Painful sexual disorders can be congenital and acquired, situational and generalized, and according to etiology - organic, psychogenic, mixed or unknown etiology.
Among these disorders:
- dyspareunia (genital pain that occurs during intercourse);
- vulvodynia - chronic pain syndrome in the vulva, observed in the absence of infectious, dermatological, metabolic, autoimmune or tumor processes
During sexual disorders treatment, it is important to identify and eliminate local irritants and potential allergens first. Patients who have localized form, when only small area is painful, local treatment helps to relieve pain. Oral medications also could be used to relieve pain of neuropathic origin.
Patients with a localized form are recommended to go through surgical procedures such as vestibuloectomy to remove hyperalgesic skin areas. Vaginal inverse biological communication and cognitive-behavioral therapy helps to reduce pain. Set of different procedures could be applied to reduce pain but this could also cause the patient certain inconveniences as in case of many other disease states of different etiologies.
Applied methods are often ineffective. There is a need to develop one universal method of treatment which could be effective and safe for patients with all forms of painful sexual disorders. Perspective method is Injections of botulinum toxin type A to correct disorders linked with painful sexual disorders. Scientific work about the use of botulinum toxin type A (BTA) in gynecologists practice was first published in 1997 by M.F. Brin in the authoritative journal Lancet.
Several reviews, including the one which is conducted by The Cochrane Library, recommend the injections of botulinum toxin for patients with refractory vaginismus, dyspareunia of unclear etiology and vulvodynia of various origins.
The indications for this procedure are:
- the presence of a verified diagnosis - dyspareunia or vulvodynia;
- pain and spasm of the pelvic floor muscles when trying to introjection (secondary vaginismus)
Procedure: treatment of dyspareunia and vulvodynia with injections of botulinum toxin type A
Purpose: to eliminate pain, spasm of the muscles of the pelvic floor, restore the possibility of a sexual intercourse / gynecological examination
How it works: the nature of the analgesic effect of BTA remains unclear but following mechanisms are discussing nowadays: suppression of the release of not only acetylcholine, but also other neurotransmitters such as CGRP, substance P, which modulates the sensory afferent flow;
suppression of neurogenic inflammation - an important factor in the pathogenesis of pain syndromes
This allows the use of BTA for dyspareunia and vulvodynia;
Result: in 14 days
Important: the result may differ from what you imagine
Method: after preliminary consultation with photo bracing and determination of the level of invasion, anesthesia is performed in the area of the proposed intervention. The botulinum toxin is injected into the submucosal layer, using thin needles
Anesthesia: regional / topical;
Procedure time: 30-45 min
After treatment: 2-3 weeks of sexual rest, up to a month without thermal procedures
Duration: it is recommended to repeat the procedure if necessary, but no more than once in 6-12 months;
Caution: the procedure should be performed by a specialist trained in intimate plastic;