Search Results for 'what muscles to inject'

[Bat Sheva Marcus, LMSW, MPH, PhD]

Hi. I just need to clarify, that Botox injections alone is not very helpful. In fact, if that is all that is done, you may end up more hopeless than you started.

The way we do the Botox procedure is to manually relax the spasm, complete an exam, inject Botox and a short term numbing agent, and then INSERT A LARGE DILATOR, in order to keep the muscles from having another spasm until the Botox kicks in. All of this is done under conscious sedation so your anxiety is not a factor. We then teach you how to work through the next few months. We have not had to re-inject any patients. It kills me when I hear about practices that merely inject Botox and send you home. That would be like doing knee surgery and not giving you follow-up PT instructions and after-care procedures.

Topical lydocaine should not be harmful at all if prescribed by your physician, but in our experience it is not effective either.

Good luck to you.

[newlywed]

Following up post-baby: I did it! He was 9lbs and had a head circumference in the 97th percentile, and the only meds/assistance I had was a partial dose of lidocaine injected st the entry muscles after I was running out of energy to push (first time mom…30 hour labor starting after the work day…I remember exhaustion way more than any pain or discomfort). I didn’t even require stitches afterward. Totally doable, and I loved the experience.

I saw a pelvic floor physical therapist a few times during pregnancy, which was helpful in boosting my confidence for labor and knowing which exercises to do instead of just doing standard kegels. Also, the lidocaine at the end was a brilliant move by my midwife…I’d pushed for 6 hours, and his head was out after one push once she gave me just a tiny bit of lidocaine injected into the right spot.

All that just to say, if anyone wants an unmedicated birth post-vaginismus, it is totally doable (and our sex life has been WAY better since).

[newlywed]

I had my procedure in June of 2017. I had never been able to even insert a finger, Q-tip, tampon, etc. and my husband could not penetrate me. The pain-fear cycle was so intense that attempting any insertion would nearly make me faint, but I kept desperately trying anyway.
I was very diligent with the dilators post-procedure, and was thrilled when we were able to begin having intercourse a couple of months later, and with only minimal discomfort (mostly just from certain positions or from thrusting). However, I still had to take things very slowly, maintain a lot of control, and could not find pleasure in any type of thrusting motion. I was thrilled to be able to have intercourse though and that I could even climax during it.
Fast forward a year and a half post-procedure, and I had my first child. I had a completely unmedicated birth (minus a tiny dose of lidocaine injected at the entry muscles after a long pushing phase to help those muscles relax for the final couple of pushes when I was running out of steam at the end). My son weighed 9lbs and had a head circumference in the 97th percentile at birth, and I was able to push him out without any hindrance from vaginismus! I was a bit concerned about secondary vaginismus, but my husband and I resumed intercourse as soon as I had clearance…and it has felt 10x more amazing for me than it did previously!! There is zero discomfort in any position or from any level of thrusting, I no longer have to be in control of insertion, and I am able to climax so much more easily now that things go so smoothly.

I was so discouraged prior to the procedure. The procedure, follow-up support from Maze, and dilation enabled things that seemed completely out of reach after so much effort on my own.

I hope I can be an encouragement to others. And if anyone has a desire to have an unmedicated birth after vaginismus, it’s completely doable! I also met with a pelvic floor PT a few times during pregnancy, which was helpful to boost my confidence that I knew how to work those muscles for birth.

[mazemelissa]

Hi Yami,

Welcome to the forum.

First off, botox takes a few days to start working, and does not have maximum effect until two weeks. So you are still very early in treatment.

It could just get easier, as the botox starts working more.

You should also consider finding a physical therapist to help you with the first insertion of the dilators.

We have found in our experience that just botox injections alone are often not as effective if someone does not insert the first dilator under anesthesia for you.

So many patients need help with insertion of the first dilator. It is not easy for someone with vaginismus to insert the first dilator on their own, especially when they are anxious and afraid of penetration. This is why we insert the dilator under anesthesia, so the patient wakes up with the dilator already inside.

I would not give up hope, the botox is in the muscles, and will start working soon. If you can get over that hurdle of putting that first dilator inside, it will get easier.

Melissa

[mazemelissa]

Hi WAHerman,

Sounds like your vaginal opening was sutured smaller than before surgery, which is what is making penetration very painful.

We use the botox procedure to reverse and treat tight vaginal muscles. The botox is injected into the muscles that surround the vaginal opening. I don’t think injecting botox into your vaginal muscles would have any effect on the scar tissue at the vaginal entrance.

