Dilators for Vaginismus. Discomfort with Large Dilators and Beyond

Brief history: Danielle is a 27 year old with a five year history of Pacik/Lamont , the most severe form of vaginismus. Though she has had some penetration, intercourse has always been impossible. Numerous treatments included Kegels and dilators for one year without benefit. In addition she has tried lubes, topical anesthetics and anti-anxiety medication all to no avail. When examined in my surgicenter she was noted to have severe spasm of the entry muscle. She was treated with the Botox program for vaginismus which included Botox injections, injections of a long acting anesthetic, and progressive dilation, all under anesthesia. She was able to achieve tip only intercourse at 3 days and full pain free intercourse at two weeks. She continues to do well, now five months later.

She maintained a daily log which she sent me and on day 15 wrote the following:

“We have successfully achieved penetration twice. I don’t think I consider that to be intercourse, it’s more like dilating with his penis. Blue (#6 of 6) is still very uncomfortable. I use the numbing lubricant whenever I attempt it. Of course, I used blue before attempting penetration, so I was still numb. I want to try penetration again without the numbing gel. I am so happy with how far I’ve come in two weeks!”

After treatment with Botox for vaginismus, the dilation program is key to stretching the tight vaginal muscles. Of necessity this needs to be done slowly and sometimes it can take several more weeks before becoming comfortable with the larger dilators.

It is interesting how she thinks about intercourse. Initially there are no bells, no orgasms, patients are happy to be functional. The joy comes later. For Danielle it is simply an extension of the dilation program, and for now we are all happy with her progress.

Follow up:

“Subject: Update day 34

8/10 & 8/11 Didn’t dilate because we had friends over until really late. I’ve told him I’m not comfortable dilating with people in our house. He thinks I’m being ridiculous. Our bedroom door doesn’t lock and the lock on our bathroom (which is right off of the kitchen) only works sometimes. I’m just not comfortable with that…

8/12 half an hour working with pink. It still burns when I work with it.

8/13 AM Put pink in for an hour.

8/13 PM 7 hours with pink in (Fell asleep)”

Dr. Pacik: You are doing great, and after one month you do not need to worry about dilating every day, especially if the larger dilators go in fairly easily.

Day 112: Even though she achieved intercourse at 2 weeks, she fell off using dilators and wrote:

“10/29 Attempted and failed at intercourse. I know it’s because I haven’t been dilating enough. I dilated for an hour with pink and was incredibly sore. I’m not going to let this get me down. I have been over stressed, but all of that is going to change. Now that my midterm is over I am turning over a new leaf of dilating. I was so disappointed that I couldn’t have intercourse, but that it is going to motivate me to dilate much much more. Even though I have my period I am going to dilate with pink for an hour tonight.”

Day 129: She was true to her word and her dilation log showed it:

“Hi Dr. Pacik,

That is awesome that you were featured in Cosmo! What a great article. Attached is my update. I’m glad I’m back on track with the dilators and think I will attempt intercourse this weekend.


These communications are all important. The daily logs not only allow me to monitor the progress patients are making but also keeps them accountable for their own progress. It is common to fall off every so often, but maintaining some dilation schedule for about a year helps avoid regression. It is a big commitment, but the rewards are great.

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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