Vaginal Pain with Dilators after Botox Treatment for Vaginismus

One week post Botox treatment for vaginismus, one of our patients from the England with a seven year history of severe level 5 primary vaginismus began having pain with dilation. She writes:

“I am now home and since I’ve arrived, I have had a few issues that I did not experience in the US. I have marked this urgent because I am now experiencing a sharp, intense stabbing pain at the tip of the small blue dilator (#3) and the purple silicone dilator (#4) followed by a ‘watery bleed’. However, I have no problems with using the Salmon dilator (#2). Is this normal? My period is due on Saturday – so initially for the first two days I thought my period had arrived early but the bleeding would stop after using the Salmon dilator, with hardly any pain or discomfort. I was able to dilate with the blue and purple before leaving the US and am still taking ibuprofen.”

PureRomanceVaginalDilatorsPure Romance’s Vaginal Dilator Set includes six tapered, 100% silicone dilators used to slowly stretch the vaginal walls, making penetration and routine medical exams more comfortable. These dilators are soft, smooth, flexible and come in graduated sizes. Designed for women who experience vulvovaginal pain and discomfort.

When post Botox treatment pain does occur during dilation

Pain during dilation may occur because the vagina is not used to the trauma of repetitive dilation. Once a sore area starts, it may be difficult to get comfortable until it heals. For this patient, as well as others, I have the following suggestions:

  • For healing and comfort, buy over the counter 1% hydrocortisone ointment and apply a thin layer to the area of pain twice a day for about 5 days. If unable to get the ointment, then use the cream.
  • Back down in size to a dilator that is comfortable. Avoid the area of discomfort when inserting the dilator.
  • Avoid dilating for a few days during your period to allow healing.
  • Resume with a dilator that is comfortable and work up to larger dilators for longer intervals as able.
  • Begin reducing and eliminating the ibuprofen.

Even though pain during dilation does occur post Botox treatment for vaginismus, the above suggestions is all that is generally needed because the traumatized area heals very quickly. Using smaller dilators during this time frame allows the dilation to continue in a comfortable fashion. Once comfortable, it is possible to advance to the larger dilators once again.

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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.

Dr. Pacik

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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