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Topic: David and Goliath Revisited
Hi all!!! I know that several of you have your procedures coming up soon. 4 of you have posted about having procedures in May as well as July! I want you all to KNOW that you will have tremendous success and you are so strong and courageous for taking this step and the stand to defeat vaginismus once and for all.
In writing this, I keep thinking of Dr. Pacik’s blog: David and Goliath. http://www.vaginismusmd.com/david-and-goliath/
In it, he writes: “Speak to the patient. I value each and every conversation I have with my patients before treatment. It helps them understand, helps them overcome some of their anxiety and sets the stage for good communication after treatment. It always gives me some additional insights into what is going on for the patient, and once again I learn something about the struggles of vaginismus or a concept that is re-enforced. Slowly, even at this stage we are beginning to “know the enemy”. Knowledge is power. The first strike comes in the operating room. Under anesthesia, Goliath has been rendered helpless as the anesthesia takes effect and reduces the muscular spasm to nothing more than an easily stretchable muscle. The power of spasm becomes jelly. The tightly closed fist of the entry muscle disappears. Botox is injected while the enemy is unconscious. Before Goliath regains consciousness, the muscle is dilated to one of the larger dilators and a long acting local anesthetic is injected to keep the powerful enemy weak after he wakes up. This results in a crippling blow . . . BUT The enemy wakes up, and though weakened, Goliath can still rear its ugly head. The fight is now a balance between the dueling dilators of David and the powerful muscles of Goliath that have been weakened but not yet controlled. David fights on knowing that once the arrows delivering the Botox become effective he will be able to continue to weaken his opponent. The long acting anesthesia allows the patient to continue dilating for several hours after treatment, without fear. During this time David is further coached on how to overcome the enemy. Hours are spent learning how to prepare daily logs for continued follow up, how to transition from dilators to intercourse, how to become erotic once again, positions of pelvic floor relaxation to make intercourse more comfortable and how to prepare for GYN exams. Much more is taught, but these are the basics leading to victory. More knowledge, more power. Goliath is held at bay, and weakened he begins to fall. Knowing that Goliath has been weakened gives David the final determination to throw more dilators at the monstrous muscles. Continued daily logs are showing greater comfort using the dilators as anxiety diminishes. The battle at times feels long, but the powerful Goliath is weakening. It is hard to believe, but the end is in sight. David conquers and the story ends as it should. The underdog wins. Intercourse is suddenly possible without pain. It takes David a little longer to overcome the stress of the battle. “I need to catch up emotionally to where I am physically” simply indicates that any of us need to get beyond stressful times, and this may take awhile. David believed in God, and God helped him win over the giant.”
I’m here for you all and, again, KNOW that you will have tremendous success and you are so strong and courageous for taking this step and the stand to defeat vaginismus once and for all. Sending many prayers your way as well as huge hugs!!!! Can’t wait to read your future posts!!!!
Topic: Feeling hopeful
Hi all,
My name is Serina, and I am currently (as of 12/10/14) 2 days post-procedure. My husband and I have been together for 5 years, married for almost 3. To make a very long story short, we tried everything. Topical lidocaine injections/creams, other dilators, the whole 9 yards. Nothing really worked, much to our frustration. My husband did some research and found Dr. Pacik, and I made the call in early October. I’m very glad I did, because I now have hope where there was none. I feel that all my concerns were addressed (both physical and psychological), and that I will finally be able to have pain-free intercourse. I’m still in the dilating phase, and might be for a couple of weeks. My poor spasming muscles need time to rest! 🙂 But I will definitely update when we have been successful.
