This article aims to clarify the use of botulinum toxin treatments and its journey up until its use today, in the treatment of vaginismus. Botulinum type A is classed as a neuromodulator. It’s the same ingredient found in Botox®.
Botulinum Toxin
To be clear on the terminology used in this article, Botox® is a registered trademark from the company AbbVie (formerly Allergan). Botox® contains botulinum toxin. There are other companies making botulinum toxin, but ‘Botox®’ has entered the vocabulary as a catch-all, a bit like the word ‘Hoover.’ It’s important to know that whether you are talking about Botox® or other botulinum toxin A brands, the mechanism of the treatment is the same: to relax the muscle. The active ingredient across various brands is botulinum toxin type A, often abbreviated as BoNT. Botulinum acts as a neurotoxin, interfering with messages from nerve endings to the muscles. To be clear, we do not use “Botox® for vaginismus”; we use another botulinum-containing product, Clitoxin® for women’s sexual health issues. We also use another brand for men’s sexual health issues, Bocox®.
Botulinum toxin is a specific type of neuromodulator that works by temporarily disrupting the nerve signals that cause muscle contractions, leading to a reduction in the appearance of wrinkles and lines. Let’s explore how the use of this innovative treatment came to where it is today.
FDA TIME LINE FOR BOTULINUM APPROVAL
1960s-1970s: Alan Scott begins experimenting with botulinum toxin for treating strabismus
1989: FDA approves botulinum toxin for treating strabismus and blepharospasm
1990: Dysport (abobotulinumtoxinA) approved in the U.K for treating blepharospasm, hemifacial spasm, and torticollis.
2000: FDA approves botulinum toxin for cervical dystonia
2002: FDA approves botulinum toxin for cosmetic use (glabellar lines)
2004: FDA approves botulinum toxin for hyperhidrosis (excessive sweating)
2010: FDA approves botulinum toxin for chronic migraine
2011: FDA approves botulinum toxin for overactive bladder
2013: FDA approves botulinum toxin for crow's feet
2014: FDA approves botulinum toxin for lower limb spasticity in adults
2015: FDA approves Xeomin (incobotulinumtoxinA) for upper limb spasticity
2018: FDA approves botulinum toxin for forehead wrinkles
2019: FDA approves botulinum toxin for paediatric patients with upper limb spasticity
2020: FDA approves botulinum toxin for paediatric patients with lower limb spasticity
2021: Approval of botulinum toxin to include eight new muscles for upper limb spasticity treatment in adults
2024: FDA approves BOTOX Cosmetic for platysma bands (vertical bands connecting the jaw and neck)
FDA TIME LINE FOR BOTULINUM APPROVAL
1960s-1970s: Alan Scott begins experimenting with botulinum toxin for treating strabismus
1989: FDA approves botulinum toxin for treating strabismus and blepharospasm
1990: Dysport (abobotulinumtoxinA) approved in the U.K for treating blepharospasm, hemifacial spasm, and torticollis.
2000: FDA approves botulinum toxin for cervical dystonia
2002: FDA approves botulinum toxin for cosmetic use (glabellar lines)
2004: FDA approves botulinum toxin for hyperhidrosis (excessive sweating)
2010: FDA approves botulinum toxin for chronic migraine
2011: FDA approves botulinum toxin for overactive bladder
2013: FDA approves botulinum toxin for crow's feet
2014: FDA approves botulinum toxin for lower limb spasticity in adults
2015: FDA approves Xeomin (incobotulinumtoxinA) for upper limb spasticity
2018: FDA approves botulinum toxin for forehead wrinkles
2019: FDA approves botulinum toxin for paediatric patients with upper limb spasticity
2020: FDA approves botulinum toxin for paediatric patients with lower limb spasticity
2021: Approval of botulinum toxin to include eight new muscles for upper limb spasticity treatment in adults
2024: FDA approves BOTOX Cosmetic for platysma bands (vertical bands connecting the jaw and neck)
A Journey From Poison to Blessing
Botulinum toxin has a somewhat surprising origin, stemming from the Clostridium botulinum bacterium, which can cause botulism – a severe form of food poisoning that can lead to paralysis. Scientists have isolated, purified, and refined this toxin, allowing it to be used safely in small, controlled doses for today’s therapeutic purposes. The continued use of botulinum means that the small doses used in treatments such as botulinum toxin for vaginismus are very safe.
