Dilators: When Holding Steady is Falling Behind

Anxiety provoking aspects of vaginismus

The three most anxiety producing aspects of severe vaginismus appear to be the thoughts of intercourse, GYN exams and the use of dilators. I have had patients almost decide not to have the Botox treatment for vaginismus because they knew they needed to use dilators post procedure.

Horrors of dilation

It has been said many times that women with severe vaginismus are often unable to progress with dilators. Some have never opened the box of dilators. Others may spend years “dilating” and only able to insert the tip of the dilator or use only the smallest ones of the dilator set. I have assessed over 250 patient questionnaires and the average amount of time in failed treatments was over seven years. Of these, about half have tried dilation at some time and failed.

A return to normal

Following treatment, I ask patients to send me daily logs describing their dilation progress. Waking up after anesthesia and having the largest dilator in place definitely “flips a switch” for my patients. The woman now knows without a doubt that her anatomy is normal and it simply becomes a goal of stretching the tight vaginal muscles. When they wake up with this large dilator, all fears appear to dissipate. This is true of most of my patients, and they progress to more time with the larger dilators and are able to achieve their goals of intercourse and raising a family.

Not quite

Some of my long-term patients have more difficulty progressing with dilators. They get comfortable with the smaller dilators and report little to no anxiety. They are comfortable . . . finally; but in this situation, staying steady and not advancing with the larger size dilators is actually falling behind because no real progress is being made. They are happy with the status quo and feel that they are finally able to handle dilation.

Getting to intercourse after treatment for vaginismus

The small dilators do not get a woman ready for intercourse. They are a means to an end. To achieve intercourse after the Botox program for vaginismus, one must advance to the larger dilators. Using a large dilator for about an hour or two prior to intercourse is the ticket to success. Patient after patient verifies this.

Make a Commitment to Yourself

So if you find yourself getting stuck with the smaller dilators in a zone of comfort and not progressing to the larger dilators, remember this is actually impeding your progress and can lead to long-term failure. Now is the time to make a commitment to practice every day starting with the smaller dilators and progress to the larger dilators. This will ultimately bring you success!

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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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