When can I expect to have intercourse?

One of the first questions patients with vaginismus tend to ask is how soon can they expect to have intercourse. After many years of failed therapy and relationships that are often on the verge of a divorce, this is a question of paramount importance.

The answer to this depends on a number of factors such as how long has the patient had a problem with vaginismus, how strong is their libido and how strong is their partners libido, presence or absence of relationship issues, and how eager are they to overcome their condition. You can read more about this on our resource article titled: Outcomes of Vaginismus Treatment after Botox.

Though most vaginismus patients have a similar course of treatment consisting of Botox injections and progressive dilation under anesthesia, the outcome appears to be dependent on the above factors. For example, a woman whose vaginismus has been of short duration, who has a strong libido in a loving relationship and a partner who also has a strong libido is more likely to achieve intercourse earlier. These patients may achieve intercourse in 1-2 weeks in comparison to others who may spend 2-3 months before they achieve their goal.

Either way our patients continue to have a 90+% success rate and regression is very uncommon meaning that only one treatment using Botox for vaginismus is needed.

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Vaginismus is a terrible affliction and women spend years looking for a cure while they endure inappropriate treatments and misdiagnosis. Botox treatment for vaginismus is fairly new but catching on rapidly because it has a very low level of invasiveness and known to be safe and effective.

A touching success story is told by a 26 year old woman who suffered with vaginismus for the four and a half years she has been married. She was diagnosed as a Lamont level 4 primary vaginismus.  After enduring a road from hell she tells her success story after treatment of her vaginismus with Botox. What follows is her husband's story and what it is like to be unable to consummate a marriage. It is a must read. 

http://www.plasticsurgerypa.com/index.cfm?event=ProductView&CategoryID=51&SubcategoryID=168&ProductID=588

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Vestibulodynia, also known by the older term vulvar vestibulitis, means pain in the vestibule just outside the vagina. They are told that this is what causes the pain on attempted penetration when the real culprit is vaginismus and associated vaginal spasm.

When I get the additional history that they have never been able to use a tampon and that attempted intercourse is “like hitting a brick wall” I immediately suspect that vaginismus is at play and is the more important feature of the patient’s distress.

This is very important because Botox is effective for both conditions, but one needs to know where it is best to inject this drug. In vaginismus the entry muscle is usually noted to be in spasm under anesthesia and it is the vaginal muscles that are injected. In vestibulodynia the vestibule is injected.

We continue to have in excess of 90% cure rate using Botox for vaginismus and have noted that associated vestibulodynia disappears as the patient is able to achieve intercourse.

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Botox continues to be highly effective for the treatment of vaginismus, vulvodynia and vestibulodynia. The drug is compatible with all of the usual drugs that are normally taken, including antibiotics that may be needed for illness.

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Vaginismus continues to be under diagnosed by most health care professionals, including gynecologists. In patients who have aversion to GYN exams, inability to have intercourse and give a history of inability to use tampons, vaginismus should be part of the differential diagnosis.

Many of my patients who fail in their ability to have a speculum examination complain that they were told to “just relax” or that it is all in their head. Patients who have a more severe form of vaginismus (Lamont level 3 to 4) are often shunted from therapist to therapist over a course of many years and are unable to make any progress while their relationships are deteriorating. Vaginismus is the most common reason for unconsummated marriages.

Lamont, in 1978 (Ref 1) described four degrees of severity in his proposed classification. In the most severe form of vaginismus he describes the generalized retreat that takes place with the buttocks elevating and withdrawing and adduction of the thighs. My patients, many of whom are self diagnosed, are able to accurately classify themselves by reviewing the Lamont classification, and recording their level of vaginismus in the history they give me. Indeed, some of my patients suggest there should be a Level 5, manifested by sweating, nausea, vomiting, and “going unconscious”. In my practice the more severe cases of vaginismus are treated with Botox injections under anesthesia (Ref 2-4) and these patients show the same withdrawal behavior as the anesthesia is deepened. Attempted intercourse and hitting the “brick wall” they so often refer to is documented by severe vaginal muscular spasm, usually involving the bulbocavernosum, while the patient is deeply sedated.

There is a need for physicians to raise their awareness of vaginismus in treating these patients.

References: Lamont JA. Vaginismus. Am J Obstet Gynecol. 1978 Jul 15;131(6):633-6.

