Continued Anxiety with Dilation

Erika is 27 with a 2-year history of the most severe form of vaginismus. She cannot tolerate any penetration and has severe pain and anxiety with any attempt. Her daily logs are quite helpful showing continued anxiety to dilators despite a lack of pain.

Daily Dilation Log (Post Procedure)

Day 18

Dilated with purple for 30 minutes and pink for 1 hour and 30 minutes in pm. Notes: Had more anxiety/fear with dilator insertion tonight. Don’t know why? I dilated with minimal discomfort.

Day 17

Dilated with purple for 30 minutes and pink for 1 hour and 30 minutes in pm. Notes: Am still having less burning with pink insertion, but did feel a bit more muscle resistance this date.

Day 16

Dilated with purple for 30 minutes and pink for 1 hour and 30 minutes in pm. Notes: No pain with purple insertion. Minimal discomfort with pink. Have experienced significantly less burning over the last couple of days. Tonight I allowed Max to insert the purple dilator alone. This was huge for me! Was very pleased.

Day 15

Dilated with purple for 40 minutes and pink for 1 hour and 30 minutes in pm. Notes: Dilation went well tonight. Experienced very minimal burning with purple/pink. I did a better job at letting Max assist with dilator insertion. I also moved both pink and purple in and out several times, to get myself used to increased movement. Also experienced less anxiety this evening.

Day 14

Dilated with purple for 30 minutes and pink for 1 hour and 30 minutes in pm. Notes: I noted less burning today with pink insertion. Am still having fear with having Max assist with dilator insertion; however, tonight was the first night that I was able to have him insert the dilator with me (hand over hand). Physically I feel like I am doing better, but I am discouraged that I am still having a hard time with dilation mentally. Am scared about the transition to intercourse and having less control. Don’t know when I will know that I am ready?

Day 12

Dilated with purple for 1 hour and pink for 1 hour 15 minutes this pm. Notes: Had no trouble with purple insertion. Had muscle resistance with pink insertion and “got stuck” for a minute, but took a deep breath and was able to push through the tight ring. Experienced burning with pink for a couple of minutes. Had increased soreness after dilating with pink today.

Day 11

Dilated with purple for 1 hour and pink for 1 hour in pm. Notes: Tonight was the first night dilating with pink since starting my period. I experienced some anxiety and fear with pink insertion since it had been a couple of days from when I last dilated with it. I had some muscle resistance initially with insertion; however, I took a deep breath and pushed through and I got it in. Experienced moderate burning for a couple of minutes, which subsided. Am relieved to have gotten back to pink after having to take a break due to my period. Plan to increase time dilating with pink tomorrow.

Day 10

Dilated with purple for 2 hours this pm. Notes: Am still on my period; however, bleeding was moderate and I was able to dilate. I was very encouraged that I tolerated purple with no pain after not dilating for 3 days.

Day 7

Did not attempt dilation. Notes: Started my period early this am. Am very heavy and having severe cramping. Am disappointed since I had a good dilation day yesterday. Am nervous about not being able to dilate, but hope to resume as soon as my flow slows down.

Day 6

Dilated with purple for 30 minutes and pink for 1 hour and 30 minutes in pm. Notes: Had my best night yet. Was able to insert purple with absolutely no pain/burning. Insertion of pink was better tonight also. I felt less muscle resistance, but still had some burning, which subsided after a few minutes. I was able to dilate with pink for the longest amount of time yet. Also, I had no soreness after dilation. Still nervous with attempting blue insertion.

 Dr. Pacik commentary

Most vaginismus patients carry considerable fear and anxiety about their condition. It is not uncommon to be doing well with dilation after the Botox program and still have “mental” setbacks. As one of my patients said “I need to catch up mentally to where I am physically”. With time, this too improves and it is best to continue with the dilation program understanding that once pain free intercourse is achieved, the anxiety disappears.

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

Dr. Pacik

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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