Topic: Elements for Success
Hi ladies. There are so many different elements that made Dr. Pacik’s treatment program work for us when countless other avenues that we tried failed. In examining this, some crucial parts were having the procedure under anesthesia and waking up with the dilator in place and also having Dr. Pacik believe me when I said any form of penetration is impossible. An excellent blog actually describes all of these elements that worked for us:
Excerpt:
The Tightly Closed Fist and the Vaginismus Woman
“If one can just imagine a tightly closed fist and then trying to insert a finger from your other hand into that closed fist – the finger cannot enter – it is just impossible – it seems like you are “hitting a wall”. This is exactly what it is like for women suffering from severe vaginismus when they are trying to dilate or having any type of penetration or intercourse.”My comments:
Instead of saying as other doctors had said in the past “just relax and try to use dilators or consume copious amounts of alcohol”, Dr. Pacik recognized the very real physical block (i.e. spastic muscles) that prevented any insertion despite how hard I willed this to happen and wanted it to work. This was so important for both my husband and I.Excerpt:
Dilation Under Anesthesia with the Botox Treatment
“Our Botox Treatment Program for vaginismus is so unique because our patients are put under anesthesia for their Botox injections and for their post-injection dilation. By using vaginal Botox injections and inserting a dilator under anesthesia, patients obtain fast and dramatic improvement. Vaginismus sufferers who previously could not tolerate being touched are able to self-dilate to the largest dilator within three hours after their procedure. They continue to self-dilate the next day even after the long-acting anesthetic has worn off, and before the Botox has taken effect. Some may even allow their partner to assist in dilating!”My comments:
I tried so hard to have an exam and wanted to but just couldn’t do it. When the doctor even touched the outside area of my vagina, my butt lifted off the table and I felt like I was going to die because of such intense fear/pain response. By being placed under anesthesia, I could finally take the first steps in overcoming vaginismus. I went from never being able to insert even a q-tip to being able to successfully insert, remove, and reinsert the largest blue pure romance dilator within hours of the procedure. My husband also assisted and we both were in shock as it was actually happening and I did not have my normal response of “no, no, no” or pulling away and retreating.Excerpt:
Seeing and Feeling the Dilator an Aha Moment
“Time and time again, we are able to witness many of our patients waking up from anesthesia and realizing that they have a dilator in place. They are all thrilled to realize that their anatomy is normal and that their body can accommodate a dilator! This is truly an aha moment — a defining moment where they gain real wisdom — wisdom that they can use to change their life! This gives me great joy.”My comments:
This truly was an Aha moment for me and one I will never forget. I woke up with the dilator in place and immediately had to use the bathroom. I took it out, went to the bathroom, and then inserted right back inside in the standing position. I couldn’t believe it and was so, so, so happy. I am not sure if I ever would’ve been able to insert the dilators if I didn’t have this moment of waking up with the dilator already inside and knowing that I was not broken and something could be inside of me and also getting used to the feeling of it. I may have been able to but I believe it would’ve been more of a struggle and I needed this moment to progress forward.Excerpt:
Success with Dilation Leads to Intercourse
“It is always uplifting to witness a woman with Lamont Level 4 or Pacik Level 5 vaginismus to wake up from the anesthesia to realize that she has a dilator in place. One of our early patients later told me that waking up in the recovery room with the dilator “flipped a switch” in her brain. Unable to tolerate any form of penetration due to intense fear, she progressed from treatment to intercourse in 12 days and sent me the following email: “Day 12: My husband & I tried to have intercourse for the first time. It actually happened!!!!!! LOL. I felt relief and so grateful that I wasn’t the one person the Botox did not work on. I feel like I have a real marriage now. I feel triumphant! Thank you God and thank you Dr. Pacik!””My comments:
The same thing happened for us – thank God and thank Dr. Pacik. We practiced with the dilators while in NH and then went home and faithfully dilated daily and then transitioned and both were, again, in awe that it happened and did not hurt at all. Going from where I was (i.e. no, no, no) to that point was one of the best feelings of both of our lives and we continue to be so, so, so grateful to Dr. Pacik and all of the staff in New Hampshire.