      Pacik PT. Botox Treatment for Vaginismus. Plast. and Reconst. Surg. 124:

455e-456e, December 2009

Ghazizadeh, S. and Nikzad, M (2004). Botulinum Toxin in the Treatment of

Refractory Vaginismus. Obstet Gynecol 104, 922-925.

Abbott JA, Jarvis SK, Lyons SD , Thomson A, Vancaille TG. Botulinum toxin type A for chronic pain and pelvic floor spasm in women: a randomized controlled trial. (2006)  Obstet Gynecol. 108:915 -923.

PMID: 686049

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Patients generally have no difficulty working with the # 4 or # 5 dilators once they return home after being treated with Botox for vaginismus. Advancing to the largest # 6 dilator — jokingly referred to as Mr. Big Blue — may take more effort.

Relaxation is the key to getting comfortable with the #6 dilator. Remember, even if you’re nervous, you won’t hit that “wall”—the Botox took care of that. And while Mr. Big Blue may feel weird at first, or briefly uncomfortable, it won’t be painful; and in fact may eventually be used for arousal.

To help relax with Mr. Big Blue, practicing in a warm bath and using lubricants works wonders.

While soaking, use a silicone based lube, which lasts longer than water-based lubes. (Pjur is a good brand, just avoid those containing additives which can cause a burning sensation.) Though Vaseline is not normally recommended, a small amount won't hurt you. (I recommend cocoa butter, which smells nice too.) Apply the lubricant to the entrance of your vagina and coat the dilator. You can then stay in the bath for about 30 minutes with the dilator in place.

Once you have advanced to the large blue dilator, intercourse is not far away.

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If you're part of the one-to-six percent of the women worldwide who suffer from vaginismus, likely the last thing you associate with sex is joy. And why would you? The fear of penetration, the avoidance of intimacy, the secrecy and perceived shame that result from this condition would leave anyone skeptical that sex could be joyful.

But here is the good news. Over 90 percent of my vaginismus patients have been treated successfully, through a combination of painless Botox injections and progressive dilation. In fact, some of my patients have intercourse within two weeks after treatment.

But don't assume intercourse immediately equates to great sex. No one needs that kind of pressure!

Instead, give yourself some time to transition from "intercourse" to the art of lovemaking. With good communications (Surprise! Only 30 percent of "normal" women reach orgasm through intercourse), and an understanding of your body's erogenous zones, you and your partner will not only be able to consummate your relationship . . . but find real joy in your sexual relations.

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We continue to experience a 90%+ cure rate using Botox treatments under anesthesia for vaginismus. These results were published in Plastic and Reconstructive Surgery, December, 2009 (Ref 1). The article, Viewpoint: Botox for Vaginismus, is reprinted in its entirety in the Publications Section of About Dr. Pacik on our website.

In this study, 20 patients were followed who had Botox, a long acting local anesthetic and progressive dilation, all done under anesthesia, for vaginismus. Many of our patients had the most severe form of vaginismus (Lamont level 4) and often gave a history of failed treatments for 4-7 years.

Currently we have about 40 patients who have been treated this way. Two of our patients gave birth to healthy children and had normal vaginal deliveries. To date we have had no recurrences.

Reference:

Pacik, PT, Viewpoint: Botox Treatment for Vaginismus, Plastic & Reconstructive Surgery, Vol 124, Pages 455e-456e, December 2009

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Vulvodynia is pain involving some portion of the vulva outside the vagina. It may be associated with vaginismus or be present without vaginismus.

We have found (and the literature support this) that both conditions can be treated with Botox. In patients that we have treated for combined vaginismus with vulvodynia, the vulvodynia was cured about 2 weeks after injecting Botox into both the areas of pain in the vulva as well as the vaginismus.

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Patients are often confused how to dilate after being off dilators during their menstrual cycle. They are generally doing well after receiving Botox treatment and dilators under anesthesia for vaginismus. They are then off the dilators for a period of 4-7 days and are frightened that when they resume that they will experience difficulty.

A patient wrote that it took her 1 ½ hours to resume with the pink #5 of 6 dilator after her period and that the experience was uncomfortable.

The concept of dilators is exactly what the words mean. By backing down one to two sizes, and introducing smaller dilators first, the entire process becomes much easier. Once the smaller dilator has been in place for about 20-30 minutes it becomes much easier to advance to the next size. Also remember that the pink dilator is about 1 inch too long for most women and that the last part of the dilator will not go in. If a smaller dilator does not go in easily, then try the next size smaller, until you find the size that goes in easily. This is still a monumental step for level 4-5 vaginismus patients. Advance to the next larger size dilator from there, and so on.

