Dilators for vaginismus: The Home Stretch

Achieving Intercourse

It may take two to three months to adequately stretch tight vaginal muscles, but perseverance pays off. Some of my patients report working with dilators for 7-10 years but they were either not instructed in the proper use of dilators, or their schedule was “on again, off again”.

Once the larger dilators are comfortable, transition to intercourse is physically easy but emotionally difficult. An erect penis is more comfortable than the fairly stiff dilators so from a physical aspect the transition should be easy and in actual fact surprises most women with vaginismus how easy it can be. Yet emotionally, women are still afraid of penile penetration, and this is more difficult to overcome.

There are a number of ways intercourse can be achieved after dilating to the larger dilators:

  • Dilate for at least 15-30 minutes with one of the larger dilators, though some of my patients suggest two hours. This will stretch the muscles adequately so that pain is not experienced.
  • If your man is jumbo sized and larger than the large dilators use a larger dildo to dilate such as Mr. SoReal or make a silicone cast of his penis for dilation.
  • Set the stage. Lights, candles, music, wine, whatever turns you on (Guys-consider doing the dishes that night-big turn on for women!)
  • Use a vibrator to help relax
  • Use lots of lube
  • Use positions of comfort that you noticed when dilating. Woman on top helps maintain control. Bending over two pillows with entry from behind helps relax the pelvic floor.
  • Agree on tip only penetration, no thrusting, the first few times to ease into it.

When Sex Seems Impossible: Stories of Vaginismus and How You Can Achieve IntimacyMuch more information is available in the book “When Sex Seems Impossible. Stories of Vaginismus & How You Can Achieve Intimacy” by Peter T. Pacik, MD, FACS Chapter 12, pp 101-110. Well done professional photographs can be seen in Laura Berman’s book, “The Book of Love. Every Couple’s Guide to Emotional and Sexual Intimacy“.

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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