Physical Therapy: First Line of Treatment?

Should all Vaginismus Patients have a Trial of Physical Therapy as the First Line of Treatment?

Though physical therapy is a well-established form of therapy for vaginismus, patients who have a very high level of anxiety and fear related to any touch in the pelvic area often fail to make progress with physical therapy. I have seen this with some of my patients who are a Lamont/Pacik level 5 vaginismus and have never had any form of penetration. I have treated physical therapists themselves, who work in the field, and were unable to achieve success with physical therapy. These women were able to achieve intercourse after treatment with Botox and dilators.

The following email was written by a patient (we will call her “Candice”) who was in contact with Allie (see Allie’s story “Intercourse is Possible”). Candice suffered from a severe form of vaginismus for ten years. Because of Candice’s long duration with vaginismus, she felt strongly that Allie (who only discovered her vaginismus six months previously after her marriage) should proceed directly with the Botox program of treatment for her vaginismus to avoid wasting precious time. Allie was a severe Lamont Level 5 primary vaginismus with no ability to tolerate any form of penetration and was experiencing rapid deterioration of her relationship. Allie’s naturopathic doctor all but insisted that Allie try different forms of treatment first and encouraged her to start with a trial of physical therapy.

Candice sent the following letter to Allie’s naturopathic doctor.

My name is Candice and I am a recent patient of Dr. Pacik’s. He forwarded an email to me that you had sent him regarding Allie. He said that I could comment if I had anything to share. My intention is to help more physicians to understand more about vaginismus, from a patient’s perspective. I hope that you’re comfortable with this. I live in the state of Washington as well. I am a healthcare provider also, so I completely understand your wanting to be as conservative as possible and not jump into treatment that may not be necessary. In this case, it may not be necessary if physical therapy were to be successful treatment, but that is a big risk to take. Time is very valuable to women who suffer from this awful condition. It could make or break someone’s marriage, cause horrible insecurities, depression, and in my opinion it’s not worth the risk when there is treatment out there that we know works 95%+ of the time. I have recently had success with the treatment and that is why I am 100% behind diving head first into having the Botox treatment without exploring other options first.

I was seen for the Botox treatment for vaginismus earlier this month, and couldn’t be happier with my results. I have been suffering from this horrible condition for the last 10 years of my life, in which my boyfriend and now husband has stood by my side, him suffering also. I have been able to have a GYN exam, and I have been able to use tampons, but I absolutely have not been able to tolerate any sexual penetration whatsoever. I first knew I had a problem when I was about 17-18 years old (I’m now almost 28) and attempted intercourse with my boyfriend (now husband) several times, ending in failure. For a long time, I thought it was just hard because I was a virgin and that I would eventually be able to make it work. I had a couple GYN exams that were extremely uncomfortable and I would squeeze my thighs together so tight that she would have a really hard time examining me. My buttocks would rise into the air and everything tightened up. It took me until about 2005 to actually tell the GYN that I had attempted intercourse and it just wasn’t working. I was young, so not comfortable for a while talking about it, being that I wasn’t married. My GYN suggested that I have a surgical procedure done to break my hymen (hymenectomy), and after an unsuccessful result was then referred to a physical therapist. I saw her for about 6 weeks and saw no improvements. I then saw a new general physician for a different, fresh opinion. She too wanted to refer me to a physical therapist. I began to get extremely frustrated because no one really understood the condition, and I felt like I was being passed off to someone else who also didn’t know the answer. Just a few months ago, I tried at one last attempt to get yet another opinion and went to see an ARNP who specializes in women’s health and sexual/vaginal disorders. I was told that I need to try different positions, and try to have an orgasm without intercourse first, so that my body would crave intercourse more, which would help my muscles to relax and open up. I understand the logic behind that, but after 10 years of nothing and everything resulting in failure, an orgasm was not going to happen for me. My libido was totally gone. My head at this point was totally just in negativity mode, which completely blocked me from even getting in the “mood”. I also tried muscle relaxers, and in my own attempts to relax myself, I’ve tried drinking heavily, and that didn’t even work. All of this was 10 years of failure after failure after failure, and so much discouragement.

