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Botox injections can be performed without using anesthesia, and there are many practitioners who will inject botox into the tight pelvic floor muscles as an in-office procedure.

We opt to use anesthesia, as many vaginismus patients we see have significant fear of penetration, and they would not be able to tolerate the injections without the sedation.

I think if a woman does not have any fear, and they can have some penetration, but the muscle tone is just significantly increased, botox without anesthesia is an option.

Our protocol at maze includes the botox injections combined with progressive dilation, so we feel the anesthesia is necessary in order to perform both.