Search Results for 'what muscles to inject'

[Heather34]

Hi Steve. I want to welcome you and your wife to the Forum. Having vaginismus and also being the partner of one with vaginismus can be very difficult and we are all here to support you and your wife.

What does everyone love or hate about the dilators?

I ordered dilators from vag.com along with a workbook and was never able to insert any of them at all. They arrived and were hard, plastic white dilators in varying shapes with no handles. I tried many times and my husband even tried to help me insert them and they would never go in as I was in extreme and burning/stinging pain with any attempt. We both felt as if we were hitting a wall which we found out later, after researching and studying vaginismus and talking to Dr. Pacik, is the entry muscles to the vagina going into spasm and preventing entry. I had the Botox treatment program in 2011 with my husband by my side. After the procedure, I woke up with the largest blue dilator inside of me and my husband and I were both in shock that something was able to be inside of me and did not cause any pain whatsoever. Then, up in the office in NH and also when we returned home, we both noticed that this wall of resistance that I spoke of dissipated following receiving the Botox and this made insertion entirely possible. So, I was able to insert the varying sized dilators and stretch my vagina and then, within 1 week, we were able to have pain-free intercourse. We are now over 3yrs post-procedure and have an enjoyable and pleasurable sex-life. Concerning specific types of dilators, I used the Pure Romance Silicone Dilators following my procedure as the glass ones were not yet available. I found the silicone material to be very comfortable and I liked that they had a handle on the ends for insertion and removal. Once the glass dilators were created, I ordered a set as, at the time, I still felt more comfortable dilating prior to ob/gyn exams. I loved the glass ones and found them to be even more comfortable than the pure romance set. They are shorter in length which makes doing things while dilating possible (i.e. shopping, driving, etc.) and they also have the helpful handle. I want to share the link for the second issue of the VaginismusMD Newsletter with you that discusses all-things dilating. Specific topics include: Styles and Materials of Dilators, Getting Started with Dilation, Anxiety Control, Advanced Dilation Techniques, and Transitioning to Intercourse. http://www.vaginismusmd.com/vaginismus-resources/vaginismus-newsletter-archive/ins-outs-vaginal-dilation/

Concerning question 2 and 3, I wanted to share an excellent post from one of Dr. Pacik’s treated patients:

Palmtree: “I had tried several different things (laparoscopy, dilators, physical therapy, trigger point injections, lidocaine, etc.) prior to Dr Pacik’s procedure and nothing solved the problem or even helped the problem. My husband and I got to the point where there was no intimacy and we were just two people living in the same house like roommates. I was trying everything I could to fix myself, but he just didn’t understand and he wasn’t giving me the support that I needed. I felt like a freak and I thought I was going to lose my husband because I couldn’t give him a normal sexual relationship. We sat down and had a heart-to-heart one day and I explained how important his support was and that we needed to work together to overcome this problem. From that point on, my husband was very supportive. He was the one who actually found Dr. Pacik’s website. I had my doubts at first because I had tried so many things already and they had all failed. I had already tried dilators without much success, so I feared this procedure would fail too. I was really nervous the night before the procedure, but Dr. Pacik and his staff are one of a kind. When I arrived for the procedure and met the other women who would be getting the procedure done at the same time, I finally felt like someone understood what I had been going through for years. It is an amazing thing to go through the procedure with other women who have had similar struggles and truly understand what you are going through. My husband was with me during the procedure and it really was an eye-opening experience for hime to witness just like Dr. Pacik said above. The combination of the Botox and the dilators and Dr. Pacik’s instruction proved to be the successful combination! It has almost been 4 months since I had the procedure. The Botox has worn off, but I’m still able to dilate without a problem and my husband and I are enjoying the sexual intimacy that we dreamed of. Contacting Dr. Pacik was the best decision we could have made. You are not alone! This forum is full of ladies who understand you and can empathize with your situation.”

If you haven’t already, I would encourage you to contact Dr. Pacik and work with him in any way possible. We did and it was the best decision of our lives and, just like Palmtree above, it worked to cure my vaginismus when nothing else that we tried did. Sending you and your wife support.

[Heather34]

Hi lauxo. I, too, am so, so happy you have found Dr. Pacik’s website and this forum. The Forum is a tremendous avenue of support as so many of the girls are either going through or have gone through exactly what you are experiencing right now and we are all here to support you. I, too, struggled with vaginismus for several years and the majority of my relationship and marriage prior to finding Dr. Pacik’s treatment. I tried several other treatments prior, including using dilators on my own, PT, biofeedback, etc. and nothing worked. Thus, I was convinced that this, too, would not work. My husband, on the other hand, wanted to try it and we did … thank God. We had the procedure on June 27th and were able to have pain-free intercourse on July 4th and continue to enjoy such. There are so many different elements that I believe made this program work when all of the others didn’t and Dr. Pacik himself was definitely the biggest factor. In addition to being kind, caring, and compassionate, he is also incredibly knowledgeable about all aspects of vaginismus and the symptoms experienced, including heightened anxiety and the physical resistance feeling with any attempted insertion. I want to share one of my favorite Blogs from Dr. Pacik with you:

Vaginismus Treatment – The 1, 2, 3 Punch: http://www.vaginismusmd.com/vaginismus-treatment-the-123-punch/

Excerpts include: “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 we are all here for you. Sending support and hugs!!!

[23years]

I would say I am going to keep this short, but I’d be lying. There is nothing short about this – so if you can get through this, God bless you. But what I am about to say could potentially help so many women with self doubts or any doubts at all. Right now, I am helping me, by venting about an AWFUL HORRIBLE experience I had today in which I feel horribly victimized YET AGAIN by the horrible medical profession that is “so called” designed to help women and their health (rolling eyes).

You see, if you don’t know me, a brief introduction would let you know I have suffered for TWENTY THREE years with vaginal pain, pelvic pain, vulvodynia, vestibulitis and the big “V”. I was diagnosed in 1993 by the “so called” professionals. The next three years were spent going through guinea pig treatments, including surgeries, throwing vinegar on my skin like salt on a canker sore (only worse), having Bartholin Gland injections (without anesthesia, local anesthetic and without being prescribed pain meds for the aftermath). Well why should I have been? It was all in my head anyway right? It wasn’t a “real” condition right? And, for the “so called” professionals? Their penises still worked so they could go home at night, sleep well, eat well, exercise right and HAVE SEX with their partners and girlfriends OR BOTH – – so it wasn’t THEIR problem right? I was the one with the problem right? And for TWENTY THREE years I have had the same OBGYN. I have been SO loyal to him, it was important to me, after going through four years of IVF to conceive my daughter (not because of the big V, because my husband had zero percent morphology), it was important to me that my OBGYN of TWENTY THREE years deliver my baby.

Today, I wanted some of that same loyalty back. I wanted someone to support me, to understand, to embrace my solution and my answered prayers. But I didn’t get that. I got a harsh dose of reality. Today, I went for my yearly examination as I always do every year and saw my OBGYN, as I do every year, but this time, with a light in my eye, I was going to excitedly speak to him about the prospect of being cured! I was excited…until I was met with the harsh reality.

