• For the right patient it works really, really well! What we have discovered is that for a patient whose pain is primarily tight muscles and who have the fear that goes with the pain, the Botox can bypass months of scary and overwhelming dilator work.
• It’s really not such a big deal. The entire procedure take 15-25 minutes and seems to have little to no side effects at all.
• “Waking up” from the procedure with the large dilator inserted is an exciting and moving experience for women who have, until then, not been able to insert anything into their vagina.
• It will not work if your pain is primarily from hormonal imbalances or structural issues.
• You really need to be ready to address the problem and face a solution if you are thinking of Botox. Otherwise, the fear of penetration is just overwhelming.
• A supportive partner can make a big difference! It’s great to have someone cheering for you.
• If you’re single and avoiding dating because of your fears of sex, Botox can change your life!

I wish more women knew about the possibility of Botox – for that matter, I wish we knew about it before we did.  But I suppose, as with most things, better late than never. But now, a year and a half later, I have to say that I’m a believer.

 
One of our recent botox patients just had intercourse with her husband after 9 years of marriage. Pretty cool, no?
 
She had been trying to have intercourse for years with no success.   She tried traditional dilator therapy and though she could insert the smallest sizes, she felt pain when she got to the medium one. It was just too severe, and the years went by…
 
Then she tried traditional talk therapy. She spent two years “doing really great work” with a sex therapist.  I question the nature of that work, since the problem was pretty clearly in her vagina and not her head. A therapist who keeps a patient in therapy for two years talking about why they can’t have intercourse instead of getting them to find more appropriate help is nearly irresponsible. But the patient found it helpful… and maybe, ultimately, the work she did in therapy gave her the courage to call us.
 
About a month ago, she found our website and, despite having to fly in from Denver for the treatment, she made the decision to do so. She called and had a phone consultation, and decided that she had spent enough time trying “everything,” and that she wanted to arrange for a Botox procedure to help her overcome her severe vaginismus.
 
She received her pre-op review from her primary care physician in Denver, and then flew in to see us about two weeks ago. She came in the day before the procedure so that we could meet her and give her a last minute consult on her feelings about the procedure, and her physical preparedness to proceed.  The next day she had the procedure.
 
This patient could not believe that by the evening she was inserting and removing a large dilator with no pain.
 
She stayed in town to see us four days later and flew back to Denver and to her husband.  A week after the procedure, they got clearance to have intercourse. It took a few tries, a little bit of coaching from our staff and a sense of humor; but by this past weekend – within two weeks of the procedure – they were really and truly having pain free intercourse.
 
Now that’s what I call a week well spent!!

Women who come to the Center generally have their own primary gynecologist for routine cervical screening.  That said, when we treat women with vaginal pain, painful intercourse or  vaginismus (a condition that results in extraordinary pain when anything is inserted  into the vagina) one of the first things that crosses our mind is, “how long ago did she have a Pap smear?”.  Women with vaginal pain or vaginismus often avoid pelvic exams and Pap screening because they fear the pain it may cause. 

If you or someone you know is avoiding a Pap because it’s impossible to imagine a speculum entering the vagina without intolerable pain, there is help.  There are different kinds of treatments – from creams to dilators to Botox injections under general anesthesia – that can help a woman take care of her health in every possible way.

http://www.annarbor.com/health/understanding-the-guidelines-for-maintaining-your-cervical-health/

When I am lecturing and trying to explain vaginismus , the analogy I use to describe how a patient feels is to compare it to what your reaction might be if I told you I was going to put a pen into your eye. 

If I said to you,”Listen, I am going to put this pen in your eye. Not to worry, it won’t hurt a bit and actually it will feel good,” you would look at me as though I had three heads and run for your life.

Patients with severe vaginismus feel that way. Often with anti anxiety medications, behavior medication, relaxation exercises we can work with a woman to help her get those first dilators in. Sometimes it just doesn’t work and it’s just too hard.

 This new procedure has the women under general anesthesia while a physician injects Botox (stops the muscles from going into spasm) local anesthesia(so that there is absolutely no initial pain) and put in a large dilator. The patient wakes up having the dilator in and that really is jumping the first few hurdles. There is still significant work for the patient. She has to work with dilators, get comfortable with the idea of inserting something into her vagina, internalize the idea that there is really no pain and then make the  transfer to intercourse.

It doesn’t solve the whole problem, but it can be a big help and relief for the right patient and we are so glad that we will be able to offer  it in our office as well.