Vaginal botulinum toxin

Pain during sex may be caused by vaginismus. During sex, the muscles around the vagina contract without this being a conscious act. As a consequence, sex is not possible, or can only be practiced with great difficulty and pain (dyspareunia).

Botulinum toxin produces muscle relaxation and is therefore a good treatment option for women with these problems.


Make an appointment for a preliminary visit with Dr. Karim. During this visit we will discuss your wishes. When you make an appointment you can nearly always count on being received by Dr. Karim within 2 weeks. A medical assistant is always present during any genital visit or treatment.

Follow-up appointment
Dr. Karim will also consider the causes of your problem. If you wish, we can hold a follow-up meeting a few weeks after the first visit. Sometimes the problem turns out to be gynaecological or psychological. In that case, Dr. Karim would let you know.

The procedure can usually be performed within two weeks of the interview.

After the procedure, you should take a two-week break. Recovery from an operation is important, give yourself plenty of time and rest to recover!

You will be given an appointment for a checkup four weeks after the operation.


Because you cannot drive home after an operation (no car or bicycle), it is important to make travel arrangements.

Do you use blood-thinning drugs? Please let us know if you do. Ask the doctor from whom you get the prescription and find out if you can temporarily stop treatment. Your doctor will tell you how many days before the operation you should or can stop taking the blood-thinning drug. Dr. Karim wants to ensure this is possible in order to avoid unnecessary risks.

Fever or flu the day before the operation? Contact Dr. Karim to decide if the operation can be performed or should be postponed.

Cosmetics and personal care products
We understand that you always want to look your best, but on the day of surgery you cannot use skin care products or makeup.

You may feel nervous about the operation, but you can’t drink alcohol the day before (or on the day itself, of course!)! Drinking alcohol increases the chances of subsequent bleeding of the wound.

Tijdens de ingreep

Local anaesthetic or general.
If a better physical operation determined by the diagnosis is desired, the choice is the second option.

Injection of botulinum toxin into the muscles causing increased muscle tone.

Na de ingreep

Because your muscles are weakened, you may have some incontinence for some time after surgery, both urinary and faecal. This is just temporary.

You can shower one day after the operation.

For the first two weeks you may feel pain when urinating and walking.

If necessary, you can take two 500 mg paracetamol tablets four times a day.

Sexual intercourse
We advise you not to have sexual intercourse for the first six weeks after the procedure.

Take at least two weeks off and avoid overexertion, such as bending over or lifting heavy objects.


The manufacturer of the botulinum toxin obviously includes a list of all possible side effects. Patients with muscle weakness or neurological disorders have an increased risk of side effects.


Generally, treatment with a few injections is sufficient to relieve pain. However, multiple treatments may be required.

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