IRCT2016061828486N1 IRCT 2017-03-12 Vice Chancellor for research of Tehran University of Medical Sciences Effect of physiotherapy and botulinum toxin injection in treatment of vaginismus Evaluation of therapeutic efficacy of physiotherapy and botulinum toxin injection in treatment of vaginismus and comparison of sexual function of them 2017-02-08 anticipated 74 Complete https://irct.ir/trial/23111 interventional Randomization: Randomized, Blinding: Not blinded, Placebo: Not used, Assignment: Parallel, Purpose: Treatment, Other design features: Table of random numbers. N/A Psychogenic vaginismus. Intervention 1: intervention group 1:injection of botulinum toxin (dysport ):500 unit is diluted in 1.5 cc N/S.150-400 U disport was equally injected in the puborectalis muscles ,3 points on each side with 23 needle.in severe desease before injection 1_5 mg midazolam and 50-150 mg phentanyle are used for sedation.during treatment oxygen and pulse oximetry is done.the initial dose is 150-200 u and may gradually increase till 400 unit to prevent side effect.after injection the paitent is discharged. Intervention 2: Control group:Physiotherapy: relaxation exercises, biofeedback, desensitization and focus sensory (sensation focus) is used during weekly meetings.Patients initially trained in pelvic floor anatomy . At each visit, pelvic floor muscle massage is done in lithotomy position under infrared light to increase blood flow by therapist and exercises to relax the pelvic floor muscles and breathing exercises will be taught to do at home.Then, when the patient is admitted vaginal examination,The therapist began to gradually vaginal penetration with a finger and When patients tolerate a fingerو vaginal tampon used for 5 hours to cause further relaxation.This practice will be repeated up to three times per dey at home.At this time, in addition to tampons , vaginal electrodes tense and frequency waves used for analgesic.Sensation focus technique done by the partner at home,Where massage the entire body except breast and genital areas without penetration causes the patient feel peace. Therapy sessions along with home exercise therapy in patients continue to recover. Average of meeting are 10 sessions.