Anxiety and Vaginismus

I need to catch up emotionally to where I am physically (a quote heard frequently from post procedure patients).

Vaginismus MD ForumA series of posts on the Forum clearly show that although vaginismus patients make great strides when visiting for treatment, there is often a lag between being able to dilate physically and how they are doing emotionally. Many of my patients are consumed by long term anxiety related to penetration, and at times anxiety rears its ugly face post procedure. An occasional patient actually experiences an anxiety “meltdown”. It is important for those planning treatment to understand that the road to success can be a bumpy one. That one can be a champion dilating with sizes never thought possible, yet need time to catch up emotionally. The following information will help others understand that recovery is potentially a long term process, well beyond the ability to achieve intercourse. That after the physical aspect of vaginismus is under control, the psychologic may need to catch up.

Brief history

Patient “#200” is a 25 year old with a six year history of severe level 5 primary vaginismus. She described a strict religious and sexual upbringing as well as fear of first time sex. She failed to make progress with long term treatment doing Kegels and using graduated dilators (two years), hypnotherapy, physical therapy with biofeedback (one year), sex counseling (one year), lubricants, topical anesthetics, muscle relaxants, anti-depressants and anti-anxiety medications, sedatives and excess alcohol use. Talk about trying!! Her libido continued to be good through all this. A long term history of anxiety related to being touched in the pelvic area was confirmed with significant anxiety during cotton tip testing to rule out vulvodynia and vestibulodynia.

Strong relationship but emotional roller coaster

She describes her relationship with her husband as a strong 8 out of 10 (10 being perfect). She wrote:

“I feel as though my husband has just learned to deal with it. He is very supportive and says if we are able to achieve intercourse one day then that’s awesome, but he loves me just as much now then he will then. I just am not going to settle. I deserve to be able to have a healthy sex life with my husband. I have good days and bad days. I’m on one big emotional roller coaster.”

In the operating room she was noted to have severe spasm of the entry muscle when examined with sedation, consistent with her history that attempted penetration was like “hitting a wall“. Her pelvis continued to do the “escape dance” even under anesthesia during treatment, though she remembers nothing of this event.

A series of posts on the Forum helped spell out the difficulties anxiety can create. Allie wrote:

“I am 5 days post procedure. Physically, I am doing fine post procedure with the dilators. (Which was the one thing I was most worried about). I didn’t even think or worry about the emotional part afterwards. Maybe if I would have been more prepared I wouldn’t be having these panic attacks. Be prepared that our body and minds have been through SO much all these years of suffering. For me the week before treatment and the week of I could NOT sleep at all. That is another big part that can cause anxiety. You can’t expect to come home and everything be just fine! I am still needing to catch up MENTALLY where I am physically. Another thing, my husband had to go back to work Saturday (we came home Friday) I was a complete mess! I didn’t want him to leave. Thankfully my mom was able to come over and hang out with me all day so that definitely helped! :)”

Heather, our moderator, who struggled for fifteen years with a complete inability to have any form of penetration, noted;

“It’s entirely normal to feel some discomfort w/the dilators and also very emotional. This is expected seeing how much you have been through in such a short amount of time. It’s called the let-down period and I absolutely experienced this as well. Ellen was super, super helpful to me with this and also very supportive too. Also, Dr. Pacik told me that the soreness was from all the traffic down there and was to be expected … very, very true for me. For me, it was almost like never ever working out and then doing boot camp for 2 straight days. At the end, your muscles would be sore from all the running, jumping jacks, etc. Here, too, my muscles were a bit sore from the dilating (very normal and expected). And, my anxiety also went way up and down post-procedure too b/c of all the build-up to it and then giant sigh of relief afterwards. …Again, entirely normal and expected.”

The value of having a therapist

For those who have a therapist, and have dealt with the myriad of emotions prior to treatment, it is of great value to be under treatment both before and after treatment of vaginismus using the Botox and dilation program. Before the treatment to set the stage and develop the proper support, after the treatment for the continued psychologic support that may be needed in women with a long history of severe anxiety. With proper support, anxiety too can be overcome.

There is a great deal to be learned about vaginismus and its many manifestations. By joining the Forum one can learn firsthand through the words of women who struggle with this condition.

Contact Us

If you have any questions about our Botox treatment for vaginismus and progressive dilation under anesthesia, please contact us via our contact us form.

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About Dr. Pacik

Peter Pacik, MD, FACS is a recognized pioneer in treating patients with Botox for vaginismus and the author of When Sex Seems Impossible: Stories of Vaginismus and How You Can Achieve Intimacy. He has been in practice for over thirty years and belongs to a small group of prestigious surgeons who are double board certified by both the American Board of Surgery and the American Board of Plastic Surgery. In 2010, Dr. Pacik received FDA approval to continue his study to treat vaginismus using intravaginal injections of Botox together with progressive dilation under anesthesia.
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