You see, I stopped talking about my pain, my sex life (or lack thereof) with my OBGYN some time in the 1990’s. WE stopped talking about it. HE stopped asking! I didn’t complain anymore so let’s face it, there was nothing for HIM to try to fix was there? But I have suffered in silence for long since he had forgotten that his patient of TWENTY THREE YEARS, who met her partner in 1999, who married in 2002, who started infertility treatments in 2003, who suffered through four rounds of IVF, who delivered her baby in 2007, THAT patient STILL HAD THE BIG “V”. But the harsh reality? Wasn’t his problem right? Was mine right? There wasn’t any solution anyway right?

The medical journals continue to pour out, the conferences continue, the “so called” experts still meet for their golf games, their royal balls, their expert conferences. They have developed new pioneer ways of treating the big “V” right? They have developed laser treatments! They have decided that you can only use one type of laser because the others burn your healthy skin and not just the painful skin right? Well how did they determine this? They had to have women to practice on right? They didn’t practice on goats right or sheep? So, while they are rubbing elbows at their conferences, finding new “solutions” for their patients, “I” have been going on with my life for TWENTY THREE YEARS with no cure, in silence, suffering, BUT…..living. And other women are being experimented on and these “so called” experts – they haven’t really helped people. There are no cures out there. Okay maybe they have helped minimize the big “V” for……..hmmmmm……..some people…….MAY-BE but I’d like to see the list, the forum where I can talk to them, the place where I can get the support from these women who have been cured. I bet I won’t find any!

So my “so called” expert sees me today at my yearly exam. My expert says to me, “I hear you are getting surgery. What kind of surgery are you having?” I laugh at him and say, “Are you kidding me? I wouldn’t be discussing a foot surgery with you!” And then it’s all down hill from there. My joke is lost on the seriousness of the situation and the ignorance of this expert. I point out Dr Pacik’s letter to him (I asked Dr Pacik to write me a letter, which he did after hours, painstakingly, to assist me to speak to my physicians) and I ask him to read it. The expert asks me why Dr Pacik had to write me a letter. I tell him I have suffered in silence for TWENTY THREE YEARS with my condition and I couldn’t tell people. His reply?……………….”Well, why not?”

I wanted to scream so loud but instead I steadied myself, sitting half naked on the exam table…vulnerable as I was…”Because I have lived with embarrassment, shame, guilt, feelings of low self esteem…” He nods his head as if pretending he cares. I am starting to cry. I can’t believe he doesn’t get it. TWENTY THREE YEARS this expert has been my physician. I thought he understood. In the 1990’s he advocated for me…to his peers. Alas, finding no solution. Once again, the expert begins speaking, “I have looked at his website, it’s SLICK”. I can’t believe my ears. He goes on, “He is a plastic surgeon, I don’t know him, I can’t write a referral for you, my organization of fathers of gynecology won’t allow me to do so, I can’t advocate for a procedure and a physician I know nothing about”. These are the words I hear. The expert continues, “You know in California, people are going into plastic surgeons to have their G-Spots enhanced, their labia professionally done and there is a lot of criticism about this in my profession”…………….”Stop!” I say to him, “Are you kidding me right now? I am not going to Dr Pacik for G Spot enhancement, labia reduction, libido enhancement, a tummy tuck, my breasts augmented! I am going SO THAT I CAN BE NORMAL!!!!!!!! I am going to have my vaginal spasm reduced to a whining, crawling shivering nothing so I can have SEX with my husband!” The expert nods again as if pretending to care…

Then he says it. “You don’t have vaginismus you have Vulvodynia”. I tell this expert, “Really? Because my skin doesn’t hurt me anymore around the opening to my vagina!” He exclaims, “No?” and then adds, “Well then you must have EVOLVED”. Is that a medical term? I want to punch him in the face. I can’t believe what he is saying. “Evolved?” I ask, “What do you mean by that?” He can’t answer me. I go on to educate this expert that my pain is more at six o’clock (you see I am speaking his language because the experts of gyno see your vagina as a clock) So, if you hurt near your bum, it’s six o’clock. If you hurt near your pubic bone, it’s twelve o’clock. So I continue, “It has hurt me around 12 o’clock but this hasn’t been for many years – it now hurts most at six o’clock”. He is looking very puzzled and curious that I have never mentioned this perhaps.

Then I ask him the loaded question, “WHEN WAS THE LAST TIME YOU ASKED ME HOW I FELT? WHEN? WHEN WAS THE LAST TIME YOU ASKED ME ABOUT MY SEX LIFE?” He is stumbling so I assist him with the answer….” IN THE 1990’s!!!!” So I tell him I gave up. There was no cure for me. I was tired of being poked, prodded and probed. I was tired of the “so called” experts telling me they could cure me only to see that they can’t. And then…………I found a little girl working at a salon near my home…………….who just happened, just so happened, to have been one of Dr Pacik’s patients. And for ONE YEAR I listened to her talk about herself. I asked curious questions about this so called “Vaginismus” and bravely, I finally confided in her that “I” too had this condition and had suffered with this for TWENTY THREE YEARS. She encouraged me to contact Dr Pacik. And I did. And it’s been a roller coaster of emotions since then and I faced my fears, I came out to all my physicians, told my whole story, robbed myself of all my clothes, standing naked in front of everyone, confiding in strangers that I had no sex life, that I was “broken”……..”down there”. Split wide open like a huge wound gushing forward and spilling out over everything. I had nothing left. And, I felt VERY LIBERATED….until now…until today….when my “so called” expert saw me for the first time in one year and talked to me about Dr Pacik, a man whom he knows nothing about, about Botox which he knows nothing about, except that it helps painful muscles spasms, and whose website he calls “SLICK”. And here he was making me doubt my own integrity, my own intelligence, my own faith in humanity, by telling me he would be cautious, that he wouldn’t jump into surgery at the “astronomical” cost of it, that there was no long term follow up and no way of knowing if this would help or not and then telling me, in not so many words, that perhaps Dr Pacik had lied about being FDA approved! And then, he puts insult to injury……he calls me “DESPERATE”.

