Vaginismus, sometimes called vaginism, is a condition that affects a woman's ability to engage in vaginal penetration, including sexual intercourse, manual penetration, insertion of tampons or menstrual cups, and the penetration involved in gynecological examinations (pap tests).
Three main types of pharmacological treatment have been proposed for vaginismus: local anesthetics (e.g. Lidocaine
), muscle relaxants (e.g. Nitroglycerin
ointment and botulinum toxin
) and anxiolytic medication.[80–87] Local anesthetics, such as lidocaine gel, have been proposed based on the rationale that vaginismic muscle spasms are due to repeated pain
experienced with vaginal penetration and, hence, the use of a topical anesthetic aimed at reducing the pain is hypothesized to resolve
the spasm. Its efficacy has only been reported in a case study in which a 5% lidocaine gel was applied on the hyperesthetic areas of the vaginal introitus of a 17-year-old women suffering from primary vaginismus. A topical nitroglycerin ointment, hypothesized to treat the muscle spasm
by relaxing the vaginal muscles, was also discussed only in a case study. A Muslim Bedouin couple presenting with primary vaginismus were able to engage in a satisfactory sexual relationship following the application of a topical nitroglycerine ointment. Given that all the available information is in the form of case studies, no firm conclusion can be reached.
Botulinum toxin, a temporary muscle paralytic, has been recommended in the treatment of vaginismus with the aim of decreasing the hypertonicity of the pelvic floor muscles. In Shafik and El-Sibai's treatment study (n = 13), women with vaginismus who received an injection of botulinum toxin were able to engage in 'satisfactory intercourse' as compared with no improvement in a control group receiving saline injections. The successful outcome persisted for an average follow-up of 10.2 months. Nonetheless, there are a number of limitations to this promising study, such as the small sample size, lack of information on how vaginismus was diagnosed and lack of independent determination of treatment outcome. A recent treatment outcome study (n = 39) demonstrated that women with vaginismus secondary to PVD, who received repeated injections of botulinum neurotoxin type A into the levator ani, displayed improvements on standardized measurements of sexual activity (i.e. The Female Sexual Functioning Index), on possibility of having sexual intercourse, on levator ani EMG hyperactivity
and on bowel–bladder symptoms. After a 39 month follow-up, 63.2% of their participants had completely recovered from vaginismus and PVD, 15.4% still needed some injections, 15.4% had dropped out and the remaining had not completed the treatment protocol. Another pharmacological treatment that has been proposed is the use of anxiolytics, such as diazepam
, in conjunction with psychotherapy
based on the hypothesis that vaginismus is a psychosomatic condition resulting from past trauma and, thus, anxiety-reducing medication will resolve the symptoms. Mikhail's uncontrolled study found that the administration of intravenous diazepam during psychological interviews in four women with vaginismus resulted in successful intercourse. Unfortunately, conclusions concerning the pharmacological treatment of vaginismus are limited because most studies lack appropriate placebo control groups and do not randomly assign patients to treatment, are based on small samples or do not use standardized outcome instruments.