Other treatment options are pharmacotherapy of benzodiazepines or antidepressants in combination with botulinum toxin injections in addition to therapies such as relaxation therapy, one-on-one meetings, or both. The use of antidepressants (tricyclics or venlafaxine) or anticonvulsants (usually carbamazepine or gabapentin) has not been very successful. Success can be achieved with amitriptyline and other tricyclic antidepressants, starting with a low dose of 10 mg and increasing it up to 40-60 mg.
Anxiolytic drugs such as diazepam are the most commonly used pharmacological drugs along with psychological treatment. Drug therapy can be used mostly in anxious patients who have not adequately responded to psychological treatments alone.
Local anesthetics such as lidocaine gel may be effective in the treatment of muscle spasms, reducing repeated pain with vaginal penetration.
Botulinum toxin injection is another treatment method for relaxation of pelvic floor muscles in the treatment of vaginismus. Botulinum toxin type A can be tried in approximately 150-200 units made into the levator muscle. Success has been achieved in this regard.