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Using botox to treat painful sex in women

For women with vaginismus, what should be a pleasure becomes a nightmare, as the condition causes sex to become so painful that it is often unbearable.

Vaginismus is a condition where the vaginal muscles contract involuntarily in a way that causes severe pain. Women who suffer this problem find it almost impossible to engage in sex. Even to insert a tampon becomes extremely difficult, and the same goes for getting a pap smear or other gynaecological exams.

The extreme tightness of the pelvic floor muscles, which creates problems like burning, pain, and even the inability for penetration and intercourse, is due mainly to the tightening of pelvic floor muscles known as the pubococcygeus muscle group.

It is akin to suffering from a tight or strained neck, permanently. Imagine touching the sensitive area normally, and perpetually feeling a pain because of the inflammation. The term to describe the persistent pain that vaginismus sufferers feel before and after sexual intercourse is dyspareunia.

Causes of vaginismus

This condition can occur at any time in a woman’s life, even after years of having normal sexual activity. Vaginismus is diagnosed via a process of elimination, also known as diagnosis of exclusion, and may be caused by any number of physical or mental stressors, making it harder to diagnose quickly.

Some of the stressors may include inadequate lubrication, rough intercourse, and even negative emotions towards a partner. There are also two known types: primary vaginismus and secondary vaginismus.

Primary vaginismus: This type of vaginismus refers to a long-term condition of pain occurring whenever the patient tries to insert a tampon or engage in penetrative sex.

A marriage may suffer from lack of intimacy due to this condition, and the couple will need to be considerate of each other to make things work, or end up in a sexless marriage.

Secondary vaginismus: This condition is diagnosed in women who were previously fine and enjoying normal sexual activity, but developed vaginal tightness and pain. Some reasons may include menopause, surgery, childbirth, the development of a medical condition, or any kind of traumatic event.

Vaginismus can be caused by any of the following physical reasons:

• Age-related changes like menopause, hormonal imbalance, and vaginal atrophy and dryness.

• Abuse, including physical attack, physical abuse or sexual assault.

• Childbirth, which may result in pain from normal or difficult vaginal deliveries, complications, caeserean sections or miscarriages.

• Medications with side effects that could cause pelvic problems.

• Medical conditions, such as urinary tract infections or urination problems, yeast infections, sexually-transmitted disease, endometriosis, genital or pelvic tumours, cysts, cancer, vulvodynia, vestibuoldynia, pelvic inflammatory disease, lichen planus, lichen sclerosis, eczema, psoriasis, vaginal prolapse, etc.

• Pelvic trauma due to surgery or other trauma.

• Temporary discomfort due to insufficient arousal and inadequate lubrication.

Non-physical causes include:

• Anxiety or stress, performance pressures, previous unpleasant sexual experiences, negativity toward sex, guilt, emotional traumas, general anxiety or other unhealthy sexual emotions.

• Childhood education, e.g. an unhealthy view of sex from young, due to overly rigid parenting; unbalanced religious teaching emphasising that sex is bad; exposure to shocking sexual imagery; and a lack of adequate sex education.

• Fear of getting pregnant or contracting a sexually-transmitted disease, fear of intimacy, being inexperienced or feeling embarrassed.

• Partner issues such as emotional detachment, fear of commitment, anxiety about being vulnerable and losing control, and even abusive relationships.

• In some cases, vaginismus can develop despite there being no apparent, identifiable cause, be it physical or non-physical.

How does botox for vaginismus work?

Vaginismus is not commonly diagnosed, leaving women feeling helpless in their options for treatment. It is not an easy condition to diagnose, when there appears to be little basis for these symptoms. Patients are often advised to relax and change their mindset about sex, rather than receive treatment to solve involuntary pelvic floor tightening.

But even if the cause of a patient’s vaginismus is psychosomatic, the physical symptoms can be treated externally and botox injections may be the answer. Botox functions by halting the transfer of acetylcholine, a type of chemical that moves from nerve to muscle, thus stopping the muscle from contracting. It weakens the muscles that have been injected, rather than cause numbness.

Botox treatments may be able to halt the back and forth between contraction and pain that vaginismus patients have to bear with. When botox treatments relax the muscles, allowing for sexual activity or the use of tampons without pain, in time, the vaginal muscles will begin to ease up on its own.

By relaxing the tensed vaginal muscles, botox injections train the muscles in that area to relax and allow for penetration. Under local anaesthesia or sedation, fine needles are used to administer botox to three main muscles in the vagina, but only the areas experiencing the most spasticity and spasms receive injections.

To avoid problems like incontinence, the doctor administering the injections should be very careful to avoid getting too close to the urethra and rectum. The effectiveness of botox varies from one person to another, taking anywhere between two to five days to work.

Still, most patients are able to see the benefit of botox injections in the form of dilation, even immediately after treatment.

When botox injections kick in, patients may be unaware of the subtle changes that occur. Slowly, you may find that the once painful vaginal contractions during orgasm have improved, and arousal gets easier.

How many treatments are required?

Gynaecologists at The Gynae Centre in Britain have found that most patients only need one botox treatment. Once dilation is comfortable and intercourse is achieved, additional doses of botox are rarely needed. Botox enables the vagina to gradually build up tolerance to penetration from intercourse, menstrual aids or gynaecological tools.

It only lasts for about four months, any lingering effects would have disappeared by six months. By this time, most patients would have achieved pain-free intercourse and continue to do so. It has been shown to be effective in the majority of women who seek treatment.

For patients who continue to have relationship issues, continued fear of penile penetration or continued low libido, additional treatment by therapists is of great value.

Risks and other important considerations

The risks of US Food and Drug Administration-approved botox injections are generally minimal when used following proper procedures. It is a highly diluted toxin with a good safety track record, and you would need about 30,000 units of botox, or 200 vials, to cause serious illness.

One treatment of vaginismus only needs approximately one and a half vials, which is 150 units. Patients who undergo botox injections to treat vaginismus have been known to develop minor stress incontinence, straining to release small amounts of urine. The problem will disappear when the botox wears off after a few months.

Injections are typically only given along the side of the vaginal walls, but extra care should taken when administering the injections, to avoid areas close to the urethra, bladder and rectum. That way, side effects like incontinence can be prevented.

The entire treatment, from injection, dilation and supervision of post-procedure recovery, are highly important to successfully completing the treatment.

Botox injections are not likely to cure vaginismus directly, but the high rate of effectiveness in alleviating vaginismus symptoms indicate a benefit to getting this treatment.

The process of diagnosis, administering of injections and recovery can also be done rapidly and efficiently, cutting down time spent in therapy, which could take years without botox.

Apart from this, the complications are quite minimal. As a cosmetic procedure, botox has been proven to be safe when properly administered in the right doses.

There is no evidence of long term chronic problems, and no indication of increase in miscarriages or abnormal births. If you believe you have symptoms that correlate to the symptoms of vaginismus, you don’t have to suffer in silence and be put off by sexual intimacy.

Contact your gynaecologist for a consultation to see if botox treatment might work for you. Do ensure that your gynaecologist is certified to do this treatment.

By Datuk Dr. Nor Ashikin Mokhtar
Published in Star Newspaper, September 10, 2018