If you want to give me a call to discuss your case specifically, I would be happy to have a phone consult with you.

Melissa
914-328-3700

[21withV]

Hi all,

I am 21 years old and found out about my diagnosis when I was 18. I went to PT for one year and tried to dilate on my own unsuccessfully with liquid and gel lidocaine and buckets of lube. I have also done talk therapy and yoga and massage. I’ve also had a laser treatment for vestibulitis as well. I have also had doctors tell me at age 18 to loosen up and drink wine (Oh what we go through to figure out our bodies!)

I recently underwent a Botox procedure under anesthesia a month and a half ago. It appears that the Botox has already worn off, and I waited too long to get started dilating due to fear of failure (ironic how that fear of failure actually brings about failure LOL). I moved up maybe to the 3rd dilator (Pure Romance set) but couldn’t get anything in further than 3 inches even when Botox was active. Now nothing will go in and the muscles are rock hard & I just end in tears with each session. I also feel myself clenching throughout the day and it seems to be a stress response (can anyone relate?!)

Anyway I will most likely be having this procedure again, but this time I will be asking my gyn to inject me with lidocaine, do progressive dilation, and wake up with the largest dilator inside. Is there a place I can find what the dilating schedule is like directly after the procedure? I’m wondering if my deeper muscles inside need Botox too? Do you ladies recommended that I go to my PT maybe the first few days after the Botox and the following weeks? I would love to do the MAZE procedure but can’t afford it on a college student’s budget when I live cross country, and my gyn has offered to do it much cheaper. If this procedure and plan doesn’t work, I think coming to MAZE will be my last resort 😪

Thanks for any help! Much love to everyone suffering through this trying issue 💓💜

[Heather34]

Hi Swimmer. I am so sorry for what you are going through. As the others have written, please know that you’re not alone with this at all and have our support. I had vaginismus all during my 20s and into my early 30s. I ended up having the Botox treatment program with Dr. Pacik in NH. Dr. P trained the Maze group and they offer the Botox treatment program as well as other treatments for vaginismus. One of the key parts of their treatment, like Dr. P’s was for me, is they focus on both the physical as well as the emotional parts of the condition and fully treat both. Also, and so importantly for me and others, they, like Dr. P, understand everything about the condition of vaginismus and do not act as other providers have in the past suggesting to “just relax”; “it’s all in your head”; etc.

I also wanted to share one of my favorite past blogs from Dr. P in which he describes both the physical and emotional aspects of vaginismus treatment:

The 1,2,3 Punch
“The first punch is the injection of Botox under anesthesia. This is the knockout punch for the spastic muscle at the entry of the vagina (the “closed fist”). It will be unable to recover for about four months. The second punch is the progressive dilation under anesthesia, stretching the tight muscle(s). Once these muscles are weakened and stretched under anesthesia, the continued post treatment dilation keeps these muscles stretched. The third punch is reduction of anxiety. It is well known that fear and anxiety play an important role in continued spasm of the entry muscle. The brain says “PAIN“, the vagina responds with a protective reflex “NO ENTRY“. Once fear and anxiety lessen and women are able to tolerate penetration as well as having comfortable pain free intercourse, this protective reflex appears to diminish, and the reflexive spasm of the vaginal muscles appears to disappear.” It goes on to describe the importance of post-procedure care: “The three punches described must be combined with careful post-procedure monitoring, which includes the review of daily logs to help patients with their post-procedure dilation program. The counseling done after treatment is of utmost importance to help women understand what needs to be done when they return home and the steps needed to succeed in having pain free intercourse.”

Please know that you have my full support.

[mazemelissa]

Hi 25 and Frustrated,

I do think your story sounds like you have a low level vaginismus, and high pelvic tone. There are different levels of vaginismus, and just because you could tolerate a speculum exam, doesn’t mean that your vaginal muscles aren’t still in a hypertonic state.

It sounds like you can insert a dilator that is as large as a penis, but still having discomfort.

I think that you have a few options at this time:
1. you can purchase an even large dilator or dildo and continue to work up in size. We find that sometimes continued dilation past the size of a penis will help with ease of intercourse. I would also dilate immediately prior to trying penetration with a penis.
2. you can try pelvic floor physical therapy. Sometimes finding a PT that can help with internal massage of the muscles will help further relax the muscles.
3. intravaginal valium suppositories can help relax the muscles. This is a prescription and you would need to find a provider who could prescribe these for you.
4. consider coming in for the botox procedure. Botox injections into the muscles will help relax them further and will help decrease the initial resistance significantly.

