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Botox for vaginismus

Vaginismus is an involuntary tightening of the muscles around the vaginal opening that makes intercourse, a gynaecological examination or the use of tampons impossible or painful. Botulinum toxin injected into these muscles relaxes them for several months.

What concerns does it address?

• Intimate health — women

How is it done?

The toxin is injected at several points into the muscles around the vaginal opening. It takes effect after a few days and lasts for months; during that time, with exercises and, if needed, therapy, intercourse without tightening is established.

When is the procedure not suitable?

Botox is used only once it has been established that the cause is a muscle spasm and not a mechanical obstruction — a firm hymen or a narrow vaginal opening is treated differently, sometimes in the same visit. → Surgical hymen removal. It is not done during pregnancy and breastfeeding, during a vaginal infection or if you have a disorder of nerve-to-muscle transmission. It is done in agreement with a gynaecologist and, if needed, a psychotherapist — botox alone without this is rarely enough.

General reasons for postponing a procedure (pregnancy, breastfeeding, inflammation, a clotting disorder, smoking): When is a procedure postponed?

Anaesthesia

Before a procedure under general or regional anaesthesia, you are seen by the anaesthetist, who works full time at the clinic; the same doctor is also present during the procedure. The anaesthetic assessment and the anaesthesia for larger operations are included in the price of the procedure. What happens before, during and after anaesthesia is described on the Anaesthesia page.

Risks

Expected — tenderness at the injection site for a few days.

Occasional — temporary weakness of the pelvic floor muscles, the need to repeat the treatment.

Expected, and rare but serious → Risks and complications: what is the course of healing, and what is a complication?

What if the result is not as agreed?

The result of a procedure is assessed at a follow-up visit, once the swelling has gone down and the scar has matured, not in the first weeks. If it differs from what was agreed at the examination, the same surgeon carries out the correction.

→ Poliklinika Barbel's correction policy

In the same visit

• Perineum and vaginal opening (introitus) correction — when a narrow vaginal opening is present along with the spasm, in the same visit the opening is widened surgically and the botox relaxes the muscle.

Frequently asked questions

What is vaginismus? An involuntary spasm of the muscles around the vaginal opening that makes sexual intercourse, inserting a tampon or a gynaecological examination painful or impossible. It is not “in the head” — the muscle really tightens — but fear of pain intensifies the spasm, so both the body and the fear are treated.

How does botox help? Injected into the muscles around the vaginal opening, it relaxes them temporarily, so the spasm can no longer close the opening. In that window — three to six months on average — relaxation and gradual stretching with dilators are learned, and intercourse becomes possible. In some women the muscle stops spasming after that; in others the treatment is repeated, most often twice a year.

What does the treatment look like? Under brief sedation or local anaesthesia, because with vaginismus the examination and the injections are otherwise not feasible.

What follows after the treatment? Gradual stretching with dilators as agreed, relaxation exercises, and, when you are ready, gentle intercourse. Cooperation with a gynaecologist, pelvic floor physiotherapist or psychotherapist is part of the treatment, not an add-on.

Medical review: doctors of Poliklinika Barbel · October 2026.