When I heard about Dr. Pacik on TV, I was very skeptical, but was willing to try anything at that point. My marriage was on the rocks big time, and going downhill fast. We were willing to spend any amount of money and fly anywhere in the world to fix me. I had my Botox treatment on August 8, 2011, and have been following Dr. Pacik’s instructions of a strict daily dilating regimen (2 hours), along with daily email correspondence with him. He has been such an amazing support system – along with his staff before and after the procedure. He spends his valuable time away from his office, emailing and making phone calls to his patients checking in with them and giving advice. The dilating, and post-procedure support, is even more important than the Botox itself. The Botox just gives you the ability to dilate and stretch the muscles out, and eventually proceed to intercourse-which is impossible without it in my opinion. Before the Botox has worn off (about 4 months), ideally, and in 95%+ cases of his, your muscles are trained and are able to relax for intercourse. The Botox also breaks that psychological barrier, as you wake up with the largest dilator in place after the procedure which tells you that you are anatomically normal – something you have wondered your whole life if you haven’t been able to tolerate a GYN exam. For me, I knew I was normal because I’d had an exam, but knowing that big thing was inside me was life-changing. Another thing Dr. Pacik offers is the option to have the opportunity to speak with other women that are suffering just like you. This is something that has never been possible in any other situation I have experienced. I used to be convinced that I was an extremely rare case, and would always ask myself, “why me?” Now I understand that there are thousands of women that are going through the same thing, and I am able to talk about my feelings about it with someone who actually understands completely. This has been a HUGE help.

I was able to have intercourse with my husband on August 21st only two weeks after my treatment! After all that time of failure, and then such a quick success, I would HIGHLY recommend having the procedure done. I don’t understand why anyone would want to spend so much time trying different treatments that may not even work. It’s such an emotional thing that no one understands but the ones who suffer from it. It literally ruins your life, and I feel like I have my life back and for once I feel like a real woman.

Again, I completely agree with being conservative and not jumping to treatment options that may not necessarily be needed. I am a Registered Dental Hygienist, so in a different way, I can completely relate to this. In this situation, I don’t agree with it because there is too much on the line during the time that the patient is trying other options that may not work. If I had a patient who ideally needed a crown on a tooth, but could get away with a large filling for now that has the possibility of fracturing off, I would say do the crown because the conservative treatment isn’t a guarantee, even though it’s a lot cheaper, more conservative, and less invasive. If this treatment was going to be affecting them emotionally, mentally, and may put their marriage on the line, I’d say for sure do the crown. I know this sounds ridiculous because that would never happen, but I guess I’m trying to put it into terms that relate to my patients and what I would do.

I have been corresponding with Allie quite a bit regarding our condition and each of our experiences with it. I understand your concern with the classification that Dr. Pacik gave her, as she doesn’t have all of the characteristics, but her case is more severe than mine (and I think my case was pretty severe-Lamont level 4) and I suffered for 10 years trying several different treatments and physicians. I don’t think there are different stages of vaginismus – it’s whether you have it, or you don’t, and to what severity. In all actuality, Allie has had Vaginismus at least since she first tried using a tampon, with no success, which was likely years ago. Allie has the opportunity to prevent wasting 5, 10, or 15 years of her life with this horrible condition. I understand that everyone is different and she may have success with other options, even though I did not. To me, it’s not worth the risk, and why put someone through all treatments that “might” work, when there’s a treatment that does work.

I just don’t want thousands of women out there to have to suffer like I did. I want more physicians to be aware of Vaginismus, and faster, more successful ways of treating it. I wish that more physicians will learn about it, and be open to learning about the Botox procedure and his whole program to cure vaginismus. It would be great if more were able to provide this amazing program so that it could be more accessible for those who aren’t able to travel so far due to expenses. Dr. Pacik has been so kind to dedicate his practice to this condition so that women with Vaginismus can overcome it, move on with a normal healthy life, and be able to one day bear children like all the other women in the world. He wants to get the word out about the condition, and is even willing to educate other physicians about it so that they can help their patients in the way he does-to reach out even further to even more women. He is an amazing human being with a huge heart, and I only hope that there will be more to follow in his footsteps in the future.

If you have any questions or comments for me, please send them my way. I appreciate your opinion, and hope you appreciate mine.”

Signed “Candice” (Permission was given to post this.)

Postscript to Allie’s Story:

Allie was able to achieve pain free intercourse two weeks after treatment with the Botox program and dilation.

Postscript to Candice’s Story:

Four months after her Botox treatment Candice wrote “Just thought I would let you all know that we are expecting a little one in August!!! I still am so thankful of all of you and what you do every single day. We wouldn’t’ ever be at this point if it werent’ for you. I always thought we would never have kids because I would just have the problem forever. Or if we did, we would have to use artificial incimenation or something. Life is soooooooooo good right now. We couldnt’ be happier!!! We are saving the big news for our families on Christmas Day. Again, thank you thank you and thank you! :))”