What elements helped this program to work for you?Topic: Press Release on Dr. Pacik
Hi all. There is an excellent Press Release just published on Dr. Pacik:
http://www.digitaljournal.com/pr/2274498
Excerpts include:
“A recent study by Peter T. Pacik, MD, FACS, shows a 90+% success rate in treating vaginismus, a condition which many health care providers fail to recognize yet effects between 1 and 7 percent of all women worldwide. This multimodal approach for the treatment of vaginismus expands on a prior FDA approval for research in this field. Treatment utilizes a combination of BOTOX® injections and progressive dilation under anesthesia as well as post procedure supervised dilation, and sex counseling.”
“The BOTOX® vaginismus treatment program continues to have high levels of success helping to relax and stretch the vaginal muscles which interfere with the ability to consummate relationships” states Dr. Pacik about his treatment program. The program addresses both the physical spasm noted in women suffering from vaginismus as well as the psychologic aspects of fear and anxiety to penetration so prevalent in this population.”
“BOTOX® alone, without the full program including post-procedure counseling and follow-up is a setup for failure as has been seen in several patients,” explains Dr. Pacik about the treatment.”
This is a wonderful Press Release. Thank you Dr. Pacik for continuing to do so, so much for women with vaginismus and for breaking down the walls of silence and isolation that so often accompanies this condition!!!
Hi ladies. There is a recent July 2014 article concerning the use of Botox to treat vaginismus:
Excerpts from the article include:
“‘Botox has the property of relaxing neuromuscular junctions of muscles when injected by bringing about synaptic transmission interruption that keeps the vaginal muscles relaxed which couldn’t be achieved by other non-invasive means, thus allowing penetration and consummation,’ explains Dr. Pandey. The injection is given under deep anesthesia to relieve women from the vicious cycle of involuntary vaginal spasms.”
First, I will say that I am so, so happy to see Botox for Vaginismus mentioned as a treatment modality in the media and commend the author for writing about it.
I also wanted to briefly note that I believe Dr. Pacik’s entire treatment program, which includes Botox injections, but also includes waking up with the dilator in place, then learning how to dilate, then counseling, and finally, post-procedure follow-up and care, really made this work for us when so many other treatments failed. Also, and so importantly, is how much Dr. Pacik and the entire staff at his clinic truly care about you and support you every single step of the way. To know that he believes in you 100% is truly one of the best feelings in the world and instills confidence and helps you to believe in yourself and achieve tremendous success.
There have been many stories about failed Botox treatments for vaginismus at other clinics and locations. Julisa from the Caribbean, had two courses of Botox treatment in her home country and both failed. No post procedure support was given. After struggling with inability to have intercourse for seven years, she received Dr. Pacik’s Botox Treatment Program for Vaginismus and achieved pain-free intercourse at seven weeks. At 3 months she writes: “I’m having intercourse 3 times a week and it does not hurt at all. I’m just a little tense in my legs but that’s nothing. I’m glad it doesn’t hurt at all. And tell you the truth, I enjoyed it the last time we did it. It was different than the other times.” This is a wonderful testimonial.
Ladies, what do you think makes Dr. Pacik’s treatment program work when other treatments have failed? How important is the follow-up support and care? For a new woman considering this treatment, what advice do you have?
Hi all. There is an excellent new article published that discusses vaginismus in detail and explores various treatment methods, including Dr. Pacik’s Botox treatment program:
http://www.refinery29.com/2014/07/71427/vaginismus#page-1
The Diagnosis
The article begins with a patient receiving the diagnosis of vaginismus.
The author writes: “My vaginal muscles were having a spasm, similar to the way the epiglottis closes entry to the trachea when swallowing food. My vagina, I thought, was smart. It was protecting me against the evils of this doctor’s plastic stick. The doctor looked concerned. “Have you had sex before?” He asked. My eyes began to water. “Yes,” I said, beginning to cry, “But, it was always painful.” Eventually the doctor told me that, along with ovarian cysts, I had a condition known as vaginismus.”
Where Does Vaginismus Come From?
The article goes on to examine where vaginismus comes from.
The author writes: “The vaginismus studies of Irving Binik, PhD, show that phobia — a fear of vaginal penetration and pain — is what causes the involuntary spasm.Professor Binik explains that it’s unknown how most phobias develop. Past traumatic experiences, which may seem like natural correlations, are not necessarily the cause.”
