Importance of Dilation in the Botox Treatment Program for Vaginismus
Dilation therapy is an integral part of the Botox program to treat vaginismus. Botox helps relax tight or spastic muscles. Dilation therapy in conjunction with Botox injections helps stretch the muscles. It’s a “one-two punch”: The Botox relaxes the muscles, the dilators stretch them.
Most patients with vaginismus have considerable fear and anxiety related to any form of vaginal penetration. This includes both sexual and non sexual penetration
Penetration with dilators and advancement to the larger dilators helps women with vaginismus overcome their fears and makes the transition to intercourse easier.
Q. Are there any potential side effects that can result from repeated/consistent use of dilators?
At times the dilators may cause discomfort from repeated use. Women who have an aversion to any form of penetration are not used to having anything inserted into their vaginas and because of this their tissues may be more sensitive.
Q. Is the dilation therapy really that important?
Yes, patients must be motivated and committed to the idea of dilating after treatment. Botox injections without dilation or post procedure support and continued instruction is bound to fail.
Q. How long do I need to dilate after the Botox treatment?
There are several phases to the dilation program depending on how quickly a patient progresses. As a minimum, during the first month or two, patients should plan to dilate two hours a day, one hour in the morning and one hour in the evening and sleep with the medium sized dilator every second night. For those who have to go to work in the morning, the dilation can be done in the evening. Once the dilators become comfortable after about two months and the patient is able to advance easily to the large dilators, the amount of time can be reduced to about one hour or less a day. By one year most patients no longer need to dilate, or to dilate infrequently if there is any discomfort. Menopausal vaginismus and secondary vaginismus in general are somewhat different in that periodic dilation can be very helpful to avoid regression.
Q. Why will I need to keep a dilation log?
Patients are asked to keep a log and stay in touch with Dr. Pacik on a regular basis. This allows Dr. Pacik to modify the dilation schedule as needed. Also of importance is that the patient needs to take responsibility and be held accountable for their continued dilation.
Q. Will I always need to dilate before intercourse? I am worried about the spontaneity that my husband and I are missing and fear that the need to dilate will add a clinical feel to our lovemaking.
This is an excellent question and something that most couples struggle with. Sex needs to be fun and there is considerable counseling that we do to help couples understand how dilators can be used to enhance erotic feelings. Other aspects to enhance love making are discussed during the counseling sessions.
Q. How do I progress from dilators to intercourse?
There are many techniques that can be used. Patients find the most success when dilating for one to two hours before intercourse, removing the dilator and inserting the penis immediately as though it were a dilator. Positions of comfort, including positions that allow the pelvic floor to relax are also discussed during the post procedure counseling sessions as well as incorporating vibrators to help relax and for enhancing their love making.
Q. Will I be at an increased risk for yeast/urinary tract infections post procedure and during the dilation therapy portion of this program?
Some women are more prone to the development of yeast infections or urinary tract infections. Treatment is needed at times but it does not interfere with the overall progress a patient makes.
Q. How do I clean the dilators and is there any concern about toxic shock syndrome?
This is another question that is of concern to patients. Routine hygiene and cleaning the dilators with soap and water is all that is needed. Toxic shock syndrome occurs when a blood soaked tampon is left in place for days, causing bacterial infection to seed into the blood stream. The dilators that we recommend are non porous and with routine cleaning (using soap and water) do not pose this problem.
Q. How do I manage dilating during my menstrual cycle and will menses cause a setback in my progress?
Menses does not have any impact on one’s progress. For women who have a regular cycle it is best to plan the treatment after the cycle ends so that the patient has about three to four weeks of uninterrupted dilation. The anxiety of the treatment sometimes causes a woman to have an unexpectedly early period and we have had patients who started their period during the Botox treatment. This has not been a problem.
Menstruation is an excellent time to begin using a tampon, which many women with vaginismus are unable to do. Further, even dilating for 5-10 minutes is of benefit. For those who are completely unable to dilate, the dilation schedule is resumed after the flow slows or ceases. Starting with a slightly smaller dilator and working up to the larger dilators is resumed after the cycle is over.
Q. I have been using dilators for two years and can’t seem to progress beyond the small dilator. Could I be treated without the Botox?
Yes. For patients that are able to tolerate penetration with dilators but are still unable to advance with their dilators, or progress to intercourse, at times just progressive dilation under anesthesia works for them. The entire program is still used including post procedure supervised dilation and counseling, only the Botox injections are eliminated. The procedure is still done under anesthesia because of the benefits of stretching the vaginal muscles while the patient is asleep and the major benefits of waking up with a large dilator without pain.
Q. I am terrified of even the thought of dilators. How is it possible for me not to have pain with dilators?
Most women with severe vaginismus and severe painful sex are unable to use dilators on their own. During the treatment with Botox under anesthesia, a long acting anesthetic is injected so that the entire vagina is numbed for about eight to twelve hours. By the time the patient returns the next morning, having maintained a dilator for 24 hours, the vaginal muscles are sufficiently stretched that dilation to the larger dilators is easy and not painful. During this time a topical anesthetic is used to coat the dilator and this adds to the comfort of post procedure dilation. Later, patients are able to continue their dilation program easily without the need for topical anesthesia.