Abstract
OBJECTIVE: Vaginismus is a rare and under-researched psychosexual disorder characterized by involuntary vaginal muscle contractions that impede penetration, causing significant distress. Despite its impact, large-scale studies remain scarce. This study, one of the largest of its kind, analyzes 143 patients over a six-year period (2018-2024) to assess the efficacy and safety of intravaginal Botox injections, a promising intervention that disrupts acetylcholine-mediated muscle contractions. METHODS: This prospective study included 143 married women diagnosed with vaginismus between 2018 and 2024, making it one of the largest investigations on this condition. Among them, 106 patients underwent intravaginal Botox injections, while 37 patients diagnosed with vulvar vestibulitis syndrome received surgical interventions. Demographic data, including age, duration of marriage, and prior unsuccessful treatments, were recorded to assess treatment outcomes and patient characteristics. RESULTS: This study, involving 106 women diagnosed with vaginismus, demonstrated a remarkable success rate of 81.13% (86 out of 106 patients) following vaginal Botox treatment combined with psychological support. The majority of these patients experienced significant symptom relief, enabling pain-free intercourse, often within two weeks of treatment. In contrast, 18.87% (20 patients) did not report symptom relief and continued to experience vaginismus symptoms. Participants ranged in age from 21 to 34 years, with an average age of 26.59 years, and had been married between 2 months and 8 years. The treatment was well tolerated, with no severe adverse effects reported, further supporting its safety and efficacy as a viable treatment option for vaginismus. CONCLUSIONS: This study highlights the high success rate of vaginal Botox treatment combined with psychological support, with 81.13% (86 out of 106 patients) achieving significant symptom relief and regaining pain-free intercourse. The treatment was well-tolerated and demonstrated substantial efficacy, reinforcing its potential as a viable intervention for vaginismus. However, 18.87% of patients did not experience symptom resolution, underscoring the complexity and heterogeneity of vaginismus. Notably, due to the rarity of this condition, this study represents one of the few conducted with such a large cohort, contributing valuable insights into the management of vaginismus. These findings emphasize the need for further research into individualized treatment strategies to optimize outcomes and address the varying needs of patients affected by this challenging and under-researched condition.