Keep up all the work, you are doing great!

Hope this helped

Melissa

[Mary85]

Hi there,
So I’m new to the forum and need a little guidance.
I’ve done Botox injections (not with Dr Pacik but here in Australia).
I am using the Femmax dilators (pink, rounded head) and am at size 3 (I think this is equivalent to a size 5 in the glass trainers).
So I’m almost there. I’ve been going to physio after surgery and this has been extremely helpful. She has gotten me to do active pull down stretches with each progressive size (that means put dilator in, contract muscles,big release and pull down). I’ve found this to be super helpful to stretch out the muscles as static dilation or just leaving it in there didn’t prepare me mentally enough.
I wanted to ask though, I’m now on size 3 so I’ll do the stretches with size 2 and insert 3. I’m now attempting to do the pull down stretches with 3 and although I can pull down, when th dilator comes back up, I start to feel this burning sensation and today just got painful so I took it out. I use olive oil for lubricant which has been great but need some tips/advice? Should I leave the size 3 in for longer before attempting the stretches?
Argh, this vabinismus thing can be a real pain sometimes…

[Aimee Goldman, RWHNP]

Hi Twinkle
When treating patients for severe vaginismus we use conscious sedation for our botox procedure. Conscious sedation allows the patient to be put to sleep without having to intubate.
We find that conscious sedation is extremely useful for women who can not tolerate a gynecology exam.
After the patient is asleep we then inject a local or topical anesthetic into the vaginal walls. We then massage the introital muscles to ease any muscle spasms.
Next we inject the botox. The anesthesia and massage allow the muscles to relax so that a large dilator can be inserted.
So to answer your question we use a combination of two different types of anesthesia. Conscious sedation is similar to general anesthesia. We also use topical or local anesthesia as well.

[mazemelissa]

I really love this blog post that Dr. Pacik wrote back in 2012. It is worth reading again, as I get the question all the time, “What happens when the botox wears off?”

Patients often don’t understand the concept of vaginal spastic muscles and are also confused why the spasm does not return after the Botox wears off.

“Hitting a brick wall”
In filling out their questionnaires, a surprisingly large number of patients use the terminology that attempting intercourse is like “hitting a brick wall’! This “brick wall” represents spasm of the entry muscle of the bulbocavernosum. It is much like making a tightly closed fist and attempting to push the opposite index finger into this tightly constricted muscle mass. Not possible. Neither is penile penetration. For severe cases of vaginismus, NO PENETRATION IS POSSIBLE!

The reflex of vaginismus
It is likely that the spasm of the vaginal muscles, especially the entry muscle, the bulbocavernosum, represents a reflex. The brain appears to perceive that penetration will be painful, and the vagina responds (protective reflex) with spasm which is equivalent to the body protecting itself by saying “no entry”.

Phobic avoidance
The reaction to penetration in vaginismus patients is much like any phobia. For the person afraid of heights, you have to practically drag them to high points, there is so much fear and anxiety. The heart races, they break into a sweat, they begin shaking uncontrollably and are sure they will faint. These same responses take place in vaginismus patients faced with penile penetration. This is the bodies way of avoiding a perceived threat.

Botox injections for vaginismus
When I examine patients in the operating room there is often intense anxiety that requires sedation before an examination can be done. In the very severe cases of vaginismus (Lamont grade 4 and Pacik grade 5 vaginismus) I can actually see the constricted mass of muscle at the entrance to the vagina, making it impossible to introduce my finger until they are asleep with an anesthetic. The spastic muscle is targeted with Botox injections. Any other tight or spastic vaginal muscles are also injected with Botox.

Progressive dilation for vaginismus under anesthesia
Following the Botox injections, which are done under anesthesia, the vagina is then progressively dilated using a series of larger dilators to stretch the vagina. This is left in place and the patient wakes up with usually the largest dilator. As the Botox becomes effective during the next 2-7 days, the stretching becomes easier because of the dilators.

Stretching of the tight vaginal muscles
As patients begin stretching these tight muscles they begin to understand that dilation is not the end of the world and in fact becomes easier with time. Sooner or later they make the next leap of faith having intercourse and even GYN exams.

The home stretch
Now the brain realizes it has nothing to be afraid of and this protective reflex begins to disappear. Long after the Botox has worn off, the body appears to understand it no longer needs to protect itself against the perceived pain of penetration and the protective reflex appears to disappear. I feel I can say this because as of March 2012, having treated over 160 patients during the past six years mostly with severe vaginismus, there has been no need to re-inject any patient with Botox. When patients send me their daily logs, and follow the dilation schedule, the spasm of the vaginal muscles does not appear to return in primary vaginismus patients.

