Vaginismus Treatment using Botox
Botox treatment for vaginismus has a 90% success rate. It is part of a multimodal vaginismus treatment program that is successful in the treatment of vaginismus. Vaginismus is both a physical and a psychologic disorder. The physical nature of vaginismus relates to spasm of the entry muscle making penetration feel like it is “hitting a wall”. The psychologic aspects relate to the anxiety and fear that develops as a result of repetitive pain with attempted penetration. The Botox multimodal treatment program addresses the physical using Botox injections to help reduce spasm of the entry muscle combined with progressive dilation under anesthesia to help stretch the tight muscle. The psychologic treatment incorporates counseling the next day to help overcome the fears and anxiety of vaginismus by discussing ways to reduce anxiety and to help women understand how to progress from dilators to intercourse. This is followed by post treatment support and follow up. More can be read on how Botox works. This vaginismus treatment allows women to achieve a rapid vaginismus cure that persists in over a 90% of patients who are able achieve intercourse, use tampons and have pain free gynecological exams. Even after the Botox is no longer effective (about four to five months) the results appear to persist and re-treatment is rarely needed. Vaginismus surgery is not indicated for vaginismus.
The use of dilators to stretch tight muscles is an integral part of the program to take advantage of the weakened muscles as a result of the Botox injections. Starting dilation in the operating room when the patient is under anesthesia, and allowing the patient to wake up in recovery with a dilator, “flips a switch” that now allows them to understand that their anatomy is normal and that they are not “broken”.
Importance of Classifying the Severity of Vaginismus
There is a wide range of vaginismus symptoms, from pain with intercourse (dyspareunia) to the most severe manifestation in which intercourse (as well as any form of vaginal penetration) is impossible (Lamont and Pacik classifications). A more detailed description classifying the severity of vaginismus can be read under the section describing the Lamont Classification. As the severity of vaginismus increases, so too does fear and anxiety. For many of the more severe forms of vaginismus pelvic contact is avoided. Even kissing is avoided in some of these women because of the fear that kissing will lead to intercourse.
More information about these techniques is discussed in Chapter 13 of my book “When Sex Seems Impossible. Stories of Vaginismus & How You Can Achieve Intimacy”.
How Long is too Long?
Regardless of the technique used to treat vaginismus there should be some reasonable time frame when the patient gets referred elsewhere. It is my opinion that if a patient is not making progress after six months, this should be an indication to consider a different form of treatment. A review of over 400 vaginismus assessments showed the average amount of time of vaginismus with failed treatments to be more than 7 years. In addition these patients received an average of more than five treatments each all of which failed. The longer it takes to achieve successful treatment, the more relationship issues become a problem and the more couples suffer from a deterioration of their libido. Now the woman and her partner are dealing not only with vaginismus, but also relationship issues and less interest in sex. Long term relationship issues become more and more difficult to treat, and divorce is far too often the outcome. The “family” that was to be, is not possible.
Vaginismus Treatment using Botox, Progressive Dilation under Anesthesia and Post Treatment Counseling
Using Botox treatment for vaginismus, along with progressive dilation and post procedure counseling lends itself well to vaginismus sufferers, whether it is the woman who repeatedly fails a variety of treatment programs or for newlyweds who want to quickly overcome vaginismus. It is valuable both in primary and secondary vaginismus and can be used for any severity of vaginismus from mild to severe cases. The entire program, which includes the use of dilators as well as post procedure counseling and support, must be used. I have seen a number of patients who had Botox injections only, without the proper post procedure support, who have failed vaginismus treatment.
Botox treatment for vaginismus consists of injecting Botox using a short anesthetic (about 30 minutes). At the time of anesthesia, the patient is dilated with a series of progressively larger dilators (Pure Romance Dilators). A long-acting local anesthetic is also injected so that the patient can wake up in recovery with a large dilator and have no pain. There is no discomfort because of the injected local anesthetic which lasts about eight hours and the topical anesthesia coating the dilators. During recovery, the nursing staff instructs patients how to use their dilators. Patients are routinely able to dilate to the largest dilators, without discomfort, within hours of their procedure. They leave the clinic with a medium dilator in place and sleep overnight with this dilator. Patients are taught how to use the bathroom with the dilator in place, though by the time of discharge from the clinic, most patients are able to remove and re-insert the dilator comfortably.
When they return the following day, the dilation program is reviewed and patients dilate once again to the large dilators. It is at this time that the patient is introduced to the Pacik Glass Dilators which are custom-made for Dr. Pacik. The glass dilators are similar in size to the Pure Romance Dilators but half the length. More firsthand experience using glass dilators can be read on the Vaginismus Forum.
During this time, patients receive counseling how to use their dilators and how to create a daily log to keep Dr. Pacik informed of their progress. Counseling also includes concepts of how to transition from dilators to intercourse, positions of pelvic floor relaxation during initial attempts at intercourse, communication skills with their partners and how to prepare for a gynecological exam among some of the topics discussed.
Careful follow-up is then maintained to adjust the dilation program as needed. This program, which is the only program in the United States to have received FDA approval for continued research, has resulted in an above 90% success rate without the need to return for additional treatment. Once vaginismus is overcome and comfortable intercourse is achieved, most patients find no need for additional Botox, despite the fact that Botox only lasts about four to five months. The Botox treatment program is equally useful for short-term sufferers of vaginismus as well as long-term patients.
For patients who have relationship issues, continued fear of penile penetration or low libido, post procedure counseling with a therapist is also of great value.