“Desperate?” I repeat the word to make sure I heard my “so called” expert correctly. He doesn’t answer, not even making much eye contact at this point. And then I say again firmly, “I HAVE BEEN SUFFERING FOR TWENTY THREE YEARS WITH THIS CONDITION. I HAVE GONE TO ALL YOUR EXPERTS, I HAVE DONE ALL THE GUINEA PIG TREATMENTS”………..and then I whisper, crying, “Desperate?” “NO”, I say, “I am not desperate, I have gone on and lived my life, despite nobody being able to help me. I have a strong marriage, despite being “broken” and I have had a healthy child, a professional, human helping, job, a Masters Degree and two national certifications, despite the BIG V. “No”, I say to him, “I am not desperate. Desperate was Marjorie Lee Wantz when she became Dr Jack Kavorkian’s SECOND assisted suicide in 1991. My expert raises his eyebrow now. “You didn’t know?” I ask him, “Look it up”. I go on to educate him that Dr Kavorkian helped a woman in 1991 to end her life living with “chronic pelvic pain” (you see that’s what the experts like to categorize you as when they can’t come up with a definitive diagnosis or definitive resolution – they just lump you under the umbrella of pelvic pain). And poor Marjorie Lee Wantz had an autopsy after she died and even in death the EXPERTS said “it was all in her head” because “no pain disorder” could be found. You know why? Perhaps? I mean I don’t have a crystal ball but poor Marjorie Lee Wantz could finally RELAX. Her pelvic muscles weren’t all spasm in protective fashion after so many guinea pig treatments. She finally could rest – in death. SAD…

So, after leaving my OBGYN office today, I cried and I felt victimized once again by a medical profession who cares more about Viagra and Penis Health than a woman’s body and woman’s right to be perfectly normal – as ‘they’ are…and with nobody to turn to and nobody who understands, I take a chance…and I call Dr Pacik’s office. My gut can’t be totally wrong can it? And I ask the secretary who I can speak to about a “situation” that happened today…and I get Ellen, Dr Pacik’s surgical assistant and I tell her this whole story, not in such eloquent fashion – but in a more angry, saddened, disappointed and let down fashion. And she educates me. She explains how Dr Pacik started and she tells me, from her heart, how they became who they are, how they ended up starting, how Dr Pacik has put so much of his own money down to help people like YOU and LIKE ME. How Dr Pacik has been through litigation and had to fight those “so called” experts because they have taken him to court, accusing him of mutilating women of victimizing women! BUT the reality? I haven’t felt more supported since happening, accidentally, across Dr Pacik, and his Team of people. I haven’t felt any light of hope on curing the BIG V until I was introduced to Dr Pacik in April of this year.

And the reality? Nobody else in the NATION is helping women like YOU and like ME other than Dr Pacik. Nobody is taking the time, developing the skills or even TRYING to help women like YOU AND LIKE ME. Believe it.

I can’t tell you I will have success with Dr Pacik as I haven’t undergone the surgery yet. My surgery is scheduled for June 30th. But I can tell you this…in TWENTY THREE YEARS nobody has cared about helping me or trying to help me or cared about my feelings or asked about my feelings or how my husband feels or how WE are doing…until I met Dr Pacik and his Team. And, certainly nobody has cried with me, as Ellen did today, silently, as I spoke about my feelings. Because they get it. At the very least Dr Pacik and his TEAM GET IT.

June 30th will be my surgery date. I will embrace this date and work hard and go through the process because I believe in the work Dr Pacik is doing, even before I have met him or been through his program. I believe in it. After all, what do I have to lose? I have already lost TWENTY THREE YEARS of a normal healthy sexual life and no EXPERT has cared until I met Dr Pacik and his Team. And no matter what happens, I will stand steadfast that Dr Pacik and his wife Janet (who helped Dr Pacik refine his technique with her outside point of view and fresh look at the situation) are doing a WONDERFUL thing by continuing to assist women like me (just this one starfish) because it matters to me in my life and so it matters in theirs…

WE ALL DESERVE TO BE SUPPORTED AND LOVED AND BE HEALTHY

[heather123]

Thanks for the advice Becca 🙂

Did you say you flew “back” to NH? Or did you mean when you flew back home to Seattle?
I wasn’t sure if you had to go back for another procedure.

I figured after the procedure when the injections force the muscles to stand back/relax, the grip on the dilator inside won’t hurt as bad at all.
At lesst I would think that how it goes……

Yeah, my husband and I have been using Slipper Stuff gel for a while now so I’m glad someone else recommends it for this situation.

Did you have to have the dilator in on the plane??? haha…just figured that any girl flying more than an hour back home should be comfortable at least 🙂

~Heather

[Heather34]

Hi ladies. I came across the following article: Dyspareunia: The Menopausal Problem No One Talks About

http://voices.yahoo.com/dyspareunia-menopausal-problem-no-one-talks-about-5092597.html

“The problem of dyspareunia during menopause is a topic most women don’t want to talk about, but this condition affects up to forty-five percent of women at some time during their menopausal years. Dyspareunia is the medical term for pain during sexual intercourse; and, unfortunately, this condition is on the rise as more women choose not to use hormone replacement therapy. The problem of dyspareunia can be especially trying for women since men are staying sexually active later in life with the help of medications such as Viagra. Some women never seek treatment for this condition due to embarrassment or the belief that nothing can be done to help their symptoms.

What Causes the Symptoms of Dyspareunia?

Dyspareunia is most frequently caused by declining estrogen levels which causes a condition called atrophic vaginitis. As estrogen levels fall, the lining of the vagina starts to thin and produce less lubrication which makes intercourse more painful. Women who haven’t had children, those who smoke, and those with lower estrogen levels have the most severe symptoms of dyspareunia. Symptoms of atrophic vaginitis include burning, itching, and, occasionally, a vaginal discharge. The easiest way to treat this condition isn’t always the safest – estrogen supplementation – which most women want to avoid due to the risks and side effects.

Other Causes of Dyspareunia

The problem of dyspareunia isn’t always related to atrophic vaginitis. Infection in the vaginal region, urinary tract infection, and even some types of vaginal skin conditions can be associated with dyspareunia. Some creams, lotions, or birth control products cause irritation in the vaginal region which can lead to discomfort with intercourse. Some women also experience dyspareunia from painful spasms of the vaginal muscles when intercourse is attempted. This can be due to anxiety or even a history of sexual abuse. Sometimes endometriosis or a tumor in the pelvic area can give rise to dyspareunia. Because there are so many potential causes, it’s important to get this symptom checked out by a doctor.

Treatment of Dyspareunia: What Works and What Doesn’t

Estrogen replacement therapy isn’t always the answer to treating dyspareunia even if a woman is willing to overlook the health risks. Only about one in four women experience relief from the symptoms of dyspareunia when they start estrogen replacement. When the symptoms are due to atrophic vaginitis from lack of estrogen, using lubricants can make a difference as can keeping the vulvar region moisturized. Some sources recommend certain herbs or phytoestrogen containing foods and creams to relieve the symptoms of dyspareunia, but there’s little evidence that they work. Sometimes simply changing position during intercourse can make the experience more pleasurable and less painful for women with dyspareunia.

For women who have symptoms of dyspareunia due to spasms of the vaginal muscles, special exercises used to train the vaginal muscles to relax can help as can stress relief techniques. A new treatment for vaginal muscle spasms is the use of Botox. Preliminary studies show that it’s effective for many women and has few side effects.

Dealing with Dyspareunia: The Bottom Line?

Don’t let the problem of dyspareunia keep you on the sidelines. Find out why you’re having it and get appropriate treatment.”

