Efficacy of high doses of botulinum toxin A for treating provoked vestibulodynia

Br J Dermatol. 2011 Mar;164(3):617-22. doi: 10.1111/j.1365-2133.2011.10235.x.


Background: Provoked vestibulodynia is difficult to treat. The beneficial effects of botulinum toxin A are being considered because of the muscular anomalies observed in this pathology.

Objective: To evaluate the efficacy of botulinum toxin A in the treatment of provoked vestibulodynia.

Methods: Patients aged between 18 and 60 years presenting with provoked vestibulodynia (according to the 2003 International Society for the Study of Vulvar Disease classification) received 50 U of botulinum toxin A bilaterally in the bulbospongiosus muscle under electromyographic monitoring. Pain was evaluated by a visual analogue scale (VAS), quality of life was evaluated by the Dermatology Life Quality Index and sexual function by the Female Sexual Function Index.

Results: Twenty patients received the injections. Sixteen patients presented with a muscular hyperactivity on electromyography. After 3 months, 80% of the patients improved in terms of pain. Mean ± SD VAS values significantly decreased from 8·37 ± 1·22 (range 4·5-10) to 2·57 ± 2·67 (0-9; P < 0·0001) at month 3 and to 3·90 ± 2·92 (0-9; P < 0·001) at month 6. Quality of life and sexual function improved significantly during the first 6 months (P < 0·0001). After 3 months, 13 patients (out of 18 for whom intercourse was not possible before the injections; 72%) were able to have sexual intercourse.

Conclusion: Botulinum toxin A seems to be an effective and safe treatment for provoked vestibulodynia; 100 U botulinum toxin A significantly reduced pain 3 and 6 months after injections without side-effects. The treatment also improved quality of life and sexual function of patients. Botulinum toxin A appears to be a promising option for managing sexual pain disorder.

MeSH terms

  • Adult
  • Botulinum Toxins, Type A / therapeutic use*
  • Female
  • Humans
  • Injections, Intramuscular
  • Neuromuscular Agents / therapeutic use*
  • Pain Measurement
  • Quality of Life
  • Sexual Dysfunction, Physiological / drug therapy
  • Vulvodynia / drug therapy*
  • Young Adult


  • Neuromuscular Agents
  • Botulinum Toxins, Type A