Clitoxin™

Who This Helps

What women tell us before this procedure

Difficulty reaching orgasm

Orgasms that are weaker than before

Feeling "close" but unable to get there

Decreased sensitivity in the clitoral area

Sexual frustration affecting relationships

Wanting to enhance an already satisfying experience

The Science

Why this works — and why it was unexpected

The mechanism behind Clitoxin™ is not obvious, and it is not simply "relaxing a muscle." Understanding it properly requires understanding two components of the nervous system as they relate to female arousal.

The somatic nervous system governs conscious sensation — what you feel when the clitoris is touched. Most previous uses of botulinum toxin in the female genitalia targeted this system (for vaginismus, bladder spasms, vulvodynia). The expectation would be that injecting the clitoris with a neuromodulator would decrease sensation. That is the obvious prediction.

The autonomic nervous system governs unconscious functions — heart rate, sweating, arousal. The arousal center resides in the hypothalamus and is connected to the clitoris through the cavernous nerves, which pass through ganglia (nerve switchboards) embedded in the lateral vaginal wall. When Xeomin® is injected into the clitoris, research suggests it migrates along the nerve axon to these ganglia — the same mechanism by which botulinum toxin treats migraines by traveling from facial muscles to the trigeminal ganglion. The ganglion signals the arousal center in the hypothalamus, raising the baseline arousal set point without producing persistent genital arousal. The result is easier arousal, improved sensitivity, and more readily achieved orgasm.

There are two additional mechanisms: botulinum toxin relaxes the smooth muscle of arterioles in the clitoris, increasing blood flow and engorgement; and stimulates the growth of new blood vessels, nerves, and collagen (neovascularization, neurogenesis, and collagenesis) — effects documented in research dating to the 1950s and confirmed in wound-healing literature.

Published Research — Peer-Reviewed Dr. Charles Runels and Dr. Anna Runnels published the results of their pilot study in the Journal of Women's Health Care (2024): Clitoral injection of Xeomin® (incobotulinumtoxinA) improved the Female Sexual Function Index total score by an average of 8 points as a standalone procedure — sufficient to move the average woman presenting with dysfunction (average score 20) into the range of normal function (above 26.5). When combined with PRP (the O-Shot® protocol) in the same appointment, the average improvement was 12 points — enough to reach the average score reported by women who describe their sex lives as satisfying (average 30). For comparison, neither FDA-approved drug for female sexual dysfunction (flibanserin: +5.3 points; bremelanotide: +3.6 points) achieves the threshold improvement needed to move a woman from dysfunction to normal function. These are peer-reviewed published figures. Shannon will discuss them honestly at your assessment, including their limitations as a pilot study pending larger replication.

Off-Label Disclosure Clitoxin™ is an off-label application of botulinum toxin type A (Xeomin®). Off-label use is common, legal in Canada, and well-established in medicine — approximately 21–31% of all prescriptions written are for off-label indications. Botulinum toxin has been used millions of times annually in women of childbearing age for two decades with a strong safety record. Full informed consent including off-label disclosure is obtained at your assessment. Shannon will explain what the evidence shows and does not show, and will tell you honestly whether this procedure is likely to benefit your specific situation.

The Procedure

What happens at your appointment

1

Assessment

Your health history, current symptoms, and goals are reviewed. Shannon will confirm you're a good candidate and answer every question.

2

Numbing

BLT 20/8/8 compounded topical cream is applied for a minimum of 25 minutes. An injectable lidocaine block is added at the frenulum of the clitoris for complete comfort.

3

Injection

A small, precise amount of Xeomin® is injected superficially into the body of the clitoris per the Runels protocol. The actual injection takes only a few minutes.

4

Done

No downtime. Post-procedure instructions are reviewed and you leave. Follow-up is at 4–6 weeks.

What to Expect

Timeline

Procedure Time

45–60 minutes

Downtime

None

Onset

7–14 days

Duration

3–6 months typical

Retreatment

No sooner than 3 months

Often Combined With

O-Shot® (same appointment)

Candidacy

Is Clitoxin™ right for you?

Likely a good fit

Difficulty reaching orgasm
Reduced clitoral sensitivity
Wanting to enhance pleasure
Have tried the O-Shot® and want to go further
No history of neuromuscular disease

We'll need to discuss

Neuromuscular conditions (myasthenia gravis, ALS)
Pregnancy or breastfeeding
Botulinum toxin injection within 3 months to any site
Aminoglycoside antibiotic use
Active infection at injection site

Clitoxin™ can also be performed as a standalone procedure or combined with the O-Shot® at the same appointment for a comprehensive approach. Shannon will walk you through the options at your assessment.