitative analysis was performed on 14 prospective and four retrospective studies involving a total of 600 and 204 participants, respectively (Appendices 2 and 3, available online at http://links.lww.com/AOG/D419). 13,34–50 Prospective data showed significant improvements in patient-reported outcomes after botulinum toxin in all studies. Of the eight studies that reported the non–patient-reported outcomes of vaginal manometry or physical examination findings, seven reported significant improvements in vaginal pressure or pelvic floor hypertonicity at clinical examination.…”

Diferentes Abordagens Terapêuticas Para O Vaginismo: Uma Revisão Literária

“…Além disso, o Botulínico A também diminui os níveis da substância P e do glutamato como parte da sensibilização central, diminuindo assim a sensibilidade à dor. 3 Embora a extensão da paralisia dependa da quantidade de toxina injetada, os dados sobre a dosagem mínima necessária para o tratamento do vaginismo não são claros. 3 No estudo de ZR Helmi, a toxina foi injetada dentro e ao redor do músculo bulboesponjoso e nas áreas submucosas laterais do intróito, além de terem sido feitas injeções adicionais no músculo levantador do ânus, sempre que necessário.…”

“…3 Embora a extensão da paralisia dependa da quantidade de toxina injetada, os dados sobre a dosagem mínima necessária para o tratamento do vaginismo não são claros. 3 No estudo de ZR Helmi, a toxina foi injetada dentro e ao redor do músculo bulboesponjoso e nas áreas submucosas laterais do intróito, além de terem sido feitas injeções adicionais no músculo levantador do ânus, sempre que necessário. Quando há paralisia ou espasmo bem-sucedido do músculo bulboesponjoso é indicativo de melhora do vaginismo.…”

“…Quando há paralisia ou espasmo bem-sucedido do músculo bulboesponjoso é indicativo de melhora do vaginismo. 3 A capacidade de obter relações sexuais satisfatórias é considerada o desfecho primário na maioria dos estudos. Com base nisso, a taxa de sucesso das injeções no vaginismo varia de 62 a 100%, segundo ZR Helmi, e os pacientes submetidos obtiveram relações sexuais satisfatórias no mesmo dia do tratamento.…”