After menses is also a good time to resume sleeping with a #4 purple dilator every 2 nights to begin the slow stretch once again. The number 5 pink dilator is probably too large to sleep with for most women. One to two hours of dilation during the day (one hour in the AM and one hour in the evening) together with sleeping with the dilator will be very helpful in getting back to where you left off. After 2-3 months it is likely that dilation will be needed very little or not at all. Anytime burning with penetration starts again, start the dilation process once again, and the burning will disappear.

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A patient 3 weeks after her treatment of level 4 vaginismus with Botox and dilators writes:

"My progress is about the same. I've still been working with the pink and purple dilator (#’s 4 and 5 of 6). There have been a few instances where I have not been able to spend much time dilating now that school and work has started. Because of this, I started to have burning while dilating with the purple dilator (#4 of 6) when it was completely pain free before. But I have been dilating a lot this week so the pain has pretty much gone away while I am using the purple dilator. Is the purple dilator supposed to go all the way in? I feel like it only goes in about 80%. Hope all is well with you! " Name withheld

Here is my reply:

The onset of burning is exactly why it is necessary to keep dilating during this critical time. It does not take much for the muscles to start tightening even with the Botox on board.  The purple can go in all the way, but don't force it for now. It's the pink and blue dilators that are too long and stick out about 2 inches.

At this time, I need you to dilate up to the pink (#5 of 6) so it is comfortable. Some patients need to dilate a few hours daily (can be done while you are studying) to get to this point and it is also advised that you sleep with a dilator every 2-3 days. The WORK NEEDS to be done. This is an important time for you to be advancing while the Botox is effectively weakening the vaginal muscles. Once the pink (#5) is comfortable you will be able to start working with intercourse.

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“______ and I will have intercourse one night where I won't have any pain and find it enjoyable and the very next night, he can't even finish because it hurts again...I’m not sure if I could be sore from the night before and that's what is causing it or what??”

I asked her what her dilation program was currently. She wrote:

“I'm actually not dilating at this point.  I had been for about a 1/2 hr each day a couple wks ago.  I appreciate your help.  Thanks!”

Dilation continues to be very important during the early recovery from vaginismus after treatment with Botox. Intercourse is usually too short to provide meaningful dilation. Here was my reply:

“It sounds like you need to spend more time with the dilators. I recently wrote a resource article "Dilators for Vaginismus, Correct Use" addressing this topic.

You can also buy a vibrating dildo (internet, sex shop) that is slightly larger than ______’s penis. This is actually an excellent way of dilating and will make intercourse more comfortable without the burning afterwards. Always use lots of lube. The manufacturers of Pjur make a silicone based lube that is excellent. Let me know which ones you are using. Botox causes dryness for about 4-6 months and this is why lubrication is very important.

Let me know how it goes for you.”

This is one of the more common problems that patients contact me about. It is almost always due to not dilating for a long enough time after treating their vaginismus with Botox. After about 4 months almost all patients make a full recovery from their vaginismus.

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Botox and Dilators to treat Vaginismus:

Some of our patients scheduled for Botox and dilators for the treatment of vaginismus are unaware that this treatment is done under anesthesia. Much as going to the dentist, there is no pain because of the injection, and usually little to no discomfort after. This is similar to the treatment used when injecting Botox and leaving a dilator in place. When the patient wakes up they do not feel the dilator because a long acting local anesthetic has been injected and a topical anesthetic coats the dilator. It is for this reason that patients need not fear this form of therapy, even though they have been conditioned to associate any form of penetration with pain.

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Kelsie was the first patient that had the benefit of dilation under anesthesia while treating her vaginismus with Botox. She writes;

I thank God that you had the foresight to insert the dilator during the Botox procedure. I believe 100% that it sped up my recovery by leaps and bounds. Upon awakening and realizing that I had a dilator inside me and there was no pain involved the psychological impact of that moment is describable. Something in my head clicked and I knew that I would be able to have pain free intercourse. The panic of painful penetration was extremely diminished and I had real hopes for consummating my marriage."

