Dilators for Vaginismus. Resistance

This series of blogs will deal with questions that patients ask about their dilation following treatment of vaginismus with the Botox program.

Brief history: Melissa, a 22 year old with an eight year history of vaginismus, has been aware of painful entry ever since she was unable to use a tampon at age 14. She has been unable to have intercourse for two years and has tried numerous treatments without benefit. These treatments included Kegel exercises, dilators, lubes, topical anesthetics and excess alcohol to help relax. When examined in my surgicenter she was noted to have moderate 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 full pain free intercourse at four days and continues to do well, now six months later.

She maintained a daily log which she sent me and on day 43 wrote the following:

“I was pretty sore a few days ago while on my period but that’s calmed down a lot. Sometimes when I’m initially inserting the dilator, it feels like I’m pushing against some of the tissue fairly hard as it goes in. I tend to have a nagging fear that I’m going to tear something or hurt myself in some way, which leaves me feeling pretty anxious when we are having actual intercourse – I almost always get really concerned that the friction or moving too fast will rip or tear something.

But otherwise things are going fine, continuing with pink 1 hour and blue 1 hour. We have tried intercourse about 5 times now and I have experienced low to no pain 2 times – otherwise I do deal with some stinging and generally have trouble with any fast movements.”

Residual fear of being ripped apart, and continued fear of penile penetration, are common in patients overcoming vaginismus after treatment with the Botox program. Everything was normal at the time of examination, so there is nothing to fear in terms of ripping. Any ongoing difficulty is simply a sign that dilation needs to continue to help stretch the vaginal muscles. As time goes on the various aspects of penetration (dilation, tampons, GYN exams and intercourse) all become more comfortable. I recommend that patients continue their dilation program for about a year to avoid regression.

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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