Treatment
The article goes on to explore various treatment methods.
The author writes:
“In 2014, the main treatment for vaginismus is a combination of physical and psychological therapies … [M]ost sex therapists start women on kegel exercises to learn to voluntarily tighten and relax that PC muscle around the vagina. From there, the patient moves on to a set of dilators … Women get used to inserting these, starting with the smallest and working their way to wider dilators.”
and
“Those with severe cases of vaginismus (who have tried the dilator method without success) have gone the Botox route. Dr. Pacik, the plastic surgeon who developed the Botox treatment program for vaginismus, successfully treated 275 patients since 2005 and continues to have a 97% success rate. Botox injections (which calm the vagina muscles, making penetration possible) are administered when the patient is under anesthesia, and a dilator is then inserted. So, the woman wakes up with the dilator painlessly inside her and finds that penetration is indeed possible. Dr. Pacik adds that “just treating with Botox is not enough…you really have to treat some of the emotional issues…””
The article is very well-written in all regards and I commend the writer for working hard to further spread the word about both the condition of vaginismus and the various treatment methods available.
Do normal women consciously relax their PC muscle during intercourse? I am asking this because my wife does not know how to control her PC muscle. Normal people relaxes their PC muscle when urinating and defecating, however, my wife said she uses her stomach muscles for these activities. I am guessing what that means is that she has to use secondary muscles to manipulate her pelvic floor. She does not know how to control her PC muscle at all, in fact, she does not even know where it exists. She also does not have the urge to urinate like most people. Normal people have the common urge in their bladder after a heavy drink but all my wife feels is that “her stomach feels bloated”. This is clearly not normal.
Currently she is able to dilate with the biggest blue and sleep with pink. The blue needs a lot of lube and a bit for force. My penis is smaller than blue but bigger than pink but is still unable to penetrate during normal sex. I am however able to just penetrate immediately after half an hour dilation with blue, but unable to thrust my penis forward. It just won’t bulge. It feels as if she is using her internal force to push me out, and she mentioned that she can’t breathe when my penis is in.
I am at a loss, and feels that this is going to be a losing battle against vaginismus. If she is unable to feel her PC muscle at all and constantly spasm her stomach muscle during intercourse, I just don’t see a solution to this unique problem. Surely there is no such thing as botox to the stomach muscle, is there?
btw, she had her botox injection in Dec 2012. Prior to that, even a Q tip cannot be inserted. After months of dilation, she managed to get from a finger to the blue dilator but progress seems to have stopped for many many months. I live in Asia and is not practically for me to travel to US to see Dr Pacik, but will appreciate any form of advice.
Here is what I emailed my GP and pharmacist friends, whose medical opinions I trust, after my wife’s surgery with Dr. Pacik (edited for clarity):
Quote:My wife’s operation went well on Day #1. Dr. Pacik and the anesthesiologist were quite professional. Anatomically there is nothing wrong with her. I was at Dr. Pacik’s side the whole ½ hour. She clearly had vaginal muscle spasms even after sedation, so vaginismus is truly a psychological and physical condition; I honestly thought she was having a seizure as Dr. Pacik penetrated with the speculum more deeply, but the anesthesiologist quickly increased the sedation. I later told that it was the craziest thing I’ve ever seen, but she was just glad she didn’t remember anything. 🙂 Dr. Pacik made me insert my finger before and after dilation to prove to me that dilation does work for stretching/relaxing the muscles, even before the Botox kicks in (which will probably occur 2+ days later). He also made me dilate to show me that there is more resistance initially, and then the dilator just “drops” in place with very little resistance.If I recall correctly, he injected 3 1mL syringes of 100 units (total) of saline-diluted Botox in quite a few points of the vaginal wall, to target the muscles diagrammed below:
[This diagram comes from Dr. Pacik’s 2011 paper from here; I wish it were in his book, as it was very helpful, to me at least.]It’s not so obvious in that diagram, but my wife had more pronounced circular rings (looked like tendons or ligaments or some kind of connective tissue) on the inner vaginal wall which appeared as though they’d connect to the corresponding muscles shown in the diagram. Viz., her vaginal wall was not completely smooth. Apparently it smooths out more with age and more sexual activity.