She documented her journey in the following YouTube:
http://www.youtube.com/user/BraveWomenSpeak

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A website dealing with vaginismus made the following comment about the use of Botox as a treatment for vaginismus:

"However, Botox doesn't deal with any of the issues or fears that caused your vaginismus in the first place, with partners, with body-image, with your upbringing and view of sex."

The problem of not being able to consummate a marriage or partnership plagues women and their partners, and slowly eats away at the fabric of their connection. Though many women suffer from severe sexual upbringing, and some may have vaginismus as a result, one still needs to treat the vaginismus first and then deal with any residual issues that have surfaced as a result. The severe forms of vaginismus can be treated successfully with a combination of Botox and dilators under anesthesia. Once intercourse is possible, many of the “issues” evaporate. For those that still have problems sex or psychologic counseling is of great benefit after successful treatment.

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Almost every drug is lethal when too much is given. While it is true that Botox is derived from Botulinum toxin, and digitalis (heart medicine) can kill and too much Valium can make you unconscious, drug companies have calculated safe doses for physicians to use.

So when I read on a website: “… it is still questionable whether it is essential to insert such a poisonous substance in our vagina…” I have to ask myself what is the motive of this author? Why is it necessary to use such inflammatory language? Any drug can cause damage if used incorrectly. Botox is one of the safest drugs around with millions of doses injected and next to no complications. Sure there can be problems with knock off drugs, but this does not apply when using drugs from approved companies.

We have had a 100% safety record using Botox injections not only for vaginismus but the many other areas we treat. Our vaginismus patients, many who have the most severe form of vaginismus enjoy a 94% cure rate allowing patients to have intercourse in as little as 2 weeks after treatment. These results speak more clearly and louder than inappropriate comments on web sites.

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Some of the scare tactics on web sites speak about the pain of Botox injections for vaginismus. Here is a quote from a well read website: 

"The injections are painful and if you should decide to have it under anesthesia, there are risks associated with it, however minor, that you may want to consider."

When Botox injections are used to help cure vaginismus the treatment is done under heavy sedation or anesthesia. It would be impossible to approach a woman with severe vaginismus any other way. They are ready to jump off an examining table, and the thought of a needle for injection is something that would not be tolerated by any of our vaginismus patients. The injections are completely comfortable and the patient remembers nothing about the treatment. During the anesthesia a topical local anesthetic is used to coat the dilator which is left in place as well as the injection of a long acting local anesthetic to give the patient a completely pain free experience in the recovery room. We use American board certified Anesthesiologists to deliver the anesthetic in our certified outpatient surgicenter making for a very safe treatment. More can be found by reading the educational material on our vaginismus home page of our website.

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More misleading information about the use of Botox for vaginismus is the comment about the temporary nature of Botox treatments. While it is true that for most areas Botox needs to be injected every 3-4 months, this is not true when using Botox to treat vaginismus. We have been using Botox injections for vaginismus since 2004 and to date have had no patient return for additional Botox because of recurrent vaginismus. We do have one patient who failed treatment and this level 4 primary vaginismus patient (most severe form) was unable to progress beyond the smallest dilator. This patient is not a recurrence, but rather a failed treatment. 94% of our patients have had success and we have not had to retreat any of them. This is because once the vagina is dilated, and the patient is having intercourse, further treatments are not needed.

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Some web sites feel so strongly about persisting with conservative therapy for vaginismus that they incorporate inflammatory statements about the use of Botox to treat vaginismus. Statements like “unethical”, “poisonous” and “permanent side effects” are designed to frighten the average woman suffering for years with vaginismus. Most of my patients have had vaginismus and the complete inability to have intercourse for many years, and one recent patient for 26 years! These women have tried every form of conservative therapy and see me for Botox injections because they continue to fail their treatments; they are tired of all the “talk”, the time and the expense. We see the more severe cases of vaginismus that have failed conservative therapy. Many are desperate to save their marriages. We continue to have an exceedingly high cure rate dating back to 2004 using a combination of Botox injections and dilators placed under anesthesia. We have never had a “permanent side effect” and to date we have had no complications from this form of treatment.

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It is unfortunate that so much misinformation about the value of Botox injections for vaginismus exists on the internet. Everyone seems to have an opinion. One web site suggests that it is unethical to use Botox for vaginismus. The success of Botox treatment dates back to 1997 when a case report appeared in Lancet, a British medical journal. Following her treatment she was able to have intercourse for the first time in 8 years. This persisted for the 24 months of her follow up. A number of other reports showing the benefits of Botox for vaginismus can be found on my web site. Our own experience is that 94% of our patients are cured of their vaginismus within 2 weeks to 2 months of treatment with Botox and dilation done under anesthesia.

