ISSWSH 2013 Annual Meeting discusses the use of Botox in Vaginismus Treatments

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At the recent ISSWSH 2013 annual meeting, the use of Botox to treat vaginismus was widely discussed. It is well recognized that there are a variety of treatments for vaginismus that work. It is also understood that it is important to stratify the severity of vaginismus. Less severe cases respond to a variety of treatments including sex counseling, psychotherapy and physical therapy to name a few. More severe cases of vaginismus listen politely to the recommendations of the therapist but are unable to incorporate the suggestions into a meaningful treatment program because of high levels of fear and anxiety to vaginal penetration. It is for this reason that treatment with Botox is performed under general anesthesia at which time the patient is progressively dilated to the large dilators. Waking up with a large dilator in place often “flips a switch” and sets the stage for continued dilation at home (Ref. below).

In a recent analysis of data (see figure below), it was determined that the average patient has spent 7.5 years in treatment without achieving their goals of having comfortable intercourse. This is far too long. Worse, fully 1/3 of the patients were under treatment for more than a decade.

(F3) DurationHistogram

Fees for vaginismus treatment

Fees for the treatment of vaginismus range from a few hundred dollars for a program that is self-guided to several thousand dollars that includes the full Botox program.

  • The self-guided program includes a DVD of an interview with Dr. Pacik that is very similar to the post procedure counseling done at the time of Botox treatment and a set of dilators. This program is useful for less severe
  • Doctor and paientMore involved support is available for women who are able to tolerate some penetration but have never had comfortable intercourse.
  • The full Botox treatment program, which includes injections under anesthesia and extensive post procedure counseling, is especially helpful for women who know they have the more severe form of vaginismus.

It is for this reason that completion of questionnaires designed by Dr. Pacik is highly recommended. Once these forms are reviewed by Dr. Pacik, he will be able to advise you which treatment program would be the most suitable for you. The factors taken into consideration include the length of time of vaginismus, ability for some penetration, degree of fear and anxiety, history of extreme nervousness with GYN exams and types and lengths of failed treatment. Insurance coverage is often available for the full Botox treatment program.


Vaginismus ranges from less severe to more severe forms. Once vaginismus is properly diagnosed, a treatment program can be customized.

Reference: When Sex Seems Impossible. Stories of Vaginismus & How You Can Achieve Intimacy by Peter T. Pacik, MD, FACS (Chapters 6 and 10).

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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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