International Urogynecology Journal

, Volume 30, Issue 11, pp 1821–1828 | Cite as

Comparing the effectiveness of functional electrical stimulation via sexual cognitive/behavioral therapy of pelvic floor muscles versus local injection of botulinum toxin on the sexual functioning of patients with primary vaginismus: a randomized clinical trial

  • Mansooreh Yaraghi
  • Shirin Ghazizadeh
  • Fariba Mohammadi
  • Elahe Miri Ashtiani
  • Mahmood Bakhtiyari
  • Sayeda Mahjabeen Mareshi
  • Fatemeh Sadat Sarfjoo
  • Tahereh EftekharEmail author
Original Article


Introduction and hypothesis

Most patients suffering from vaginismus feel sinful, anxious, and incompetent, with reduced self-confidence. This study was aimed at comparing the effectiveness of the physiotherapy of pelvic floor muscles as a standard treatment and local injection of botulinum toxin on the sexual functioning of patients with primary vaginismus.


In this randomized clinical trial (RCT), the study population included women with primary vaginismus referred to the Sexual Health and Gynecologic Clinics of Imam Khomeini Hospital during 2013–2014. They were diagnosed according to DSM-5 criteria and underwent treatments with botulinum injection (intervention group) and physiotherapy as the current treatment (control group). The participants’ primary and secondary outcomes were measured based on successful intercourse and sexual functioning of each group.


The results indicated that the overall standard physiotherapy, along with other measurements, such as functional electrical stimulation and desensitization, could effectively improve the patients’ Female Sexual Function Index compared with botulinum treatment. At the end of the study, it was found that 20 and 26 patients out of the 30 and 28 patients in the intervention and control groups managed to have successful intercourse respectively (P = 0.014). Also, sexual dysfunction frequencies were seen to be decreased by 26.6% and 50% in the mentioned groups respectively (p = 0.008 and p < 0.001).


Considering the higher efficacy of physiotherapy procedures compared with those of the desensitization and electrical stimulation techniques, this therapeutic method should be considered the first-line treatment of vaginismus (IRCT2016061828486N1).


Lifelong vaginismus Botulinum toxin Sexual function Physiotherapy Functional electrical stimulation 


Compliance with ethical standards

Ethical approval

All the procedures performed in the human participants studied were in accordance with the ethical standards of the institutional and/or national research committee(s), and with the 1964 Declaration of Helsinki and its later amendments or any other comparable ethical standards.

Informed consent

Informed consent was obtained from all the individual participants included in the study.

Conflicts of interest



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Copyright information

© The International Urogynecological Association 2018

Authors and Affiliations

  • Mansooreh Yaraghi
    • 1
  • Shirin Ghazizadeh
    • 2
  • Fariba Mohammadi
    • 3
  • Elahe Miri Ashtiani
    • 4
  • Mahmood Bakhtiyari
    • 5
  • Sayeda Mahjabeen Mareshi
    • 6
  • Fatemeh Sadat Sarfjoo
    • 7
  • Tahereh Eftekhar
    • 1
    Email author
  1. 1.Department of Gynecology and Obstetrics, Imam Khomeini Hospital, Fellowship in Pelvic Floor MedicineTehran University of Medical SciencesTehranIran
  2. 2.Department of Gynecology and Obstetrics, Imam Khomeini HospitalTehran University of Medical SciencesTehranIran
  3. 3.Department of Dermatology, Imam Khomeini HospitalTehran University of Medical SciencesTehranIran
  4. 4.Tehran University of Medical SciencesTehranIran
  5. 5.Non-Communicable Diseases Research CenterAlborz University of Medical SciencesKarajIran
  6. 6.Department of Gynecology and ObstetricsIran University of Medical SciencesTehranIran
  7. 7.Department of Infertility, Shariati HospitalTehran University of Medical SciencesTehranIran

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