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Breakthrough in the Treatment of Vaginismus

The Use of Dilators, Long Acting Local Anesthesia and Botox under Anesthesia

Two of the most important advances that we made in the treatment of vaginismus are leaving a large dilator in place at the time of anesthesia and injecting a long acting anesthetic into the spastic muscles of the vagina. This is all done during the Botox treatment of vaginismus at the time the vagina is injected with Botox under anesthesia to give long term (4-6 months) relief of the spastic vaginal muscles.

Most of the patients that we treat are Lamont Grade 4 vaginismus patients, the most severe form of vaginismus. A grade 4 vaginismus patient is usually unable to have a GYN examination, can’t use tampons and often can’t even get a Q-tip inserted. Intercourse is totally out of the question and their relationships are on the verge of falling apart. These patients have a history of many years of conservative therapy such as reading books, attempted but failed use of dilators, physiotherapy (the therapist can’t get near them), psychotherapy, sex counseling, hypnotherapy, bio-feedback and the list goes on and on.

Examination under anesthesia confirms the severe spasticity of a number of muscles within the vagina. These muscles are injected with Botox as well as a long acting local anesthetic. A large dilator is coated with a topical anesthetic. The combination of topical anesthesia and injected anesthesia allows the patient to wake up in the recovery room with the dilator in place AND THE PATIENT FEELS NOTHING!! Talk about flipping a switch! For the first time these patients understand that it is possible to have vaginal penetration.

It used to take 1-2 months for patients to move from treatment to intercourse when only Botox was injected. With this expanded program of treatment patients are often able to have intercourse in as early as 10-14 days, and one of my patients recently drove to her home out of state and had intercourse (1/2 way) the night she arrived home one day after treatment!

More educational resource articles can be found on the vaginismus home page:. 

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This 28 year old patient with primary grade 4/4 vaginismus had treatment with Botox, dilators and the injection of a long acting anesthestic. She was able to achieve intercourse 12 days after her treatment. Initially she did not experience much pleasure fom intercourse and asked about lubrication.

Question: Yesterday we were not planning on attempting intercourse and it just kind of happened and that's why I didn't get the chance to dilate first, but it wasn't too bad. I think I preferred it that way but on the other hand I should still use the dilators for the time being. Yesterday it wasn't an empty experience at all. I think its getting better - slowly. There is slight burning but I get use to it after a minute or two. Should I use less lube as we progress? Maybe I'm not feeling much because of the amount of lube I use? May be not? I don’t know.
 
The Botox should wear off gradually, is that right? I'm just worried that when it does wear off whether I’ll be able to continue with things or not, dilation, intercourse etc, but like you said the Botox doesn't actually numb the muscles it just paralyzes it so I shouldn't feel any pain as such when the Botox starts to wear off.

Answer: You are only 1 mo since your treatment and you need to use lube for a full 4-6 months because the Botox causes dryness. It will wear off but you will be well dilated by then. I have not found the need to re-inject. After 6 months it would be fine to get pregnant and you should be able to have a vaginal delivery if your body can handle a vaginal delivery( has nothing to do with the vaginismus).

By the time the Botox wears off, you will probably experience more sexual joy.

Another patient cured of her grade 4 primary vaginismus and now 6 months pregnant commented: Me, pesonally, I used my dilators before we had intercourse for the first month or so. I would just leave it in for a minute or two, then pull it out right before penile penetration. This really helped. Also, I agree, she needs to be extremely lubricated. That is key to so many things!

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We continue to have a very high rate of success using Botox and vaginal dilation under anesthesia for vaginismus. Patients continue to progress rapidly through their dilators but continue to have fear with penile penetration. In addition there is early burning and discomfort during the first few experiences with intercourse.

