This single 31 year old doctor struggled with vaginismus for 15 years. She used dilators with Kegel exercises for 6 months but was unable to progress. In addition she had six months of psychotherapy, used lubricants all the time and also failed to make any progress after hymenectomy. She was treated with the full Botox program for vaginismus and on examination under sedation was noted to have spasm of the entire vagina, but most severe spasm at the entry muscle. In addition it was noted that the entire vagina was small and very tight. The goal in this type of patient is to develop comfort with the larger dilators until she meets someone and is ready for intercourse.
“From: P. 1 week post-procedure
I have been sleeping with the small blue #3 of 6 dilator every other night, and dilating for about a total of 1 1/2 hours daily using the purple #4 dilator and then the pink #5 one. The pink one has been difficult to insert for some reason and feels uncomfortable. The purple dilator seems to hit my cervix and is uncomfortable to sleep with, but I will try it anyway tonight. I haven’t tried the big blue yet.”
Dr. Pacik: Although we were successful using the largest blue #6 dilator in the clinic after treating you with Botox, it is common for patients to regress somewhat post procedure. The pink #5 of 6 hurts because you may not be ready for it yet. As little as 5-10 minutes is helpful when you are ready and then you can increase the time as tolerated. If it is too difficult sleeping with the purple please stay with the #3 of 6 blue. Hold off on big blue until you are comfortable with pink.
“From: P. 10 days
For the past three nights, I have slept with the small blue dilator. I have also dilated for 1 hour per day with the purple, and then about 50min with the pink, which is feeling a bit more comfortable now. However, the pink dilator still takes up to 10 minutes to insert. I might take a break from dilating tonight b/c I’m feeling sore.”
Dr. Pacik: It is OK to take a break or just stay with the smaller sizes for now and only 10-20 minutes with the pink. You need to flow with the dilation, it is hard to force it or rush it. It is OK to use ibuprofen or Tylenol for about a week to overcome the soreness.
“From: P. 13 days
I have been continuing to sleep with the small blue #3 dilator every other night, and use the purple#4 dilator for 45min-1 hour daily, and the pink one #5 for 30min. The past few days have been quite tough, and I can tell that I have a yeast infection. (I will pick up some OTC med tomorrow.) I have a hx. of such infections, and I have been under a lot of stress recently: work-related, as well as frustration relating to dilating for 2 hours per day in addition to working 10 hours per day. Actually, I got called into the ER today, and am still at work (it is 11:20pm on Sunday night). So, it is no surprise to me that I have an infection.
Although I have been forcing myself to continue dilating, it has been very uncomfortable, and even the purple one has been difficult to tolerate- it actually starts coming out on its own and I have to push it back in. I can’t even get the pink one in as far as I used to be able to.
This is all likely due to the yeast infection that’s brewing. Should I stop using the dilators for now?”
Dr. Pacik: Yes, you might be working too hard at the moment. I agree that you should slow down, perhaps stop dilating for a day or two, and when you are ready resume with some of the smaller dilators. If you try the pink, use this for only 5-10 minutes until you become more comfortable, then longer in slow stages.
“From: P. 3 wks
It is getting more difficult to use the dilators. I was hoping it would get easier. Even the purple one takes longer to insert these days. It is very uncomfortable using the pink one. I have made several attempts to insert it (three 20 minute attempts during each dilating session), but it does not go in beyond one inch or so. It’s as if there is a brick wall there. I thought the botox would have taken care of that.
I did take a Diflucan 200mg tablet a few days ago, which should have taken care of the yeast infection symptoms (mainly itching; I didn’t have any discharge). However, I still have some discomfort/itching, so I’ll try some over-the-counter Monistat.
I am not sure what else to do at this point, other than keep trying.”
Dr. Pacik: Stay with the purple for about 1-2 weeks, it is still helping you.
If you sleep with the purple you can skip the AM dilation and just do one hour in the evening. See how that goes and let me know. I’ll then work with you to help you advance.
Stay in touch daily please so I know how the purple is working. Setbacks do occur, but I am usually able to get my patients past these.
Follow up: By three months she was doing much better and able to tolerate the larger dilators. She was never able to advance to the largest blue #6 of 6 dilator, but this is not a concern in that patients are able to achieve intercourse just dilating to the #5 of 6 pink dilator.
It is hard to stay motivated when single, and dilating daily can be tiring, especially with a busy work schedule. Yet one needs to stay with the program so that one day vaginismus does not need to get in the way of a new relationship.
Setbacks and frustrations with dilator therapy after Botox treatment can be common. One day the dilation is easy, the next may be difficult. This is all related to the need to stretch the tight muscles. Perseverance is very important and ultimately rewarding.
If you have any questions about our Botox treatment for vaginismus and progressive dilation under anesthesia, please contact us via our contact us form.