We receive many inquiries about the use of Botox for vaginismus. One patient writes:” I have been diagnosed with vaginismus and was interested in learning more about the botox injections for this. I use dilators currently but still experience pain.”
There appears to be a continuum of painful intercourse ranging from mild burning pain with penetration, to the complete inability to have ANY form of penetration including a GYN examination. A number of patients have told us that they had to be sedated to have a GYN exam.
We always recommend that patients try conservative therapy first. For milder cases conservative therapy of vaginismus can be successful when dilators are used in combination with psychotherapy, sexual counseling and physical therapy working with Kegal exercises.
The problem is that in more severe cases, this can take a long time, become frustrating, and hurt relationships. For patients who want to speed up the process, Botox injections done under sedation with a light general anesthetic shortens the entire period to about one month. We have had excellent success using Botox for vaginismus and find that even milder cases of vaginismus are candidates for this approach.
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I had gastric bypass surgery in January of 2007. I lost 110 pounds and still have 20 pounds to lose to reach my target weight. I seem to have reached a plateau as I am having a difficult time losing the last 20 pounds. Do I need to lose this weight before I start the process and consider weight loss surgery?
I had gastric bypass surgery two years ago and lost 140 pounds. I exercise three to four times a week. I am 5 foot, 4 inches and my weight is 140 pounds. Some areas of my body have responded well in that the skin has tightened. My abdomen, however, has a lot of excess skin, as well as the upper portions of my arms. I read your website and feel that I am candidate for a tummy tuck and arm reduction, can these procedures be performed at the same time?
Breast reduction (reduction mammaplasty) and breast lift surgery (mastopexy) are similar in that both raise the nipple to the correct position and both reduce the size of the breast envelope. The primary difference between breast reduction and breast lift is that breast tissue is removed during a reduction while none or very little is removed during a mastopexy. 
The usual technique for a breast lift is a lollipop incision, though at times, an anchor incision is needed. The lollipop incision (illustration to the left) is made around the perimeter of the areola and vertically down from the areola to the breast crease. The anchor incision (illustration to the right) is made around the perimeter of the areola, vertically down from the areola to the breast crease, and horizontally along the breast crease.
Bariatric surgery is being performed on older patients every year. The techniques have become much safer, as has the perioperative management of massive weight loss patients. Certainly you will benefit greatly from your Lap Band surgery and any comorbidity such as hypertension, diabetes, sleep apnea will likely be significantly improved or cured following your weight loss. 
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Many areas are affected during massive weight loss. The face is certainly no exception. Some patients have all areas affected while others have specific areas affected. The most common areas which are affected are the face and neck, the arms, the breasts, the abdomen, buttocks and thighs. When a significant amount of fat is lost the face loses volume and the skin tends to sag. In very mild cases, this may be corrected or improved with use of facial fillers. Other patients require a lower face and neck lift. Both can give excellent results.
Liposuction can be performed for very small volumes of fat, as well as significantly large volumes. Depending upon the patient’s goals in terms of body contouring, liposuction can be performed in combination with surgical procedures. Many patients wish to just reduce the overall bulk and would like to look and feel and fit better in their clothing. I have performed liposuction for people who are not at an ideal weight but who afterwards feel much better in that they are fitting better into their clothes and their clothing has actually gone down several sizes. Anything in excess of 5 liters of liposuction is considered large volume and is done in the hospital setting, usually with an overnight stay. Anything less than 5 liters can be done in the outpatient setting with the patient going home that day. 
Even after the vagina relaxes, there continues to be fear and pain. It is important that the smallest dilator is used for 2-3 days before attempting the next size and so on for about 7-10 days before intercourse. Once you feel ready for intercourse, use the dilator and relax for about 15-30 minutes to allow the vagina to slowly stretch. Lubrication and foreplay are essential, as well as a loving atmosphere. The first several times can be expected to be uncomfortable, but this gets better with time. The photograph to the right represents different size dilators and the handle.
For the past several years we have been treating vaginismus with Botox in the group of patients who are resistant to conservative measures or those patients who want to speed up the process of being able to enjoy pain-free sex. This form of therapy is not well known and there appear to be fewer than 50 case reports in the literature.
Labiaplasty is the reduction of excessively large labia minora, the inner lips in a female. These areas project beyond the labia majora, the outer lips of the labia, surrounding the entrance to the vagina. Younger women desire the surgery for either cosmetic reasons, or discomfort with sports such as cycling or spinning classes. Tight jeans may also cause discomfort. Other issues relate to trauma during intercourse.