The following suggestions may make the process easier for the woman:

• Start by using a dilator for about 15-30 minutes before intercourse. This will be helpful with pre-stretch. If you assume the “on top” position you will have better control of the amount of penetration.
• Full penetration is too much for most women recovering from vaginismus. This is a completely new experience for you and usually the deeper muscles are not yet stretched out. 
• For the first 2-3 times only the tip should be inserted. If this is OK advance to just midway, again 2-3 times to continue a slow stretching process. Once you are comfortable with this move towards ¾ penetration but not yet full penetration, also 2-3 times. This will give you another 2-3 weeks of stretching and you will be able to pace yourself. It will be awhile before it is enjoyable for you, but that day will come.
• For each of the above, have him just linger without moving. This will allow you to have a slow stretch and the experience will be more comfortable for you.
• If full penetration is too much even after the above, just simply hold off on that until you are comfortable. The vagina does stretch rather quickly so you should be OK.
• With you on top you can maintain control of the amount of penetration.

It usually takes about 4-5 weeks to become comfortable with intercourse, so give yourself adequate time. This will allow you to be more comfortable with what is a monumental transition for women with vaginismus.

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For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website on Vaginismus for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE .

A patient asked what happens to the spastic vaginal muscles after Botox treatment for vaginismus wears off. Do they undergo spasm again?

Once the vaginal spastic muscles relax, they seem to be relaxed permanently. The brain is very powerful in controlling many things involving the body. An example is tension headaches or carrying tension in the neck, back or feeling it in the "pit of your stomach". There is nothing organically wrong with any of these sites, yet they are under the powerful influence of the brain. It appears to be the same with vaginal spasm. There is nothing wrong with the vagina, yet there is some psychologic process that triggers this involuntary uncontrolled spasm of the vaginal muscles. Once the Botox or vaginal dilation allows the area to relax, and intercourse is possible, the original problem causing the vaginismus seems to abate. The confusing thing is secondary vaginismus, where someone was able to have intercourse on a regular basis, and something happens once again usually psychologic, that triggers vaginismus. They are treated in a similar way.

Our patients who have been treated for vaginismus using Botox injections appear to have permanent improvement.

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For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website on Vaginismus for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE .

Botox is rapidly becoming the procedure of choice for vaginismus as more and more patients are overcoming vaginismus after Botox injections. Some of our patients also notice that they are no longer able to do Kegels (contraction of the pelvic floor). This is not 100% and some of our patients are still able to do the Kegels even though the Botox has taken effect.

The reason for this discrepancy is that the Botox is injected intravaginally directly into the bulbocavernosus muscle which is a superficial muscle at the entrance to the vagina, and the specific muscle causing vaginal spasm and vaginismus. The larger muscle controlling pelvic floor tension and the ability to do Kegels is called the pubococcygeus muscle (PC muscle) and this muscle is not directly injected.

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For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website on Vaginismus for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE .

Tyra Banks will be broadcasting a show dealing with vaginismus, time and date to be announced. They will interview three of our patients, one patient who had successful treatment of her vaginismus with Botox injection and the other two who will be having their treatment shortly.

These courageous women have decided to publicly tell their story so that other women do not have to live with the dread of their vaginismus condition. They want the world to know that there is a disturbing secret that women live with called vaginismus. They want others to know how devastating this condition is, and how disruptive vaginismus is to their relationships.

Please click here for Rachel’s story which can be found on our website. Click her for Kelsie's story which is told in video format on You Tube.

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For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website on Vaginismus for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE .

A patient 5 days after her Botox injections for vaginismus asked when she should start keeping her journal. We ask that all of our patients keep a diary so that we can give them the proper guidance during the use of dilators progressing to intercourse. Here is my response:

Please start making notes if you notice ANY changes and record day by day. I'm not yet sure if everyone notices the change of the Kegels.

Botox begins to work at 7-10 days though in some of my patients it could be 2 weeks. Regardless of your ability to do Kegels please start working with the smallest dilator at about 2 weeks. If you are not able to do a Kegel you can start at that time. The smallest dilator does not have to go in all the way; even small penetration is a start. Use lots of lube.

Stay with the smallest dilator for a few days, then progress. Once again, the next size does not have to go in all the way the first time...and so on until you are comfortable with the largest dilator.

Once you start using dilators do keep a journal.

Though the goal of the Botox treatment for vaginismus is the ability to have intercourse, some of the other deeper pelvic muscles not injected with Botox may continue to be tight. It is likely that this is the reason that there may be discomfort and burning during the early attempts at having intercourse. The stretch that occurs with the largest dilator is helpful in overcoming any residual tight muscles and it is best to use the largest dilator for about 15-30 minutes before attempting intercourse. A loving atmosphere and lots of lubrication is essential for success.

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For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website on Vaginismus for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE . 

