Dilating Gets Easier Every Day

Botox for the Treatment of Vaginismus

Botox for vaginismus is a simple, nonsurgical treatment. When Botox is injected directly into the spastic vaginal muscles, the nerve impulses to the areas of spasm are blocked. This reduces muscle activity and thus reduces vaginal spasm. Botox’s full effect on the vaginal muscles occurs within the first 5 to 7 days. The combination of Botox to weaken the spastic muscles and dilators to stretch these weakened muscles provides the “one-two punch” to allow for progressive dilation and then intercourse.

Importance of Dilating Immediately after Botox Treatment

I cannot stress enough the importance of dilating immediately after the Botox treatment even though Botox’s full effect is not realized. For the first few days, we advise our patients to use Lidocaine 2% Jelly, which contains a local anesthetic agent in combination with Surgilube, a unique blend of natural water-soluble gums that provides instant, continuous lubricating action.

Once the Botox Reaches Full Effect, Dilating Will Get Easier Every Day

By Day 5 after the Botox treatment for vaginismus, our patients usually report that dilating is getting easier. The relaxed entry muscle of the vagina makes it possible for easier insertion of the dilator. To further reduce any pain and soreness associated with dilating, we always suggest that you start with a smaller dilator and progress upwards. By progressively dilating to the next larger size that is comfortable, the vaginal muscles will be sufficiently stretched over a period of time making intercourse possible. Following the inability to dilate, such as during menses, it is always best to start with the smaller sizes and work back up.

Dilate for a Year is Highly Recommended

A two-hour a day dilation schedule is recommended for the first month or two. After this period of time, the amount of dilation time can be reduced to as little as 30-60 minutes a day. I highly recommend that our patients sleep with the medium sized dilator (#4 Purple in the Pure Romance line of dilators, or equivalent Pacik glass dilator) every second night for the first year. Some of my patients sleep with the dilator nightly and some sleep with the pink #5 dilator, though this larger size is usually unnecessary.

One of our Patients Writes in her 1-week Dilation Update . . .

Hi Dr. Pacik,

I’m excited to inform you that dilating is getting easier every day. The soreness I was feeling post-surgery is completely gone and the pain during daily dilation is minimal. For the past two days, I’ve been able to dilate daily for two hours each day. Both times I have started with the #4 purple dilator and stayed with the purple for 2 hours.

It has been a big accomplishment to start with the #4 purple dilator, since I no longer have to use the smaller #2 red and smaller #3 blue to work myself up to the purple to sleep. I have gone up two dilator sizes in a few days. I will soon begin to try the #5 pink one, I am building up a little more courage for that one.

But so far all is going well, and the progress is evident. I have decided to sleep with the purple dilator EVERY night rather than every other night. It really is helping me realize how comfortable I have become sleeping with the purple dilator. I can’t believe my thoughts have changed so much in so little time. It’s great to get some control back from this problem I was struggling with for so many years.

Thanks again for everything. I will continue to keep you updated. This is a long email, but I had to express my feelings of excitement!

By the way, ________ (name withheld) is shocked to see my progress and reminds me every day how proud he is of me :) I have always given up with this problem, but I am now determined that this time around things will be different. You all have given me the hope, and courage to continue towards my goal.

Update at 4 weeks – Success with Ms. Pink!

Hi Dr. Pacik,

Today I was able to reach full penetration with the pink #5!

There were 2 days this week I decided not to dilate because I was feeling some discomfort and felt overwhelmed and I decided to take a small break. It really helped. I did not try the pink #5 dilator earlier this week like I promised myself, but today I finally did it! We are very excited!

Last night, I slept with the purple #4 dilator and this morning I tried the pink #5 right after I removed the purple. To my surprise, it only took 10 minutes to insert the pink completely!!! I felt no discomfort at all! No soreness, no tightness or burning like I felt during previous attempts. I can’t believe it :) This was the first time I reached full penetration at home with the pink. Three weeks ago, I was only able to put the tip in.

Update at 6 weeks – Continued Success with Ms. Pink!

Hi Dr. Pacik,

Thanks so much for your feedback. You are absolutely right, my anxiety is much lower after finally achieving penetration with the pink #5 dilator. I would like you to know that all continues to go very well with dilation :)

I had a brief interruption with my dilation schedule since I had my menstrual cycle this month. After 6 days without dilating due to my menstrual cycle, I was able to continue my dilation schedule today. And . . . I was able to dilate up to the PINK again! I didn’t experience any discomfort at all. I began with the purple just in case and then I realized how comfortable I was so I progressed to using the pink. In about 5 minutes, I was successful with the pink! 
It’s so rewarding to know that even though a couple of days passed without dilating, I’m still able to dilate so well! 
Thank you once again . . .

For more information on dilation, please visit our VaginismusMD Blog Section on Dilation.

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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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