Observations – Vaginismus — Botox vs. Dilation Only

Dilation only in the treatment of vaginismus

In the treatment of vaginismus using the Pacik Botox Program, I have a number of patients who have opted for the dilation part of the program without the use of Botox. This still includes progressive dilation under anesthesia, waking up with the large dilator, supervised dilation, post-procedure counseling and dilating at home on a daily basis. Daily logs are sent to me either way. Just the Botox portion of the treatment is eliminated.

Reasons for dilation only

There are a number of reasons why patients might chose dilation only. This includes a fear of Botox (which is unfounded) and the desire for early pregnancy without waiting the four months. It is also slightly less expensive.


I have observed that without the Botox added to the vaginismus program, there tends to be more burning and slower progress during dilation as the muscles are stretching. Anytime a muscle is overstretched it causes pain, which is perceived as burning. When Botox is injected for vaginismus, the Botox weakens the muscles; therefore, now less tight (less spasm) the vagina can accommodate dilators more easily. When a woman is able to dilate without the constant associated pain, anxiety levels tend to diminish. Conversely, when the Botox is not used, it simply takes longer to become comfortable when stretching the tight (or spastic) vaginal muscles.

End result of dilation only as treatment for vaginismus

In the end, as long as a disciplined approach is taken to dilation, the outcome can be expected to be similar in that the vagina is stretched to the degree that now intercourse is comfortable. Whether or not Botox is used, patients do need to continue with their dilation program for at least a year (or more) to fully overcome vaginismus. If there is any regression, the first and most important thing to do is to reach for the dilators once again and start stretching. The Pacik Glass Dilators can be worn during the day while going about one’s normal activities. This provides a nice continued slow stretch with benefits similar to sleeping with the dilator.

Who is suitable for dilation only?

In the treatment of vaginismus, patients can be classified according to those who are able to tolerate some penetration versus those who are unable to tolerate any penetration.

Generally those who are able to tolerate some penetration have the less severe form of vaginismus and have less anxiety surrounding this condition. In these patients, an attempt at dilation only can be used. When dilation is done under anesthesia, and the patient wakes up with the largest dilator in place, this does appear to “flip a switch” and is the beginning of a dilation program, which can lead to the cure of vaginismus. This in contrast to a program of PT (physical therapy) and dilation, dilating under anesthesia appears to work more quickly and more effectively.


The use of dilators only without Botox injections can be an effective treatment plan for vaginismus, especially in those women who have the less severe form of vaginismus and have some experience with penetration. Women who have the severe Pacik grade 5 vaginismus, high anxiety and inability to tolerate any form of penetration, are likely to require Botox injections under anesthesia as part of the treatment plan.

Pacik Glass Dilators

Since Dr. Pacik retired on September 1st, 2015, we are not selling the Pacik Glass dilators through our office anymore but we do have a web page with the manufacturer Crystal Delight where you can still order them. You can order the dilators as a set or individually with or without a pouch.

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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