Skip to main content

Vaginismus: Review of Current Concepts and Treatment Using Botox Injections, Bupivacaine Injections, and Progressive Dilation with the Patient Under Anesthesia


Vaginismus is a poorly understood condition affecting approximately 1–7% of females worldwide. This article aims to bring attention to this disorder and to review the use of Botox injections to treat these patients. Vaginismus, also known as vaginal penetration disorder, is an aversion to any form of vaginal penetration as a result of painful attempts and a fear of anticipated pain. It is involuntary and uncontrolled and functions much the same as any reflex to avoid injury. It is the most common reason for unconsummated marriages. The etiology is thought to be unknown. Numerous papers note a history of religious or strict sexual upbringing or aversion to penetration because of perceived pain and bleeding with first-time intercourse. Sexual molestation may be more prevalent in this group of patients. The Lamont classification is very helpful in stratifying these patients for treatment. Lamont grade 5 vaginismus is introduced. Vaginal Botox injections for the treatment of vaginismus has received increasing attention since the technique was first described in a 1997 case report. Plastic surgeons worldwide with their experience using Botox are well positioned to learn more about this relatively unknown entity and render treatment.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. Sims JS (1861) On vaginismus. Trans Obstet Soc Lond 3:356–367

    Google Scholar 

  2. Spector I, Carey M (1990) Incidence and prevalence of the sexual dysfunctions: a critical review of the empirical literature. Arch Sex Behav 19:389–396

    Article  PubMed  CAS  Google Scholar 

  3. Lahaie MA, Boyer S, Amsel R, Khalife S, Binik YM (2010) Vaginismus: a review of the literature on classification/diagnosis, etiology, and treatment. Woman’s Health 6:705–719

    Google Scholar 

  4. Goldstein A, Pukall C, Goldstein I (eds) (2009) Female sexual pain disorders, 1st edn. Blackwell, New York

    Google Scholar 

  5. Reissing ED, Binik YM, Khalifé S, Cohen D, Amsel R (2003) Etiological correlates of vaginismus: sexual and physical abuse, sexual knowledge, sexual self-schema, and relationship adjustment. J Sex Marital Ther 29:47–59

    Article  PubMed  Google Scholar 

  6. Graziottin A (2001) Clinical approach to dyspareunia. J Sex Marital Ther 27:489–501

    Article  PubMed  CAS  Google Scholar 

  7. de Kruiff ME, ter Kuile PTM, Weijenborg PTM, van Lankveld J (2000) Vaginismus and dyspareunia: is there a difference in clinical presentation? J Psychosom Obstet Gynecol 21:149–155

    Article  Google Scholar 

  8. Engman M, Lindehammar H, Wijma B (2004) Surface electromyography diagnostics in women with partial vaginismus with or without vulvar vestibulitis and in asymptomatic women. J Psychosom Obstet Gynecol 25:281–294

    Article  Google Scholar 

  9. Binik YM (2010) The DSM diagnostic criteria for vaginismus. Arch Sex Behav 39(2):278–291

    Article  PubMed  Google Scholar 

  10. Reissing Ed, Binik YM, Khalife S et al (2004) Vaginal spasm, pain, and behavior: an empirical investigation of the diagnosis of vaginismus. Arch Sex Behav 33:5–17

    Article  PubMed  Google Scholar 

  11. Reissing ED, Hattori K, Davis HJ (2003) Vaginal penetration disorder: an empirically based and clinically relevant alternative for the diagnosis of sexual pain disorders. In: 30th Annual conference of the Canadian Sex Research Forum, Edmonton, AB, Canada

  12. Friedrich EG (1987) Vulvar vestibulitis syndrome. J Reprod Med 32:110–114

    PubMed  Google Scholar 

  13. Lamont JA (1978) Vaginismus. Am J Obstet Gynecol 131:633–636

    PubMed  CAS  Google Scholar 

  14. Pacik PT, Cole JB (2010) When sex seems impossible: stories of vaginismus and how you can achieve intimacy. Odyne Publishing, Manchester, NH, pp 40–47

    Google Scholar 

  15. Pacik PT (2011) Vaginismus: the Lamont classification revisited. Poster presentation at the ISSWSH Annual Meeting, Scottsdale

    Google Scholar 

  16. Brin MF, Vapnek JM (1997) Treatment of vaginismus with botulinum toxin injections. Lancet 349:252–253

    Article  PubMed  CAS  Google Scholar 

  17. Ghazizadeh S, Nikzad M (2004) Botulinum toxin in the treatment of refractory vaginismus. Obstet Gynecol 104:922–925

    Article  PubMed  CAS  Google Scholar 

  18. Abbott JA, Jarvis SK, Lyons SD, Thomson A, Vancaille TG (2006) Botulinum toxin type A for chronic pain and pelvic floor spasm in women: a randomized controlled trial. Obstet Gynecol 108:915–923

    Article  PubMed  Google Scholar 

  19. Shafik A, El-Sibai O (2000) Vaginismus: results of treatment with botulin toxin. J Obstet Gynaecol 20:300–302

    Article  PubMed  CAS  Google Scholar 

  20. Bertolasi L, Frasson E, Cappelletti JY et al (2009) Botulinum neurotoxin type A injections for vaginismus secondary to vulvar vestibulitis syndrome. Obstet Gynecol 114:1008–1016

    Article  PubMed  CAS  Google Scholar 

  21. Yoon H, Chung WS, Shim BS (2007) Botulinum toxin A for the management of vulvodynia. Int J Impot Res 19:84–87

    Article  PubMed  CAS  Google Scholar 

  22. Pacik PT (2009) Botox treatment for vaginismus. Plast Reconstr Surg 124:455e–456e

    Article  PubMed  CAS  Google Scholar 

Download references


A grant received from Allergan provided free Botox for an FDA-approved study group of 30 patients. No compensation was given to the investigator.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Peter T. Pacik.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Pacik, P.T. Vaginismus: Review of Current Concepts and Treatment Using Botox Injections, Bupivacaine Injections, and Progressive Dilation with the Patient Under Anesthesia. Aesth Plast Surg 35, 1160–1164 (2011).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Botox treatment for vaginismus
  • Dyspareunia
  • Painful intercourse
  • Treatment of vaginismus
  • Unable to consummate
  • Unable to have intercourse
  • Vaginismus
  • Vestibulodynia