Fibrotic hymen as a cause of superficial dyspareunia: surgical approach combined with CO₂ laser and botulinum toxin – a case report

Abstract

Superficial dyspareunia is a multifactorial condition capable of significantly compromising female sexual function, quality of life and interpersonal relationships. Among its possible organic causes, fibrotic hymen is an uncommon but potentially disabling anatomical alteration, acting as a mechanical barrier to vaginal penetration and favoring the development of secondary changes such as vaginismus and pelvic floor muscle hyperactivity. The aim of this study was to describe the clinical, functional and sexual outcomes of a patient with fibrotic hymen who underwent a multimodal approach comprising surgical correction, fractional CO₂ laser and type A botulinum toxin. This is an observational, retrospective case report of a 28-year-old patient with a three-year history of severe superficial dyspareunia and inability to achieve complete vaginal penetration. Treatment included surgical resection of the fibrotic hymenal ring, subsequent application of fractional CO₂ laser to the vaginal introitus, botulinum toxin in the pelvic floor muscles, use of vaginal dilators and referral to pelvic physiotherapy. Increased introital space, feasibility of vaginal penetration, reduced defensive contraction and significant improvement in sexual function were observed. The total Female Sexual Function Index (FSFI) score rose from 5.3 to 24.8 points, while pain intensity assessed by the Visual Analogue Scale (VAS) decreased from 10 to 4 points. The results suggest that the integrated approach may represent a promising therapeutic strategy for patients with superficial dyspareunia associated with complex anatomical and functional alterations.