FAQs: General

FAQs General questions about the
Botox Program to Treat Vaginismus

We get many inquiries about the treatment of vaginismus. Most frequently patients will ask if they can be referred to a center near their home. The Botox program that we designed is unique. To achieve the high rate of success enjoyed by our patients it is necessary that all facets of the program be offered to the patient. In this way we can predict a successful outcome. There is a great deal of work that is done behind the scenes with continued follow up, support and constant monitoring. We have developed expertise for handling the many aspects of vaginismus treatment and providing post procedure care.

I have seen a number of patients who had prior Botox injections, sometimes as many as two or three treatments, who failed their treatment. These patients had no instruction in proper dilation, no follow up and no counseling. Vaginismus is far too complicated to think that merely a few injections of Botox will cure the condition. Vaginismus treatment needs to address the fear and anxiety that are a part of vaginismus, and for some the continued fear of penile penetration and also relationship issues and low libido. These aspects do not disappear by simply injecting botox into the vagina. The following questions are of concern to patients. The answers are brief but elaborated in greater detail elsewhere on the website.

Treatment of Vaginismus Using the Botox Program

Q. I am interested in learning more about using botox for vaginismus. Do you have any programs for individuals who are out of the area (I live in Chicago)?

Our program is unique in that Dr. Pacik’s continued research involving vaginismus is the only ongoing research program in the United States that is approved by the FDA. Our program doesn’t include just injecting Botox into the vaginal muscles that are in spasm; it also includes progressive dilation under anesthesia, pre and post procedure counseling, on-going follow-up by emails with Dr. Pacik and our staff, and collaboration with other therapists as needed. Only by paying attention to these multiple aspects of the treatment of vaginismus can we be confident about of a successful outcome.

Q. Why is Botox used to treat vaginismus?

Botox is well known for its ability to interfere with muscular spasm. It relaxes muscle. For women who are unable to consummate their relationships, and have pain with intercourse, or who are completely unable to tolerate any form of penetration, vaginal muscular spasm is generally identified. Botox sets the stage for a successful dilation program and the ability to achieve pain free intercourse. For those patients who feel intercourse is like “hitting a wall”, this symptom of vaginismus is generally an indication that severe muscular spasm is present.

Q. How often will I need to be re-treated?

Though it is well known that Botox generally lasts about four months, re-treatment for painful sex is highly unlikely. Once a patient has stretched her vaginal muscles and intercourse is possible, the spasm does not appear to return. For any patient experiencing regression, resumption of the dilation program is recommended. Botox for vaginismus is only needed once for most patients.

Q. What if I am the one who does not have successful treatment?

We would continue working with you using the dilation program until success is achieved. As of July 2014, in the treatment of 300 women with vaginismus only one patient needed to be re-treated for vaginismus using the Botox program. 

Q. How is the Botox administered?

Botox for vaginismus is given through tiny 30 gauge insulin needles injected just under the lining of the vagina. Anesthesia is used because of the extreme fear and anxiety that most patients have with penetration and the thought of having their vagina injected. Normally when Botox is injected into the face, no anesthesia is used.

Q. How often do I need to return for treatments?

Most patients require only one treatment. Even though Botox lasts about 4 months, patients seem to do fine as long as they are committed to properly dilating. If there is any regression, the dilation schedule is resumed.

Q. I am single, am I still a candidate for Botox treatment?

We have a number of single women who have been treated with the Botox for vaginismus. These women continue with their dilation program until they meet someone they are comfortable with. In some ways this is easier for a single woman in that there is less time pressure to become successful with intercourse.

Q. Does Botox interfere with fertility, cause abortions, or create congenital abnormalities?

Botox neither interferes with fertility nor does it have a role in miscarriages and has no known influence on a child’s development. We ask patients to avoid getting pregnant for four months after Botox treatment for vaginismus  simply to play it safe. Congenital abnormalities can happen at any time, and we don’t want Botox to be blamed for this.

Q. Do the Botox injections have any effect on my menstrual cycle?

No, there is no effect.

Q. What is the success of using Botox injections for vaginismus?

One can expect a success rate in the high 90th percentile as reported in several scientific publications by Dr. Pacik. It is important to understand that the entire program is important in achieving a successful outcome as measured by the ability to have pain free sex or the ability to advance to the large dilators in the absence of a partner.

