Feeling stuck post Botox Treatment for Vaginismus

Feeling stuck post Botox Treatment for Vaginismus

A recurring problem following Botox treatment for vaginismus is getting too comfortable in a dilation routine. Patients settle in with their dilators and every day they dutifully do the dilation schedule they were taught. They assume the same position and use the same size dilators. They tend to use the dilators day after day advancing very slowly or not at all and are slow to think about transitioning to intercourse.

A menopausal 50-year-old patient with 6-year history of secondary vaginismus writes two weeks following her Botox treatment for vaginismus:

Problem & Solution

“I have been feeling a little stuck in the same place and not sure how to progress slowly.”

I have another patient that has been doing the same routine for almost a year and she still does not feel “ready” for intercourse.

“What is the solution?”

Like anything in our lives, we need to spice it up, think about variety, and think out of the routine. We need to change our positions for dilation and much like intercourse relinquish some of the control to our partner. Play with the dilator in different positions, much as intercourse is ever changing with different foreplay, different positions and experimentation. Use these changing positions with your partner/husband inserting the dilator and “getting it on”. We need to remove the “clinical” from what can be an exciting array of different forms of sexual play. Use toys that are comfortable for you including external vibrators and internal ones.

Don’t get too comfortable with certain size dilators. Dilation is progressive. Only by using larger dilators for longer periods of time will you adequately stretch the vaginal muscles to have comfortable intercourse. When I see daily logs describing exactly the same size dilators for the same lengths of time, week after week, I worry. I worry that my patient is so happy to be dilating comfortably that further progress does not seem necessary. Hubby is supportive of this, but this is not helpful. Sameness promotes inertia, and inertia means no forward progress. My patients who have taken 8-12 months to achieve intercourse are proof of this statement.

Getting unstuck post Botox Treatment for Vaginismus

Take the lead and experiment using a variety of positions to dilate, make it fun, and make sure you move towards the larger dilators. Once the Botox is working, and the muscles are getting dilated, it is actually very easy to move ahead stretching the vaginal muscles.

Patient after patient writes how surprised they are when they transitioned to intercourse and how comfortable they are having intercourse with their loved one!

A patient writes two months post Botox treatment for vaginismus:

“I honestly still can’t believe how much my life has changed. I’m about two months post-procedure now. My boyfriend and I have had sex a bunch of times now and it’s still hard to wrap my brain around. I really have minimal if any anxiety when we have sex, which is surprising because I always thought it would be my biggest obstacle. One time, we were even able to be a bit more spontaneous than we had been since I got the procedure and ended up having sex a couple of hours after dilating. I was nervous he wouldn’t be able to enter, but it wasn’t a problem! Tonight after dilating, we even tried a new position for the first time!! I just want to say this procedure changed my life and is without a doubt the best decision I ever made!”

Contact Us

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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