My wife was one of Dr. Pacik’s most severe patients, though, but this is due primarily to the anxiety she had post-op. She came off the anesthesia (which was really a strong sedative, but the amount she needed was strong enough that Dr. Pacik said he could do an operation on her) pretty content and alert, which was good. (The first thing she talked about was how she wanted to go to the mall haha). Quite a bit of blood did come out after she did the twisting and thrusting exercises with the largest dilator (6″ long and 5″ diameter) and finally removed the dilator, which was inserted before taking her off anesthesia; there was much blood because Dr. Pacik had to prick her at quite a few points to distribute the Botox evenly. She uses a 50/50 mix of surgical gel with 2% Lidocaine anesthetic on the dilators, which she is supposed to have inserted 2 hours daily, but she hasn’t been up to it due to her thinking the blood was from something ripping, even though nothing ripped, and to a burning feeling/pain, probably due to the needle pricks or salt of the Botox solution. So, although the surgery was successful, she has for the most part failed the dilation regimen so far, but it’s definitely not too late for her to make progress; it’s probably just a temporary setback. She has a good physical therapist she just started seeing before we left for Manchester who specializes in vaginismus, too.
I have to admit that I’m not usually queasy, but maybe I was not used to breathing through a face mask, plus seeing my own wife instantly succoring to the sedative, and her being strapped to the operation table, and then that there was more blood involved than I thought! (I thought there wouldn’t be any…) I felt like I went through the surgery, too! I totally lost my appetite the rest of the day, and I usually have an appetite. Thankfully, she didn’t lose her appetite at all, though. Dr. Pacik is clearly a very experienced doctor, as he maintained such composure and steadiness and worked efficiently and kept everyone else in-line.
Day 2, Dr. Pacik just talked to us all there and answered questions. Of course I ask about the female orgasm 😎 , but I’m actually really glad I did because he told me it is a peristaltic action like swallowing designed to draw the semen upwards (which sounds like a very good thing, esp. for my wife and I, as we’re trying to conceive), and this is completely different from the muscle spasms my wife often has midway through intercourse, which are more clenching.
On a more positive note, I was just so amazed how beautiful the human body is! You would think that there wouldn’t be so much intricacy and beauty in such a seemingly simple organ as the vagina. I definitely encourage the husbands to observe Dr. Pacik’s operation. You will learn something new about your wife. The more you know about her the more you can love her.
In my second email update to my doctor and pharmacist friends, I said (again, edited for clarity):
Quote:Today is day #3, a backup day that only my wife needed to use. To the surprise of the nurses and the doctor, she was able to progress very rapidly with the dilation, and with much less anxiety. Everyone was amazed and quite impressed.Considering she wasn’t able to reinsert the largest dilator on Day #2, after she took it out on Day #1, and that she couldn’t even insert the tinniest dilator at all on Day #2, her rapid progress on Day #3 all the way up to the #5 glass dilator is quite impressive.
Look at what she wrote before the operation here:
Quote:Quote on July 5, 2014, 03:59
Hello everyone,My procedure is coming up in a little over a week on July 14th. I will be traveling all the way from Arizona. I am happy that this may finally help me. But at the same time I have many worries. I worry that I don’t actually have vaginismus and that it really is all in my head. That the doctor will say that I am completely normal and just making it up. On the other hand I worry that my case is the worst ever and that my muscle will not react to the botox. That I will wake up with my muscle the same which would mean that I am so broken there is no way to fix me. I am even worried that the anesthesia wont work and and I will jump off the table that second I fee anything touch me. I know that this all sounds crazy but at this point I am just very anxious for the day to come so I can finally get thought it.
The hardest parts for her were the IV needle and reinserting the dilators, but she did both those things!