Secondary vaginismus
In patients with secondary vaginismus which seems to have different causes, two patients in this time frame were noted to have three recurrences. Both patients were treated with resuming their dilation schedule and neither required additional Botox treatments.

Summary
The use of Botox and progressive dilation under anesthesia for vaginismus appears to set the stage that allows patients to continue their dilation programs and in this way overcome the spasm of the vaginal muscles which are the hallmark of severe vaginismus.

If you have any questions about our Botox treatment for vaginismus and progressive dilation under anesthesia, please contact us via our contact us form.

[mazemelissa]

I really love this blog post that Dr. Pacik wrote back in 2012. It is worth reading again, as I get the question all the time, “What happens when the botox wears off?”

Patients often don’t understand the concept of vaginal spastic muscles and are also confused why the spasm does not return after the Botox wears off.

“Hitting a brick wall”
In filling out their questionnaires, a surprisingly large number of patients use the terminology that attempting intercourse is like “hitting a brick wall’! This “brick wall” represents spasm of the entry muscle of the bulbocavernosum. It is much like making a tightly closed fist and attempting to push the opposite index finger into this tightly constricted muscle mass. Not possible. Neither is penile penetration. For severe cases of vaginismus, NO PENETRATION IS POSSIBLE!

The reflex of vaginismus
It is likely that the spasm of the vaginal muscles, especially the entry muscle, the bulbocavernosum, represents a reflex. The brain appears to perceive that penetration will be painful, and the vagina responds (protective reflex) with spasm which is equivalent to the body protecting itself by saying “no entry”.

Phobic avoidance
The reaction to penetration in vaginismus patients is much like any phobia. For the person afraid of heights, you have to practically drag them to high points, there is so much fear and anxiety. The heart races, they break into a sweat, they begin shaking uncontrollably and are sure they will faint. These same responses take place in vaginismus patients faced with penile penetration. This is the bodies way of avoiding a perceived threat.

Botox injections for vaginismus
When I examine patients in the operating room there is often intense anxiety that requires sedation before an examination can be done. In the very severe cases of vaginismus (Lamont grade 4 and Pacik grade 5 vaginismus) I can actually see the constricted mass of muscle at the entrance to the vagina, making it impossible to introduce my finger until they are asleep with an anesthetic. The spastic muscle is targeted with Botox injections. Any other tight or spastic vaginal muscles are also injected with Botox.

Progressive dilation for vaginismus under anesthesia
Following the Botox injections, which are done under anesthesia, the vagina is then progressively dilated using a series of larger dilators to stretch the vagina. This is left in place and the patient wakes up with usually the largest dilator. As the Botox becomes effective during the next 2-7 days, the stretching becomes easier because of the dilators.

Stretching of the tight vaginal muscles
As patients begin stretching these tight muscles they begin to understand that dilation is not the end of the world and in fact becomes easier with time. Sooner or later they make the next leap of faith having intercourse and even GYN exams.

The home stretch
Now the brain realizes it has nothing to be afraid of and this protective reflex begins to disappear. Long after the Botox has worn off, the body appears to understand it no longer needs to protect itself against the perceived pain of penetration and the protective reflex appears to disappear. I feel I can say this because as of March 2012, having treated over 160 patients during the past six years mostly with severe vaginismus, there has been no need to re-inject any patient with Botox. When patients send me their daily logs, and follow the dilation schedule, the spasm of the vaginal muscles does not appear to return in primary vaginismus patients.

Secondary vaginismus
In patients with secondary vaginismus which seems to have different causes, two patients in this time frame were noted to have three recurrences. Both patients were treated with resuming their dilation schedule and neither required additional Botox treatments.

Summary
The use of Botox and progressive dilation under anesthesia for vaginismus appears to set the stage that allows patients to continue their dilation programs and in this way overcome the spasm of the vaginal muscles which are the hallmark of severe vaginismus.

If you have any questions about our Botox treatment for vaginismus and progressive dilation under anesthesia, please contact us via our contact us form.

