Botulinum Neurotoxin Type A Injections for Vaginismus Secondary to Vulvar Vestibulitis Syndrome

被引:47
作者
Bertolasi, Laura
Frasson, Emma
Cappelletti, Jee Yun
Vicentini, Silvana
Bordignon, Monia
Graziottin, Alessandra
机构
[1] Univ Verona, Dept Neurol Sci & Vis, Sect Clin Neurol, I-37100 Verona, Italy
[2] ULSS15 Cittadella Hosp, Dept Neurol, Padua, Italy
[3] ULSS15 Cittadella Hosp, Dept Management Control, Padua, Italy
[4] San Raffaele Resnati Hosp, Ctr Gynaecol & Med Sexuol, Milan, Italy
关键词
TOXIN TYPE-A; FEMALE SEXUAL FUNCTION; ELECTROMYOGRAPHIC BIOFEEDBACK; INTERSTITIAL CYSTITIS; INDEX FSFI; WOMEN; PAIN; VULVODYNIA; MANAGEMENT; BLADDER;
D O I
10.1097/AOG.0b013e3181bb0dbb
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
OBJECTIVE: To investigate whether botulinum neurotoxin type A improves vaginismus and study its efficacy with repeated treatments. 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: Botulinum neurotoxin type A is an effective treatment option for vaginismus secondary to vulvar vestibular syndrome refractory to standard cognitive-behavioral and medical management. After patients received botulinum neurotoxin type A, their sexual activity improved and reinjections provided sustained benefits. (Obstet Gynecol 2009;114:1008-16)
引用
收藏
页码:1008 / 1016
页数:9
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