Timing of Botox Treatment

Some of the emails I get ask specifically about the right time to have Botox treatment. There are a number of factors that influence the best time for treatment:

  • menses
  • being single
  • being in a committed relationship, but partner leaving for an extended period of time
  • separation or divorce.

Menstrual cycle and best time for Botox treatment program for vaginismus

It is often best to time the Botox treatment program for vaginismus shortly after menses have ended. This will make it the easiest to begin a good dilation schedule without having to interrupt the dilation due to heavy flow. The timing is never 100% accurate. With the anticipatory anxiety that is common prior to treatment, some women find themselves in an irregular cycle, and some of my patients have started their period just as I was injecting the Botox. It is a bit more messy this way, but does not derail the program. If the patient needs to delay their dilation schedule, they are still taught how to do this during their post procedure counseling.


One may be single and not dating or one may be in a committed relationship only to discover their partner needs to leave for an extended period of time (business, military deployment, etc). Further some patients suddenly go through unexpected separation or divorce at about the time of their treatment. In all these situations, treatment is still recommended.

Single women have the advantage of being able to dilate without pressure. When they meet someone, they may or may not share their vaginismus story. Either way, the first time a woman has intercourse after treatment, an exit strategy is recommended if they find they are unable to successfully complete intercourse.

For women who suddenly expect their partner to be absent, once again it gives them a chance to dilate in an unhurried fashion.

I received the following email from such a patient:

“My husband and I had a Skype session with you about a year ago. Another year has passed with no change and it is time for us to do whatever we have to do to be able to come see you and your team. My only concern is that my husband is deploying to Egypt sometime during Sept-December this is year. We will be separated nine months to one year. Do you think that this will interfere with my success with the program? He has concerns that the long period of us not being together will cause my vaginismus to return. Please let me know what your thoughts are on this. I look forward to hearing back from you soon.”

This is a similar scenario to the single woman in that this person will also be “single” for a period of time. Her treatment can be scheduled anytime, and during the interval she can be quite successful dilating slowly to the large dilators. This way she will be ready when he returns.

Continued anxiety often exists transitioning from dilators to intercourse. This is covered during the two to three days at the clinic involving several discussions of “how to” transition to intercourse. Another area of concern and anxiety is the dreaded GYN exam. Tricks of preparing for a GYN exam include dilating prior to the exam. As long as a patient is committed to maintaining her dilation schedule, one can predict a successful outcome.

If you have any questions about our Botox treatment for vaginismus and progressive dilation under anesthesia, please contact us via our contact us form.