Q. What does the “Botox program for vaginismus” mean?

The treatment of vaginismus is much more complicated than simply injecting Botox under anesthesia. A comprehensive program is needed to treat vaginismus because it is both physical (spasm) and psychologic (fear and anxiety). A large dilator is placed in the vagina after the botox injections, under anesthesia, so that there is no discomfort when the patient wakes up with the dilator in place. The program continues with supervised dilation in the recovery room. Patients maintain and sleep with a medium sized dilator until seen the following morning. Patients return the next day for continued supervised dilation, counseling regarding use of the dilators, advice regarding transitioning from dilators to intercourse, ways to improve their libido, positions of pelvic floor relaxation for intercourse, relationship counseling and discussion of achieving pain free gynecological exams. All of these components are important. Patients who have associated conditions or need care beyond the continued follow up that we provide are advised to continue with clinicians near their home who are experienced in the type of care they may need. Though usually unnecessary, this might include sex counseling, physical therapy, relationship counseling and gynecology follow up. Patients have had a very high success rate when the entire program is used to treat vaginismus and when they continue to communicate with us on a regular basis after treatment.

Patients who have been unsuccessful find that the condition returns after they have given up on their dilation program and fail to communicate with us.

Q. I have a less severe form of vaginismus but can’t seem to advance with dilators. Do I still need the Botox?

This would be assessed after Dr. Pacik reviews your questionnaires and has a phone conversation with you. Some patients simply need dilator therapy without the Botox injections. Progressive dilation under anesthesia can be very helpful. Many patients use their dilators incorrectly and this is addressed by Dr. Pacik. Almost any vaginismus patient is benefited by the counseling we do.

Q. How many days would I need to spend in Manchester, New Hampshire?

Our patients usually arrive on the day before the procedure, have the procedure the next day and then spend the next 1 to 2 days involved with post-procedure dilation and counseling. A return trip home can be planned the evening of the third day.

  • Day 0 arrive in Manchester
  • Day 1 Treatment using Botox vaginal injections and progressive dilation under anesthesia with post procedure supervised dilation (about 4-5 hours).
  • Day 2 Supervised dilation, counseling and follow up about 5 hours.
  • Day 3, optional day, recommended for the more severe forms of vaginismus with associated high anxiety and fear to penetration. Repeat supervised dilation and more counseling is given. Patients are then able to return home later in the afternoon or evening.
  • Some of our patients stay in the area touring and visiting for a week. We offer a complimentary follow up visit to check their progress the week after their treatment.

Q. Do you have weekend hours?

No, we do not.

Q. Can I complete all follow-up treatment at home?

Yes, follow up treatment at home is possible because Dr. Pacik and team stay in close contact post-procedure via email (and phone when necessary) to ensure a successful outcome. Patients within driving distance are encouraged to return to the office for follow up. All treatment continues in the privacy of your own home.

Q. How do I tell the difference between primary and secondary vaginismus and does Botox work for both conditions?

In primary vaginismus a woman has always had pain with penetration and has never had comfortable intercourse. In secondary vaginismus a woman has had normal comfortable sex, and because of some event such as a yeast infection, birth control pills, childbirth, trauma and sometimes for no known reason, intercourse becomes painful. This is called secondary vaginismus. Whether the diagnosis is primary vaginismus or secondary vaginismus, the vaginal muscles appear to become spastic causing pain with penetration. When this is the case, the Botox program can be helpful for both conditions.

Vaginismus, Vulvodynia, Vestibulodynia and Vestibulitis

Q. I was diagnosed as having vulvodynia but I think I have vaginismus. How do I tell the difference between the two?

Generally vulvodynia is painful even without sexual involvement as when simple pressure from underwear or pants causes pain. The painful areas are aggravated by intercourse. Vestibulodynia, pain in the vestibule (located between the inner lips and the vagina) is often a panic reaction of “too close for comfort”. “Tip only intercourse” is likely penile penetration into the vestibule but not the vagina. Vestibulitis is an older term that is being phased out and refers to vestibulodynia. Both vulvodynia and vestibulodynia are rarely associated with vaginismus. Chapter 3 of my book “When Sex Seems Impossible…” describes the differences between these types of sexual pain. Perhaps the most important vaginismus symptom is that penetration is like “hitting a wall” indicative of spasm that is often present at the entry muscle.