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3. Dear my colleague
   Iam dr Hanaa. Obstetrics and gynecology consultant from Egypt and Iam intrested in cosmetic gynecology field can you help me to get any free sites or journals improve my knowledge about this
   Also in my old knowledge that if we need to inject botolinum toxoid for vaginismus we must be away from middle point to prevent effect of the drug on bladder or rectum due its paralytic effect on muscles which can cause urinary or fecal incontinence
   In your presentation you inject directely into the clitrose is this does not affect the urtheral competence

   Many thanks in advance

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   1. Hello Dr. Farouk,

      Yes, it does seem counterintuitive, when you think about the somatic nervous system. But when you consider the autonomic nervous system and how botulinum toxin increases parasympathetic tone, it makes sense.

      I agree that injecting directly into the various muscles of the urinary sphincter could worsen urinary incontinence. But, when you use the clitoris as a conduit to inject teh ganglion of the lateral vaginal wall–it becomes clear how benefit could occur.

      The best references to bring it into focus can be found at the end of the paper we published, here<--

      The videos here and here may also help.

      You can also download a written explanation here<-- (that also contains references).

      You can learn best how to provide the procedure to your patients here.<--

      Thank you very much for writing. I hope this helps.

      Best regards,

      Charles Runels, MD

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