Dr. Pack has written an excellent blog concerning Menopausal Vaginismus:

http://www.vaginismusmd.com/menopausal-vaginismus/#sthash.zyqHMuxV.dpuf

He writes: “intercourse is possible but often results in pain and burning after, which is called dyspareunia. Artificial lubricants seem to do a poor job replacing natural lubrication. As the condition gets worse, the patient appears to develop vaginismus, and when examined, appears to have the same spasm of the entry muscle as seen in the primary vaginismus patients.The spasm can be treated with the Botox program, which includes Botox vaginal injections and progressive dilation under anesthesia together with post procedure counseling as is done in our primary vaginismus patients.”

I encourage you to read the article on dyspareunia and Dr. Pacik’s blog and I welcome your comments and feedback here.

[Heather34]

Hi ladies. I came across the following recent 2014 article:

http://www.theguardian.com/lifeandstyle/2014/jan/13/unable-have-penetrative-sex-with-husband-vaginismus

This is a very interesting article and also has many recent comments (126 total) from others affected by vaginismus.

Excerpts include:

“Over the past year I have been unable to have sex with my husband. The problem began a year ago when penetration started to be painful. It now seems I completely tighten my lower muscles and my husband is not able to enter me. I’ve never had this problem in 30 years. I am past menopause and have never had children.”

Regarding menopausal vaginigmus, Dr. Pacik has written:

“Menopausal Vaginismus, which is a common cause of painful sex at midlife and beyond, is initially caused by the dryness and thinning of the vagina due to a drop in estrogen. When a woman has less estrogen, there is less vaginal lubrication; the vagina is less stretchable and more prone to tearing. This results in the menopausal woman feeling vaginal tightness during sex with pain, burning and/or soreness. In many cases, the problem starts with small tears called microtears that cause inflammation and irritation leading to more discomfort and bleeding of the tissues with any penetration of the vagina. During this time, intercourse is possible but often results in pain and burning after, which is called dyspareunia. Artificial lubricants seem to do a poor job replacing natural lubrication. As the condition gets worse, the patient appears to develop vaginismus, and when examined, appears to have the same spasm of the entry muscle as seen in the primary vaginismus patients.The spasm can be treated with the Botox program, which includes Botox vaginal injections and progressive dilation under anesthesia together with post procedure counseling as is done in our primary vaginismus patients.”

For the ladies who have experienced menopausal secondary vaginismus and have gone through Dr. Pacik’s treatment program, what have been your experiences? Would you recommend it to others? Also, what dilators would you recommend using and why?

[Heather34]

Hi ladies. For those of you who have your procedures coming up in 2014, I wanted to share one of my favorite Blogs from Dr. Pacik: Vaginismus Treatment – The 1, 2, 3 Punch:

http://www.vaginismusmd.com/vaginismus-treatment-the-123-punch/

Excerpts include:

“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.”

I entirely agree that all of the combined steps of the treatment program along with the post-procedure care are what makes it work so well and be so effective in curing vaginismus. For me personally, once the first and second punch occurred, the third immediately followed. Specifically, once I woke up from my procedure with the largest dilator in place and knew that I could remove and re-insert it without any pain whatsoever, my anxiety was immediately reduced from around a 10+++ to close to nothing. The more that my husband and I practiced with the dilators this day and the more we saw first-hand that I was experiencing no pain, again, the less anxiety I experienced about future penetration. I knew that if worked this time, it would always work and practicing with the dilators truly does re-train your brain. I no longer experienced this pain/fear with insertion that I had experienced for so many years. I wish I could explain it in better terms but it simply disappeared once I experienced pain-free dilation for the first time.

To the veterans reading this right now, do you believe it was a combination of first punch, second punch, third punch, and post-procedure care that worked for you? What specifically would you like to share with a future patient who may be reading this right now and who may also be considering having this treatment done but is not sure? Any advice that you have would really help.

[Heather34]

There have been many stories about failed Botox treatments for vaginismus at other clinics and locations. For example, in Julisa’s story, it was noted “this patient lives on one of the Caribbean islands and failed to make any progress with two sets of Botox injections. After her treatment, she was not instructed in the use of dilators and given no follow-up support.” What truly makes Dr. Pacik’s Botox treatment work is the entire combined program (i.e. the well placed Botox injections into the spastic muscles, progressive dilation under anesthesia, supervised dilation in the recovery area, post procedure counseling, and careful follow-up and support post-procedure). And, most importantly and what made it work for me, was 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.

I can’t stress enough how important the after-care and post-procedure counseling was for me. Through the use of daily dilation logs, you become accountable for your own change. It helps both you and Dr. P to track your progress and also address any challenges and it aids so much in the success of the program as a whole.

To the treated patients or ‘veterans’ reading this, how important was your after-care communication post-procedure?

[Heather34]

Hi bosox2004. I seriously KNOW that you will have tremendous success tomorrow and you are so strong and courageous for taking this step and the stand to defeat vaginismus once and for all. You wrote “I’m more nervous of the actual procedure than anything else … I just keep telling myself that it will be over before I know it.” It will be over with before you know it and this nervousness is such a common feeling to have pre-procedure and one that I certainly shared with you. I was incredibly nervous but held on to the hope that it would work and I would prevail.

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 bosox2004 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!!!!

[Heather34]

Hi ladies. In a prior post, this week, there was a question about having the procedure without a partner and using the dilators thereafter without intercourse. This is such a common feeling and please know that you are not alone with any of this at all and so many of Dr. Pacik’s previously treated patients have felt so similar in the past.

In a prior thread, the following has been written about these very concerns:

Patient 1: I’m wondering if I could hear from other women that went through the procedure without a partner and what their experience was like. I’m also curious how you ladies went about practicing intercourse afterwards without a partner.

Patient 2: I had my surgery in early July 2012. My cousin attended with me… and after surpassing the initial nerves, I felt comfortable and great in NH during and after the procedure. Getting used to the dilation process was interesting… and stressful in the beginning, but I was determined to make progress and follow through on Dr.P’s program. Upon returning from surgery, I was determined and continued with the program. I got purple in, pink and got blue in only a few times with lots of difficulty. My muscles were extremely tight and Dr. P mentioned that it would take me a while to stretch them out with dilation. A little less than a month after surgery, I had the opportunity to spend some time with the guy I was seeing and although I was nervous (about vaginismus, not about him) I pretended that “it’d had been a while” and I wanted to take it slow. He totally understood and we were able to achieve penetration on our “first” physical night, with little pain, lots of excitement and a lot of fun! Since then, it’s been getting better as I’ve learned to understand what I like, feel less nerves and become a bit more open with myself… he still has no idea about my struggles with vaginismus, and every now and then comments on how much better it is “now that we know each other”. I sometimes dilate a bit before I see him, but sometimes I don’t if I don’t have much time. While in NH I had the opportunity to see two great husbands with the patients that were sharing my room… they were concerned for their wives and doing everything to help them. I have also heard of wonderful partners that have gone through a lot to support their wives and girlfriends through the struggle – I think that is amazing! In some ways, I think it’s really very difficult for single women to enter into that surrounding without the same support… after all, all women are there because they want to be loved (pun intended 🙂 and when you don’t have that directly by your side, it’s hard not to feel self concious.. jealous… or even stressed. Regardless though, on the flip side, I think that in some regard, there’s an advantage to being single – you don’t have to tell any new prospects in your life about your struggles with vaginismus (if you don’t want too) and there is a bit less pressure to perform. You move at your own pace and do what’s right for you… and in some ways, that’s very freeing and liberating. Hope this answers your questions and concerns about being single and going through pre and post surgery. All the best to you (and all the other single ladies out there). I definitely feel for you… and understand what you are going through. Be positive, dilate and be strong (-:

Patient 3: First of all, I want to say you are in great hands! Dr Pacik and his team are incredibly compassionate and knowledgeable – they have changed my life. I’m single and was at the time of having my procedure in September last year. The opportunity for intercourse hasn’t arisen yet, and I’m still nervous at the prospect, because the last time for me was with my long-term boyfriend at the time (before I started having difficulties with Vaginismus). So I completely relate to your concerns about the first time. But once you have the procedure and are able to dilate, I’m sure you will feel a lot less nervous about it. Before I had it done I couldn’t even allow myself to think about dating again, let alone sex. Now that I dilate every day, with ease, I feel like intercourse will just be a natural progression when the time comes. I think I’ll take a similar approach the previous post and say “it’s been a while”…this will both gauge his patience and let him know you need to take it slow. If he’s not willing to do that it’s better to find out early, before sharing something so personal and misunderstood. I also just want to reinforce the importance of dilating – make time to fit it in, especially when you’re single. It keeps progress going (and anxiety at bay). All the best for your procedure, it’ll be smooth sailing! 🙂

In addition to this thread, Dr. Pacik has also written a great blog too: http://www.vaginismusmd.com/vaginismus/dilation/single-and-dilating/

He writes: “A number of my patients are single, yet they succeed in the treatment program. Once the Botox has been injected into the spastic muscles, continued dilator therapy is key to success and ultimately intercourse when the woman is ready.”

Please know that we are all here to support you and in your journey of overcoming vaginismus. In addition to the stories noted, I would love to hear from other women who have completed the treatment without a partner or while their partner was deployed? What were your experiences with dilation post-procedure and prior to having intercourse?

[Leena]

I wasn’t sure I wanted to use my real name in my user name, so I chose another, but I now feel that I can be honest and open here. My name is Michele, and it is nice to meet you.

I’m 44 years old, and I’ve never been able to have sexual intercourse. At first, I didn’t know having sexual intercourse was a problem for me because I wanted to wait until I was in a loving, committed relationship. That took me to the age of about 26, when, although I was in a relationship I wasn’t quite sure if I loved him but felt it was a step I needed to take. When I was unable to have intercourse with him, I figured it was because I didn’t really love him. I remember feeling the “wall” that so many people with vaginismus refer to, but I thought it was because I just didn’t really want to do it. Over the years I’ve tried additional times, but the wall issue continued, along with great fear.

I’ve never been able to insert a tampon or a finger or have a successful gynecological exam. I’ve tried, but I haven’t been able to, and I get very nauseous and feel faint when I think about it too much. The only time I have been penetrated was under anesthesia, when I had to have a D&C and hysteroscopy (insertion of a tube into the uterus) due to twice-monthly periods (which wound up being caused by hormonal fluctuations due to early menopause). After the surgery, the doctor told me I was very tense during surgery and made a sign with his hands as if my muscles were in spasm. But he never mentioned anything about vaginismus so I figured I didn’t have it. After surgery, and for days afterwards, my vagina felt as if the muscles had been all torn up. It was excruciating. Whenever I moved my legs, I felt the strong tearing feeling again. It was the same when I tried to sit down, though a donut pillow helped a lot.

I’ve never been able to maintain a romantic relationship for very long. The longest was 10 months, but it is usually less than 3 months. I’m sure this is for a number of different reasons, but not being able to have sexual intercourse is a really big one. I now feel that I will never be able to have another romantic relationship because at this age I am sure the men I would meet would expect full sexual intercourse fairly quickly and would not have much patience with me. I know that people say some men are not like that, but those are few and far between in my experience, and I have other issues such as depression and mood swings and a lack of self-esteem in romantic relationships that seems to change my personality with men and undermine me in my attempts at romantic love.

Frankly, I feel like a loser. Like I’m not a real woman. Like I’ll never be able to have another romantic relationship. And it makes me so sad. I’ve spent most of my life out of romantic relationships and don’t really feel I need to have one to define who I am, but it would be nice to have the option for a lot of reasons – intimacy, enjoyment, companionship, to name a few. I have sexual desires and in the past have seemed to be quite sexual with partners and enjoy physical intimacy, including oral sex, but not including any type of penetration. I’ve felt a bit better reading this site, but I feel like I would be one of the few who would not be a success story. I actually felt so much better when I read another woman’s post that said she felt that way after treatment but then was able to have intercourse with her husband.

I first heard about vaginismus several years ago on an episode of the tv show Private Practice. It was a little bit of hope, but then I couldn’t find much information on it, and I thought that must be something different from what is “wrong” with me. I felt mine must be all psychological. The next time I heard about it was on Tyra Banks’ talk show a few years later. That is when I really felt this could be what I have. When one woman explained the “wall” feeling, I could hardly believe it. So many things the women talked about resonated with me so strongly, and that had never, ever happened to me in my entire life with this problem. I started to research it again and this time found some information, but the more I read about the dilators, the more nauseous and scared and hopeless I became. At times I wanted to try it, but then I would just get so scared and nauseous I would put it out of my mind and continue with my celibate lifestyle. From time to time I would look online to see if there were any resources that might help me, like an online support group where I wouldn’t feel so alone in all of this. I found one once, but I never joined it. Then I found a video on YouTube of Dr. Pacik explaining the procedure of putting the patient under anesthesia so she is asleep (yes!), injecting botox and then a dilator, and then leaving the dilator in so she wakes up with it inside her (yes!). This was the first time I thought that a treatment might work for me. Then I looked further into it and learned that the patient then needs to continue to put dilators in on a regular basis herself, and I kind of freaked out again, feeling there is no way I can do this and feeling nauseous again, like I might throw up at any second. I also saw that a lot of patients had a husband or boyfriend to accompany them on this process, and for me I feel that I would need to solve this problem on my own before I could even get a boyfriend at this point in my life. Even the word boyfriend sounds silly to me at my age – there should be another word 🙂 But the thought of dilating on my own waiting for a boyfriend to come into my life is not something I feel comfortable with. So I’m writing here for two reasons, I guess. To share my story and to put it out there for comments and helpful suggestions. Could I be a candidate for successful treatment even though putting in dilators myself after surgery seems impossible to me and not at all something I would even want to do. If I get past that fear, I think I’d have a hard time doing all the dilating without having the opportunity to have intercourse.

