Widely known for treating wrinkles, onabotulinum toxinA injections are proving useful for another purpose: helping women who struggle with painful sex. The drug, more commonly known as Botox®, works by relaxing contracted muscles and releasing muscle spasms when it is injected.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
Doctors can use it to treat muscle spasms in the pelvic floor (the muscles that support the organs in the pelvis) to ease certain types of pelvic pain, including pain during intercourse (dyspareunia).
“The injections can also treat painful contractions of the vagina referred to as vaginismus,” says Marie Paraiso, MD, who heads Cleveland Clinic’s Center for Urogynecology and Reconstructive Pelvic Surgery.
Dr. Paraiso recounts how a patient had been unable to have intercourse for two years after pelvic floor surgery. “She and her husband wanted to have another baby,” she says. “After we used Botox, she was able to conceive and has since delivered her second child.”
More commonly, the drug is injected by a telescope into the bladder to treat urge incontinence. However, Botox can also relieve severe anal spasms during bowel movements, also called paroxysmal puborectalis muscle contractions.
It can help when other treatments fail
Botox is usually offered after other treatments have failed.
“For people with pelvic floor spasm or vaginal pain associated with intercourse due to muscle spasm, Botox might be an option,” Dr. Paraiso says.
She says it can help people who do not respond to physical therapy or biofeedback involving training to help people consciously control and release muscle tension in the pelvic floor. It also may be used if overactive bladder medications and physical therapy aren’t effective in treating urge incontinence.
If you talk to your doctor about this option, be sure to also check with your insurance company because these injections may or may not be covered by insurance, Dr. Paraiso says.
What to expect during treatment
Because the drug requires an injection, your doctor may start with a local anesthetic to numb the area.
“In some cases, the injections are done at the same time as another exam that’s being done in the operating room, so you’ll already be under anesthesia,” says Dr. Paraiso.
Next, your doctor will place the injection based on the problem being treated:
- Pelvic floor spasm: Injections target the muscles of the pelvic floor around the vagina.
- Anal spasms: Injections are given into the anal muscles.
- Urinary retention: Injections are given in the smooth muscle of the urethra (the opening where urine comes out).
- Urge incontinence: Doctors use a cystoscope (a telescoping instrument inserted into the bladder) for injections into the bladder muscle.
“You may have a minimal amount of bleeding afterwards from the injections, which is normal,” says Dr. Paraiso.
Here are some other recommendations:
- Avoid having intercourse for up to 72 hours after the injections
- Call your physician if you have what you feel is an abnormal amount of bleeding
- Check with your doctor if you have any signs of infection (fever; chills; or increased pain, swelling or redness at the injection site)
Possible side effects
Fortunately, injection side effects are rare.
“Injections in the bladder can cause urinary retention,” Dr. Paraiso says. This means that the bladder doesn’t empty completely. “Injections in the urethral muscles, anal sphincter or pelvic floor could lead to urinary leakage or fecal incontinence,” she adds.
How many injections you need depends on what your condition is and its severity. Onabotulinum toxinA treatments are often temporary. You’ll likely need to return periodically at varying intervals for additional injections.
“Some people need injections every six to nine months,” Dr. Paraiso says. “Others may only need them every 12 to 24 months.”
Botox® is a registered trademark of Allergan, Inc.