Abstract | OBJECTIVE: METHODS: Outpatients were referred because standard cognitive-behavioral and medical treatment for vaginismus and vulvar vestibular syndrome failed. From this group, we prospectively recruited consecutive women (n=39) whose diagnostic electromyogram (EMG) recordings from the levator ani muscle showed hyperactivity at rest and reduced inhibition during straining. These women were followed for a mean (+/-standard deviation) of 105 (+/-50) weeks. Recruited patients underwent repeated cycles of botulinum neurotoxin type A injected into the levator ani under EMG guidance and EMG monitoring thereafter. At enrollment and 4 weeks after each cycle, women were asked about sexual intercourse; underwent EMG evaluation and examinations to grade vaginal resistance according to Lamont; and completed a visual analog scale (VAS) for pain, the Female Sexual Function Index Scale, a quality-of-life questionnaire (Short-Form 12 Health Survey), and bowel and bladder symptom assessment. RESULTS: At 4 weeks after the first botulinum neurotoxin type A cycle, the primary outcome measures (the possibility of having sexual intercourse, and levator ani EMG hyperactivity) both improved, as did the secondary outcomes, Lamont scores, VAS, Female Sexual Function Index Scales, Short-Form 12 Health Survey, and bowel-bladder symptoms. These benefits persisted through later cycles. When follow-up ended, 63.2% of the patients completely recovered from vaginismus and vulvar vestibular syndrome, 15.4% still needed reinjections (censored), and 15.4% had dropped out. CONCLUSION: LEVEL OF EVIDENCE: III.
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Authors | Laura Bertolasi, Emma Frasson, Jee Yun Cappelletti, Silvana Vicentini, Monia Bordignon, Alessandra Graziottin |
Journal | Obstetrics and gynecology
(Obstet Gynecol)
Vol. 114
Issue 5
Pg. 1008-1016
(Nov 2009)
ISSN: 1873-233X [Electronic] United States |
PMID | 20168100
(Publication Type: Journal Article)
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Chemical References |
- Neuromuscular Agents
- Botulinum Toxins, Type A
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Topics |
- Adult
- Botulinum Toxins, Type A
(administration & dosage)
- Coitus
- Dyspareunia
(drug therapy)
- Electromyography
- Female
- Humans
- Injections, Intramuscular
- Intestinal Diseases
(drug therapy)
- Neuromuscular Agents
(administration & dosage)
- Pelvic Floor
(physiopathology)
- Prospective Studies
- Quality of Life
- Surveys and Questionnaires
- Urination Disorders
(drug therapy)
- Vaginismus
(drug therapy, etiology, physiopathology)
- Vulvar Vestibulitis
(complications)
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