[Heather34]

Hi all. I came across an absolutely awesome thread on Reddit that describes a women’s success story of overcoming vaginismus this past December with the Botox treatment program at Maze Women’s Sexual Health. It’s such a great thread to read:

https://www.reddit.com/r/vaginismus/comments/4dzjjm/botox_cured_my_vaginismus/

Excerpts include:

“For me, the experience was AMAZING! I wish I had done it earlier, but at the same time, I did it when I was ready, so I have no regrets. I went to a place in NY state, I’ll post the link below, and they were so kind and easy to talk to. It’s a day procedure, I live out of state so I stayed at a hotel the night before. The day of, we went to the place where they do the procedure, it’s like any basic medical thing, they get you ready, give you a gown, you pee in a cup, etc. The anesthesiologist comes in and gives you an IV, and then they put you under. While you’re under (about 30 minutes or so), they numb the area, give you a pap exam, and inject Botox into the muscles. Even though you’re under, they can see the muscles spasm or tighten and also if you have a hymen, they will cut it (this causes a small amount of bleeding, like you wear a pad for a couple of days, but no pain). For me, I woke up and the largest dilator from the Pure Romance set was inside of me. This was a huge thing because I hadn’t even been able to get the smallest one in on my own before. I was numb down there, so while they taught me to insert it in and out and all that, I couldn’t feel any discomfort. They did have to cut my hymen and there was some blood, nothing scary and no pain at all. They sent me home soon after with #4 inside. They want you to keep #4 in as much as possible, even sleep with it in that night. The numbness wore off around 8:00 that night, but it was still super easy to get the dilator in and out. It took me some time to find exactly the way to guide it in, the best way to sit or lay while doing that, but once I could do it, it was in within seconds and then I was fine. I went in the next day for a follow up, they do a basic exam, no inserting anything, just looking at the area and then talk more about dilation. They gave me a prescription for lube that has lidocaine in it, but I’ve barely used it. They give you a paper with info about dilation at home, they recommend trying to do it 30 minutes a day, I would do about 15 minutes with one size, then change to the next size up. Within 2 weeks I was using the largest dilator on it’s own without the need for a “warm up” and there was no pain, no resistance, that feeling of hitting a wall was completely gone.”

[Heather34]

How can I overcome if I’m terrified of even the thought of dilators?

I was absolutely terrified of every aspect of dilating prior to my procedure with Dr. Pacik. In fact, because of this fear, I almost asked my husband to turn around on our trip up to NH. Until I went through with it, I just could never envision being successful with the dilators as I had never been able to even insert a q-tip. I couldn’t have been more wrong and was able to successfully dilate post-procedure. What helped me so much personally was waking up with the dilator in place and, later, being able to insert as I did not experience the normal wall of resistance that I always had as the Botox took effect.

Dr. Pacik addresses this very question as well and writes:

“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.”

[Heather34]

Hi Daffodil. You wrote:

“…I have been trying to move the ‘mountain’, my vaginismus, for almost 5 years. Its just this year I am given an impression that it is more in my head rather than inner thighs….”

I’m so sorry that you were given the impression that vaginismus is in your head. I have read so many similar stories and have my own story of seeking and receiving several failed treatments for vaginismus. The pain associated with vaginismus is not “in the women’s head” and does not readily respond to suggestions to “just relax”. Vaginismus is a ‘real’ physical pain and the Botox treatment for vaginismus works to address both this physical pain and to also diffuse the fear of penetration. First, the Botox injections work to weaken the tight vaginal muscles that often make penetration impossible. Second, waking up with the dilator already in place works very well to diffuse the fear associated with penetration. For some patients, such as myself, this was the first time that something was inside of me “pain-free” and, in realizing this, it entirely eliminated any anxiety associated with penetration. The uniqueness of this combined approach to vaginismus is what truly makes it work so, so well.

You also wrote:
…”Thinking how to overcome but one thing is for sure I need immense amount of Hope to find my way.”

Please have hope and know that you can and will overcome this! If you haven’t yet, please try to work with Maze Women’s Sexual Health in any way possible. In a recent post, Melissa wrote an excellent message to another Forum member who lives out of country. She writes: “We would love to treat you here in the US, as I believe the Botox procedure with progressive dilation would really be the best treatment option. If you want to speak with someone about the procedure, please don’t hesitate to call. Melissa (914)-328-3700”

I also wanted to share some wonderful quotes of inspiration with you:

“To get through the hardest journey we need take only one step at a time, but we must keep on stepping.” – Chinese Proverb

“I believe in pink. I believe that laughing is the best calorie burner. I believe in kissing, kissing a lot. I believe in being strong when everything seems to be going wrong. I believe that happy girls are the prettiest girls. I believe that tomorrow is another day and I believe in miracles.”
-Audrey Hepburn