Intercourse is Possible

Note from Dr. Peter T. Pacik

My heartfelt gratitude to this patient for sharing her story. It was a joy taking care of her. She was highly motivated from day 1, followed my instructions, and conquered her vaginismus. She had such a major degree of spasm of the entry muscle, even under anesthesia, that it is little wonder they “couldn’t find the opening”. Under anesthesia the vaginal opening appeared like a tightly closed fist. Additional anesthesia was needed to allow her to relax enough so I could insert my finger to do an examination, inject the Botox and progressively dilate her to the largest dilator.

Allie’s Story – My Experience with Vaginismus, Botox Treatment, and Continued Recovery

“I was a Lamont level 5 primary vaginismus case who had never had any form of penetration. Despite this, I was able to have pain-free intercourse two weeks after vaginal injections of botox. This is my story.

My husband and I were married in April of 2011. We had decided to wait until marriage to have intercourse; I was a virgin, but my husband had had previous sexual experiences. Our wedding night came, which we were both so excited about. When we tried for penetration, it just wasn’t happening. It was like hitting a wall. My husband tried to encourage me to find my vaginal opening, but much to my embarrassment, I couldn’t. I had never been able to use a tampon and had never had a gynecological exam. We thought maybe it was just nerves, so we decided to try again later. However, days of “trying” without success went by and it became clear that something was wrong. We wanted to find help right away because having a sexual aspect to our relationship was important to us.

We began by searching online for a sex therapist in Seattle, where we live. We were blessed to find Dr. Diana Wiley. With her knowledge and help, we realized that I had vaginismus. I had never heard of it before, but it made sense. About three months of sex therapy followed. We met every other week, and Dr. Diana gave us reading material in addition to exercises to do with each other at home.

My husband and I were experiencing significant disappointment. We were so happy to have the support of Dr. Diana, but the extent of the situation was still painful emotionally. My self-esteem had plummeted; I felt stupid and inadequate. Why couldn’t I do what everyone else was able to do? Why me? What had I done to deserve this? My husband was depressed about the situation and his libido dropped. It was a hard time!

When it became clear that we had tried everything we could in terms of exercises, cognitive therapy, etc., Dr. Diana tentatively said the next step would be pelvic floor therapy. However, she knew that I had strong feelings against physical therapy. I just didn’t think it would work for me. I could barely tolerate touch around my vaginal area, let alone the thought of actual penetration. How would anyone be able to get their finger in there?! It seemed impossible. Furthermore, it seemed like it would be horribly traumatic. That was when Dr. Diana encouraged us to read Dr. Pacik’s book, When Sex Seems Impossible. I was eager to read it, and when I did, I knew that I had to see Dr. Pacik. I had to receive this botox treatment. As crazy as it seemed to fly across the country to receive a vaginal treatment, I knew it was what I needed and my husband agreed. Reading the experiences of actual patients in Dr. Pacik’s book finally made me realize I wasn’t alone! There were other women who were struggling with the same thing. The same feelings. The same betrayal from their bodies. But, there was a solution! One that would not take years and years to find and achieve.

I feel so lucky because I did not have to search for the solution for very long. Many women with vaginismus spend years being bounced from doctor to doctor, from physical therapist to physical therapist. A lot of doctors do not know about vaginismus! They don’t understand it! They misdiagnose because of this. What they don’t realize is that they are extending and increasing anxiety, fear, and depression in these patients. Doctors need to learn about this condition. Not everyone is as fortunate as I was to find help (the right help) so soon.

I got established with a naturopathic physician (who knew about vaginismus) that Dr. Diana referred me to prior to my botox procedure. This physician encouraged me to try pelvic floor therapy first, but I knew that seeing Dr. Pacik right away was the best for me. I do agree that pelvic floor therapy could be good and effective for a patient with low levels of vaginismus, but I knew mine was more severe (I had never had any form of penetration). I didn’t want to prolong this issue if it didn’t need to be.

Receiving treatment from Dr. Pacik and his staff was beyond anything I had ever imagined. I was accepted. I was treated well. I did not have to feel ashamed. I actually wasn’t too nervous for the procedure. I’m in the medical field, so needles and the sort do not bother me. My husband was in the room when I was treated. He said it was an insightful experience; it made him realize that my vaginismus was a protective reflex. Despite being put under, it was still happening. My legs were closing. I was pulling away from the touch of Dr. Pacik. I was lifting my arms to try to stop him. This is a serious condition. And Dr. Pacik’s treatment is the right treatment. It is humane. It’s fast. And it works! I woke up with the largest blue dilator. And boom. I realized that vaginal penetration was possible. It wasn’t scary. It wasn’t painful.

After the procedure, I began the dilation schedule and emailing Dr. Pacik reports daily. At first, dilating was hard. It took me up to 30 minutes to insert one. I was tentative and slow inserting it. Transitioning from lubricant containing topical anesthesia to regular lubricant was kind of strange. All of a sudden, you could feel everything! Every movement. It was weird at first. Sometimes it was tight. My husband was a great support during those first few days. When I would get frustrated he would say, “You know it’s possible. You know you can do it. You had it in this morning, remember? Just do it.” He was sensitive enough, but what I really needed was to be pushed because a lot of this is anxiety. You think you can’t do it! You don’t think it’s possible! But after the botox treatment, it is.

The 30 minute insertion decreased to 20 minutes. And then it was 5-10 minutes. Pretty soon, I could insert a dilator in 15 seconds. I pushed myself when it came to dilating, and I think that is why I was able to achieve intercourse two weeks after treatment. I slept with the purple dilator every night (versus every other night) and I dilated up to 4 hours per day. I wanted this bad, so I put in the time. One of my fellow patient/mentors told me dilating was like exercise, and that stuck with me. If you put in the time and do it, you will see progress. If you don’t, you won’t. And I just kept reminding myself that it was possible.

My husband and I felt I was ready to try intercourse a couple weeks after the procedure. Dilating was going really well and I felt good. We were going to just attempt tip-only, but once we were there, it just kept going! In a matter of seconds, we had achieved full penetration. Pain-free. Easy. We could not believe it. It was such a contrast to what we had experienced before the botox treatment. Before, we could not find my vaginal opening because it was closed so tight! Now, it was there. It was open. It was real. It was possible.”