Early Medical Use
The medical journey of botulinum toxin began decades ago. Initially, it was used to treat specific muscle-related conditions, like crossed eyes (strabismus) and involuntary eyelid twitching (blepharospasm). These early applications demonstrated the toxin’s ability to relax muscles, leading to better control and reduced discomfort. These early uses helped establish the safety profile of the toxin.
The Cosmetic Revolution (and Beyond)
People are familiar with botulinum toxin’s cosmetic use in reducing wrinkles. However, its capacity for muscle relaxation has opened up many other medical avenues. This led researchers and clinicians to explore its application for conditions involving involuntary muscle contractions, and this included applications within pelvic health. The use of vaginal neurotoxin is becoming more widespread, and more recognised as a safe treatment option.
Botulinum Toxin and Vaginismus
In cases of vaginismus, the pelvic floor muscles involuntarily tighten, making sexual activity and medical examinations painful or impossible. This can be incredibly distressing and impact many areas of life. By carefully injecting very small doses of botulinum toxin into these muscles, they can be temporarily relaxed, allowing for easier physical therapy, dilator use, and ultimately, more comfortable sexual activity.
A Part of a Larger Treatment Plan
It’s important to understand that botulinum toxin injections form a part of a broader treatment plan for vaginismus. Often paired with physical therapy, psychological support, and dilator training, it allows women to more comfortably retrain and control the pelvic muscles and overcome vaginismus symptoms. For more information on the different treatment options, see our dedicated page – find out more about vaginismus treatment, or explore the possibility of regenerative gynaecology or laser vaginal rejuvenation as part of your wider plan. It is important that you find an expert, such as a gynaecologist, for your treatment plan.
FDA-Approved Uses For Botulinum Toxin Type A
Botulinum toxin type A has several FDA-approved medical uses, demonstrating its versatility beyond cosmetic applications. These uses include the treatment of various neurological, urological, ophthalmological, and dermatological conditions.
Research is ongoing in various fields and it is expected that this list will increase over time. Below is a list of approved uses.
Neurological Conditions
Chronic Migraine
Prophylaxis of headaches in adult patients with chronic migraine (≥15 days per month with headache lasting 4 hours a day or longer).
Cervical Dystonia
Treatment in adult patients to reduce the severity of abnormal head position and neck pain.
Spasticity
- Treatment in patients 2 years of age and older.
- Upper limb spasticity in adult patients.
- Lower limb spasticity (approval expanded to include additional muscles).
Urological Conditions
Overactive Bladder (OAB)
Treatment of OAB with symptoms of urge urinary incontinence, urgency, and frequency in adults who have an inadequate response to or are intolerant of anticholinergic medication.
Urinary Incontinence
Treatment due to detrusor overactivity associated with a neurologic condition (e.g., spinal cord injury, multiple sclerosis) in adults who have an inadequate response to or are intolerant of anticholinergic medication.
Neurogenic Detrusor Overactivity (NDO)
Treatment in paediatric patients 5 years of age and older who have an inadequate response to or are intolerant of anticholinergic medication.
Ophthalmological Conditions
Blepharospasm
Treatment associated with dystonia in patients 12 years of age and older.
Strabismus
Treatment in patients 12 years of age and older.
Dermatological Conditions
Severe Axillary Hyperhidrosis
Treatment that is inadequately managed by topical agents in adult patients.
Glabellar Lines
Temporary improvement in the appearance of moderate to severe glabellar lines associated with corrugator and/or procerus muscle activity in adult patients.
Lateral Canthal Lines
Temporary improvement in the appearance of moderate to severe lateral canthal lines associated with orbicularis oculi activity in adult patients.
Forehead Lines
Temporary improvement in the appearance of moderate to severe forehead lines associated with frontalis activity in adult patients.
Platysma Bands
Temporary improvement in the appearance of moderate to severe vertical bands connecting the jaw and neck (platysma bands) associated with platysma muscle activity in adult patients.
The above list is subject to change as more uses are approved.
Next Steps
If you are suffering from vaginismus, you should contact a professional to discuss your treatment options and understand the correct treatment plan for you. If you are looking for botulinum toxin treatment for vaginismus in London or elsewhere in the UK, please contact our team for a consultation.