My other concern is one of cost and insurance coverage. Though I haven’t reached out to get a quote yet, I am not currently working. It sounds like some of the better insurance plans cover some of the cost, but I am sure this must be expensive (though certainly worth it, if one has the means). Dr. Pacik likened treating vaginismus to treating erectile dysfunction in men. I think that is so true, and I never thought of it that way. I think it is important for insurance companies to have parity with regard to treating sexual dysfunctions. In this regard, I wonder how can we lobby insurance companies, or put pressure on them, to cover treatment of vaginismus at the same levels as treatment of erectile dysfunction?

I actually became very emotional reading through the posts on the forum. So many women voiced my biggest fears – like “what if I am one of the few this treatment won’t work for?” or “I cannot imagine being able to use the dilators on my own”. This was very comforting. I got kind of teary several times – sometimes when I read these types of posts that comforted me, made me feel less alone, and gave me some hope; sometimes when I started to get scared when I actually imagined trying to do the treatment and all the courage it would take for me to do it and what would happen if my hopes were dashed by failure – could I even take that kind of let down; and some tears were from all of the emotions I’ve experienced around this condition over the course of my life – from not knowing about it and thinking it was just me to believing I just won’t have this kind of relationship in my lifetime – and all the pushing down of these feelings because they were too painful, confusing,embarrassing, or overwhelming to deal with. No matter what happens in my case, I see Dr. Pacik as a real blessing to women with vaginismus. His treatment method, the continuum of care, and all of the information and sharing across his website, especially in the forum, feel like real miracles to me. I’d like to thank Dr. Pacik, his team, all who have shared their experiences, and all who read this post for your support. It does help me feel a bit of hope and not so alone in this condition which has been so heartbreaking to me for so many years.

[Heather34]

Hi Rachel. I found an excellent resource article written by Dr. Pacik – http://www.plasticsurgerypa.com/organization-lectures-ssss/

I had the honor of being invited to teach a continuing education course on vaginismus at their Eastern Regional Meeting, June 5-7, 2009. The 1-1/2 hour course was an excellent blend of therapists interested in learning about the cure of vaginismus using Botox and dilators. Two hour continuing education courses were presented at the 2010 annual Las Vegas meeting and the 2011 annual Houston meetings titled “An Overview of Vaginismus: Etiology, Diagnosis, and Treatment with Botox and Dilators under Anesthesia: Physicians and Sexological Clinicians Working Together for Healing” I was impressed by the large turnout for these educational sessions, and pleased that more and more heath care professionals want to learn about vaginismus. The audiance was very engaged, and each of the two-hour sessions went by very quickly.

The abstract that the attendees recieved was as follows:

“Vaginismus is an involuntary, uncontrollable contraction of the pelvic floor muscles surrounding the vagina occurring when any penetration is attempted, even a finger or tampon, causing severe pain, burning, and fear. Vaginismus, the main cause of unconsummated relationships, impairs or prevents gynecological examination and has serious personal and social implications for the sufferer. This condition is under-reported; its extent is unknown, but it is far more common than previously believed, now thought to afflict one to six percent of women worldwide. These women, often maintaining a wall of silence and isolation, are in desperate need of treatment. Because many physicians and clinicians are misinformed or unfamiliar with the symptoms, causes, and scope of sexual pain, sufferers of vaginismus who do seek help are often misdiagnosed and inappropriately treated.

The syllabus included:
1. Clarification of painful intercourse from dyspareunia to vaginismus, and the effects of these on the lives of individuals and couples, will be presented.
2. Lamont’s classification of vaginismus, a system identifying severity levels of the condition and impacting determination of treatment, will be reviewed.
3. Issues discussed will include medical conditions: possible causes that may need ruling out; updating terminology: clarifying a plethora of misconceptions, terms used, and differences among similar conditions, including vulvodynia and vaginismus; reasons for failure, despite often prolonged use, of conservative treatments; description of minimal penetration intercourse, a strategy which allows some patients to transition from dilators to intercourse without fear; and pelvic floor anatomy with illustrations, terminology, and conceptual understanding of the underlying anatomical problems.
4. Treatments to be discussed include emerging researched approaches using Botox and vaginal dilation under anesthesia, combined with post-procedure care and counseling. A review of case histories with audience participation will elucidate types of counseling needed for this population both before and after treatment. Over 90% of women treated with Botox and dilation were able to achieve pain-free intercourse within two weeks to three months and required no further treatment. Prior conservative treatment received, some for as long twenty years, had failed. In addition to medical treatment, most patients benefit from clinical sex counseling for quality of life, mental health, relationship issues, and to support a comfortable transition from dilators to intercourse. Among the 10% of women who do not transition to intercourse easily, most are successful with dilators, but concomitant relationship and sexuality issues require additional sex therapy.”

I give you my full permission to use my story as one of your case studies. I suffered with primary vaginismus for as long as I can remember. I was never able to insert a tampon and tried numerous times while in high school. I then went off to college and began my first committed and long-term relationship. We tried several times to have intercourse and it was absolutely impossible. It even hurt terribly bad when he tried to insert a finger and was impossible. We were both in our early 20s and he broke up with me because of our inability to have sex. Thereafter, I met my husband when I was 24 years old. I fell so in love with him and thought that sex would now somehow magically work because of my intense feelings. It didn’t. We tried and tried and every time, he said it felt like he was hitting a wall and I felt this terrible pain, burning, resistance feeling. Also, my body would physically withdraw from any touch at all in the area because I learned to associate it with terrible pain. I tried many times to sabotage the relationship and to push my husband away, but he didn’t move even an inch and was truly my one and only support and my rock while enduring this time. I reiterate that he was my one and only support during this because I lied to all of my close friends and family or simply did not tell them what we were going through. I wanted to be similar to all of my friends who spoke of their great sexual relationships with their boyfriends/husbands while the whole time suffering in silence with this huge problem. We were intimate in other ways (i.e. kissing, touch, oral sex, etc.) but I often felt like a failure because I wanted so badly to be able to have actual intercourse. For many years, I ignored and put off this problem. To this day, I don’t know why I put it off for so long, but at the time, I truly believed that it would somehow just go away on it’s own and the next time would be different. The next time was never different despite my preparation (i.e. booking a romantic getaway, wearing a sexy costume, etc.). It always caused excruciating pain with any touch and sex was simply impossible. I finally took the step to visit a gynecologist at the age of 29. While my husband wanted to support me and go with me, I didn’t want him to and wanted to simply visit the doctor and fix “my” problem and then everything would be fine. I went to the appointment alone, telling absolutely nobody about it, and it was one of the worst experiences I’ve ever had. I researched the symptoms I had on-line, including excruciating and burning pain with ANY attempt at penetration (i.e. tampons, fingers, penis) as well as the feeling like every time I tried to insert anything (even a q-tip), I couldn’t get past the wall of resistance and nothing would go in. I had no pain whatsoever with touch on the outside area of my vagina and also while wearing tight clothing. After researching the symptoms that I both did and did not have, I determined that I had vaginismus. I printed out my symptoms described and an abbreviated handout about vaginismus. When I got to the gynecologist’s office, I was incredibly nervous (i.e. sweating, feeling like I was going to pass out, rapid heartbeat, etc.) just while sitting in the waiting room. This was the first time that I had ever experienced anxiety/panic simply from visiting a doctor and it felt horrible and frightening. I then went into the exam room and undressed, while still feeling all of the physical anxiety symptoms described but now intensified to the highest degree. When the doctor came in and we met for the first time, she asked me what I had been experiencing. It was incredibly difficult for me to explain to her my symptoms of vaginismus while being so nervous, so this is why I had written them out in advance. I gave her a copy of my symptoms and how they correspond to a diagnosis of vaginismus and also provided her with the abbreviated handout on vaginismus. She didn’t read any of what I had written nor the information about vaginismus and just placed the papers to the side. She then asked me to try to relax and she would do the exam. I could not relax at all and when she got even close to touching the outside area (skin), I almost jumped off of the table and felt a sharp, stinging, burning, excruciating pain. She was very frustrated and said, “I’m not even near your vagina and you can’t even relax.” She tried the exam again and I had the same reaction, except I was crying at this point. She told me to get dressed and we would speak in her office. I was so embarrased and just felt so humiliated at that moment. I got dressed and went into her office, trying very, very hard to not cry. There, she told me that I had vulvodynia and she would not see me again nor ever try to perform an examination until I visited a sex therapist that she recommended. She said she believed that I had some serious issues that needed to be sorted out there and, only after receiving this treatment, would she be able to examine me. I left this appointment feeling so ashamed, embarrased, and humiliated. I never returned to see her again nor did I visit her recommended sex therapist. I continued on-line research about vaginismus and ordered dilators and a workbook. I completed every step of this workbook and tried every single night to insert the q-tip, the smallest type of tampon, and the smallest dilator and nothing would go in without the same burning/stinging pain and the feeling like I was hitting a wall. I then tried pelvic floor physical therapy but I could not make any progress with stretch and dilation because I couldn’t insert anything. This was an epic fail and I gave up hope that I would ever find a cure. I felt several emotions during this time as did my husband. He was constantly supportive and my rock but I felt like the condition was really hard on our entire relationship/marriage. The years passed and I became concerned with age as we both wanted to start a family together. This prompted me to continue researching vaginismus on-line and through yahoo forums. In May of 2011, I was fortunate enough to see a new post from one of these Forum members about Dr. Pacik and his comprehensive treatment program, which included Botox injections which progressive dilation as well as counseling. Finding this treatment provided both my husband and I with a hope that we hadn’t had in so long that we could finally put this behind us and this would work. I underwent the procedure in June 2011 at the age of 34 with my husband right by my side. Concerning the emotional aspects of this treatment program and vaginismus as a whole, Dr. Pacik and his staff treated us like no clinician ever had and we could feel in our heart and know that they cared so much. I experienced a tremendous amount of anxiety pre-procedure and this was addressed in consultation as well as office communication. I even remember bringing my handouts about vaginismus to our consult and Dr. Pacik taking the time to read what I had written and to also listen to my story and then thoroughly explain vaginismus and the procedure. I asked so many questions and they had so much patience and, again, really cared. My anxiety was further addressed on the day of the procedure as I was able to receive a tremendous amount of support from Dr. Pacik and the staff prior to the procedure. I was also given IV Verced prior to going into the procedure room and this worked magnificantly to relax me. All of my physical symptoms of anxiety that I had experienced during my first terrible visit to a gynecologist weren’t there and I felt relaxed, supported, and ready to face vaginismus head on. I had the procedure and remember waking up with the largest dilator inside of me. This was the first time in my life that something was inside of me. My husband and I were both in absolute shock but so happy. I felt like I wasn’t broken and it really felt surreal that a large sized dilator was inside of me when I wasn’t able to insert a q-tip for so many years. I then relaxed in the recovery room with heated blankets and my husband sitting right by my side and holding my hand. I then practiced removing this dilator and re-inserting it. It was liberally coated with lidocaine/surgilube and the resistance feeling that I had always had (i.e. the brick wall) wasn’t there. I could now insert, remove, and reinsert these dilators. I then slept with the medium sized dilator in the evening of day 1. This did not cause physical pain but I simply felt strange at times because something was inside of me and a little uncomfortable/sore at times. I found that taking a Tylenol PM helped me a lot this night. On day 2, I returned to the office and practiced, again, inserting, removing, and reinserting the 3 medium to largest sized dilators. Also, on day 2, Dr. Pacik and Ellen provided us with comprehensive counseling regarding tips for transitioning to intercourse and building our intimacy within our marriage post-vaginismus. I recall returning home and practicing very hard with the dilators. I dilated for 2 hours per day and every other night and sent Dr. Pacik and his staff daily dilation logs which also addressed any issues that I had post-procedure with discomfort as well as anxiety. Thereafter, on July 4, 2011, seven days post-procedure, I dilated for 2 hours with the largest blue dilator and my husband and I decided to try intercourse. We both decided that there was no pressure if it didn’t work. We were intimate with the dilators and he removed the largest blue dilator and gently inserted himself in. It went right in with NO resistance and we even tried thrusting. WE DID IT AND FINALLY ACHIEVED INTERCOURSE!!!!!! Thereafter, it took us 3-6 months until we got into a rhythym and discovered how to turn robotic and just-happy-to-be-working intercourse into pleasurable love-making. This step also required post-procedure follow-up and communication with the office which helped greatly. Today, I am 100% cured from my struggles with vaginismus and believe in my heart that this never would’ve been possible without a physician and staff who truly cared and all of the important elements of the treatment program.

[Heather34]

Hi ladies. One of my greatest fears pre-procedure was dilating (see my above post). How would I ever be able to dilate when I hadn’t been able to even insert a q-tip in the past without the feeling like I was hitting a wall and pain/burning. I was simply terrified of everything about the dilators. Dr. Pacik has addressed this fear and writes the following:

Q. I am terrified of even the thought of dilators. How is it possible for me not to have pain with dilators? “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.”

To the veterans reading this, what was your greatest surprise with dilation post-procedure? For those patients who were successful using dilator kits on your own pre-procedure, what was the difference you noticed in using the pure romance and/or glass dilators post-procedure???

[Heather34]

Hi ladies. Dr. Pacik was recently asked to participate as a “Guest Author” on Jane Murphy’s vaginismus blog:

http://www.myvaginismusstory.com/blog/2013/07/29/insurance-coverage-for-treating-vaginismus-with-botox/

In his posting, the issue of insurance coverage for vaginismus treatment was re-visited and is so very important:

“A frequently asked question concerns insurance coverage for vaginismus using the Botox treatment program. Since there is much more to treatment of vaginismus than injecting the spastic muscle(s) with Botox it follows that a delineation of treatment plans will be helpful in getting coverage. Many of my patients have failed to make progress using dilators. For severe vaginismus, dilation can be a form of torture! Little to no progress is made despite the support of physical therapy and counseling. Nevertheless this is covered by most insurance companies. It is for this reason that progressive dilation under anesthesia, as a part of the Botox treatment program for vaginismus, is carefully documented in the operative summary. In addition counseling is frequently covered, and the counseling we do as part of the program is also delineated as part of the medical record. The counseling includes instruction in using the dilators effectively to help stretch the vaginal muscles and transition to intercourse. This is made easier because of the Botox injections. Most of my patients are able to achieve pain free intercourse within weeks of the treatment. Though the Botox injections may not be covered, enough information is provided regarding other forms of therapy during the treatment program that often patients receive about 1/2 to 2/3 insurance coverage. We work with Diane, an experienced third party insurance biller, who has been very effective in helping women with vaginismus get reimbursement. She can be reached through my office in Manchester, NH at 603 669 0290.”

There are several additional posts concerning insurance coverage for vaginismus treatment. One of my favorites is a post from the husband of one of Dr. Pacik’s previously treated patients:

“We were fortunate that our insurance covered Dr. Pacik and his office. His practice was in our insurance network! When we had our procedure done, a wonderful lady named Diane Tremblay filled the insurance for Dr. Pacik’s office. She was awesome! She made sure that we would get as much of a refund as possible. We had to pay up front for the procedure, but in about a month, we got our insurance reimbursement. After going to Manchester, and meeting the wonderful staff, I would have paid for the procedure regardless if the insurance covered or not. The work that they’re doing is remarkable in my opinion.”

In a prior post, we discussed how insurance may be now more likely than not to cover the procedure based on the new DSMV name for vaginismus – genito-pelvic pain/penetration disorder. What other questions do you have regarding insurance coverage? To the veterans, what has been your experience receiving insurance coverage? Has anyone taken out a private loan (i.e. through CareCredit, etc.) and then paid this back with your insurance reimbursement check? I would love to receive your comments and feedback here regarding insurance coverage for this treatment.

[Heather34]

Hi ladies. I read an interesting article concerning the differing views of vaginismus from surgeons, gynecologists, and psychiatrists.

http://www.thedailybeast.com/articles/2010/03/27/the-female-sex-pain-mystery.html

Excerpts from the article include:

“Pain during sex affects millions of women, and the medical community’s explanations for why it happens seem nearly as numerous. Gynecologists have treated sufferers with everything from vaginal insertions to Botox. Surgeons want to solve the problem with a scalpel. Psychologists prescribe anti-anxiety meds for it. Despite centuries of study, it’s an area that remains in dispute.Stacie, a stay-at-home mom in Nova Scotia, Canada, struggled with sex-related pain for years. She says that she’s seen a shrink who convinced her that her problem was simply a symptom of anxiety. “Doctors automatically think it’s stress,” says Stacie. “They say, ‘You’re too stressed out, just relax.’ I’ve seen a psychiatrist and all he really wanted to do was to prescribe pills.” She’s tried a handful of different antidepressants to no avail and is skeptical of the idea that she has a psychiatric condition. “I have no doubt that there’s something physically wrong with me,” she insists. “I know it’s not in my head.” Binik doesn’t think the idea that pain during sex might have psychological roots should serve as license for providers to write it off. “I don’t have much sympathy for doctors who say, ‘It’s all in your head.’ If it’s used in a dismissive sense, that the pain doesn’t really exist, that’s very unfortunate.” But he still believes that some type of pain/penetration disorder is worthy of inclusion in the DSM, an assessment bolstered by the fact that cognitive-behavioral pain management, a form of psychotherapy that focuses on relaxation and mental control techniques, has been shown to reduce pain during sex significantly. But since talk therapy doesn’t work for every sufferer, a range of other treatments of varying effectiveness have been tried. One of the most controversial is Botox. In a 2004 study by Shirin Ghazizadeh at the University of Tehran, 18 of 24 vaginismus sufferers were able to have relatively pain-free intercourse after a single series of Botox injections to the pelvic region.”

I think this is an interesting article for so many reasons. First, I never knew that vaginismus dates back to 1880 (Sims article). Second, it is interesting how the doctors and clinicians treating this condition have such a different opinion as to what they believe works and what doesn’t work. I have read so many of your stories and testimonials and have experienced myself both a doctor and clinician saying “why don’t you just relax” and “it’s all in your head” when I described my physical symptoms of vaginismus (i.e. every time I went to insert anything, the feeling like I was hitting a wall). I appreciated what Binik wrote “I don’t have much sympathy for doctors who say ‘it’s all in your head if used in a dismissive sense, that the pain doesn’t really exist, that’s very unfortunate.” I believe that vaginismus does have a significant physical component that should be recognized and acknowledged. In the final sentence, the 2010 article discusses Botox as being a controversial treatment yet goes on to note it’s effectiveness.

In a prior post, the husband of one of Dr. Pacik’s treated patients who is a psychiatric nurse, discusses both the psychological and physical aspects of the condition and their post-procedure success:

“A very long story short: we went for treatment, and I saw everything. It is amazing how someone can display muscular spasms and attempt to avoid treatment even under anaesthetic. This underlines the “involuntary” nature of this debilitating condition. Rachel did not feel a thing; she was not aware of anything whatsoever. Yet, she was attempting to resist treatment during the procedure. This is not a problem that is attributable to mere psychological constructs or defense mechanisms. There are psychological components to vaginismus, most definitely. However, this is an essentially physiological condition which is reinforced by the following: lack of education, distorted perceptions and beliefs, rumination, catastrophising. The initial memory and pain of intercourse triggers and maintains these psychological constructs, which simply reinforce the problem. So there is a cognitive element to this condition. However, the root of the problem is not psychological. Rachel had the treatment. She dilated in no time at all. She had inserted the dilators without problem. I had even inserted the dilators without problem – into Rachel that is!!! Where was the impossibility now? Rachel thought that she was too small. Rachel thought that nothing could “get in there”. Now, she had the biggest dilator inside her. The problem is no longer a problem, and Rachel was walking around Portland like a duck with the evidence inside her vagina. So, when the psychological conflicts arose, there was no evidence to substantiate or validate their claims. Rachel and I knew it. We went home, back to Canada. We followed the golden rule of “tip only intercourse”. No problems. Why? The botox has temporarily paralysed Rachel’s vaginal muscles so that she cannot spasm. This has given Rachel time to get over the so-called physical impossibilities and her unsupported psychological constructs. Rachel now knows that she is not too small; she now knows that she does not need a hymenectomy; she now knows that she has a normal vagina; she now knows that she can insert a dilator that is the size of an erect penis. The “arguments” in her head have been levelled to the ground. We have now even had full intercourse.”

In the past, I, too, was told to “just relax” and “it’s all in your head”. Despite hearing this, I persevered and had Dr. Pacik’s Botox treatment program and was able to have pain-free intercourse within 7 days. Has anyone else been told by a doctor or clinician to “just relax” or “it’s all in your head”? What is your advice to other women currently suffering with vaginismus who have also been told this???