Vaginismus is a spastic muscular disorder of the vagina in which almost any form of vaginal penetration is impossible. It is present in a surprisingly large number of women with some reports as high as 10%. Many women complain of painful intercourse, and this is known medically as “dyspareunia”. There is a wide range of degree of discomfort and the more severe cases, often for unknown reasons, may also be covered.

In 2008 we were able to get a partial reimbursement for one of our patients who had Botox treatment for her vaginismus. Botox is also helpful for the more severe forms of painful intercourse.

Vaginismus is listed as a “sexual pain disorder” in the DSM –III-3 (American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders. Washington D.C.) We have a coding expert on our staff, and she has been able to help patients with reimbursement for those who have “out of network” coverage.

Insurance companies differ in areas of reimbursement as well as the amount they will reimburse. We have had long term frustrations with the near total lack of any consistency between companies. Nevertheless there is a ray of hope that this devastating condition will find the sympathy of some of the insurance companies.

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For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website on Vaginismus for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE . 

 A well controlled statistically analyzed research study of painful intercourse and vaginismus was reported in the Journal of Sex and Marital Therapy (29: 47-59, 2003). This Canadian study used structured questions to investigate the role of sexual and physical abuse, a woman’s self perception of her sexuality, sexual functioning, relationship adjustment and psychological distress in 87 women matched for a number of parameters including women who experienced no pain with intercourse.

They note that many previous studies are methodically flawed in the lack of use of formal statistical analysis, control groups or standardized measurements.

The authors found that women in the vaginismus group were twice as likely to report a history of childhood sexual abuse than women in the no-pain group. There was no correlation to physical trauma during childhood. Women with vaginismus were more likely to have a poor perception of their own sexuality compared to women in the no-pain group. Apart from these positive findings there were no differences in sexual knowledge, marital adjustment or psychological distress.

In our practice we have found many similarities between those women who complain of painful intercourse and women who are unable to experience any form of vaginal penetration. All of these women, regardless of the causes of vaginismus, appear to respond to intravaginal injections of Botox.

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For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website on Vaginismus for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE . 

 A well done Swedish study of vaginismus showed a high percentage of burning pain followed by itch in vaginismus patients. The spectrum of painful intercourse to the complete inability to have any form of vaginal penetration is present in a surprisingly large percentage of pre-menopausal and menopausal women with statistics ranging from 10 to 48%.

The study, published in the 2007 issue of the Journal of Sex and Marital Therapy (33:171-186) reported that light touch with a cotton tipped applicator to the vulva was perceived as a burning pain followed by itch. This was compared to a normal population of women none of whom had any discomfort with light touch.

The vulva consists of the external area of the vagina consisting of the labia, clitoris and vestibule (entrance to the vagina). Studies in the past have ignored the external discomfort that women experience in both everyday life with clothing and preparation for GYN exams, and instead have focused on the pain that occurs with vaginal penetration. This study showed a clear difference between patients who suffer from vaginismus and the normal population when something as benign as light touch with a cotton tipped applicator caused burning pain.

In our patients Botox has been successful in rapidly curing vaginismus and also in eliminating the burning and itch that some of these patients report.

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For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website on Vaginismus for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE .  

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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For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website on Vaginismus for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE . 

 A patient asked why get injections of Botox if she has to use dilators anyway before attempting intercourse.

Vaginismus is a complicated situation that has a combination of emotional overlay and physical spasm both of which make intercourse either impossible or associated with a great deal of pain and fear. Just because a patient has Botox does not mean that they are cured after the Botox takes effect.

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.

An excellent resource for vaginismus and the purchase of dilators is http://www.vaginismus.com/products/dilator_set. 

It is the COMBINATION of Botox and dilators that work better than either approach alone.

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For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website on Vaginismus for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE . 

Vaginismus is a condition of severe vaginal spasm making intercourse impossible or very painful at the least. Patients who have vaginismus develop an intense fear of any form of vaginal penetration which includes a GYN speculum examination, insertion of tampons, finger or penile penetration.

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.

We have had excellent success using Botox and repeat injections of Botox has not been necessary. One of our patients developed considerable dryness from the injections. This is related to the Botox and is temporary. We suggest that all of our Botox treated patients for vaginismus use water soluble lubricants especially for the first 3-4 months after injection, until the action of the Botox wears off.

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For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website on Vaginismus for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE .