Search Results for 'what muscles to inject'

[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???

[Kesa]

Dear all,

For such a long time now I have read this forum in anticipation of the day that I could join the ranks of you brave ladies, and now sitting here having had the botox I feel quite overwhelmed and out of my depth.

I live in Europe and the option of coming to the states was never feasible given my finances. I’m 30 years old and have primary vaginismus so I could never insert a single thing, no matter how small into my vagina. In an act of kindness I can never repay my husband used all his savings to pay for private botox treatment. Due to my doctors lack of availability the whole thing happened so quickly and 2 weeks ago today I had the botox under general anaesthetic. Unlike Dr Pacik’s program, I did not have dilation and I was told to wait for 10 days before attempting penetration which was somewhat confusing given the way Dr Pacik does it. I followed this advice and for the past four days I’ve been inserting the smallest dilator, although only for 15mins at a time (but i can move it in and out without a problem) The burning sensation and psychological fear is still there, but the muscles give way! It’s a miracle!

I’m starting to panic though. Reading these stories of how other women could have sex within the first two weeks has disturbed me as i’m nowhere near ready to insert something as big as a penis. I also fear that the botox will wear off before I get to the stage where I can accommodate the largest dilator. On the net as well, I read a blog by a women whose doctor told her that most women need 3 injections before they can achieve intercourse. That is not a possible for me.

All in all, I think I will try to use the dilators for much longer and try to sleep with it in at the weekend before moving up a level. What my husband has given me is the most precious gift of all and i’m so grateful. For years I suffered with depression and abused drugs to block out the impact this condition had on my life. I just pray that this works…

Thanks for reading and any suggestions would be greatly appreciated x

[Heather34]

Hi Chocolate. In a blog in which Dr. Pacik discusses the spastic muscles, it provides an excellent explanation of how this program works to help patients overcome level 5 vaginismus and this is how it worked for me.

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

This is exactly how it felt every single time I tried to insert anything in the past (i.e. intercourse, speculum for ob/gyn exam, plastic dilators, and even a q-tip).

Next, he writes:
“The reflex of vaginismus: It is likely that the spasm of the vaginal muscles, especially the entry muscle, the bulbocavernosum, represents a reflex. The brain appears to perceive that penetration will be painful, and the vagina responds (protective reflex) with spasm which is equivalent to the body protecting itself by saying “no entry”.
Phobic avoidance: The reaction to penetration in vaginismus patients is much like any phobia. For the person afraid of heights, you have to practically drag them to high points, there is so much fear and anxiety. The heart races, they break into a sweat, they begin shaking uncontrollably and are sure they will faint. These same responses take place in vaginismus patients faced with penile penetration. This is the bodies way of avoiding a perceived threat.”

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

I know that I’ve written about this extensively but this was seriously the turning point for me in overcoming vaginismus. When I woke up with the largest dilator in place, I knew that something was able to be inside of me pain-free and it worked to change my whole mentality.

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

This, again, happened for me following the procedure. I was able to practice taking the dilators out and re-inserting them and each time, felt more and more comfortable and confident with this. Again, once I woke up with the dilator in place and knew that it had worked and I was able to re-insert it pain-free, I knew that anything would be possible. We made the transition to intercourse within 1 week. Thereafter, I had my first successful ob/gyn examination.

Dr. Pacik finally describes the home stretch:
“Now the brain realizes it has nothing to be afraid of and this protective reflex begins to disappear. Long after the Botox has worn off, the body appears to understand it no longer needs to protect itself against the perceived pain of penetration and the protective reflex appears to disappear.”

This is exactly what happened for me. Once I woke up with the dilator in place and practiced taking it out and reinserting it, my way of thinking changed from the fear/pain response to “this works and does not cause any pain.” The same thing occurred with both intercourse and ob/gyn exams.

I had very severe Pacik/level 5 vaginismus and could never insert a thing without this fear/excruciating pain response. Today, I am able to have pain-free gynecological exams/tests and my husband and I are enjoying a pain-free and wonderful sex life, all something I never could’ve even dreamed of prior to this procedure.

Please know that I am here for you 100% and always will be. Sending Hugs!!!

[Dr. Pacik]

Hi Chocolate

You raised a number of points in this very valuable exchange of information. You and the others reading this should understand the role of hymenectomy. The main problem with vaginismus is spasm of the vaginal entry muscle. Therefore the treatment needs to address this spasm which is Botox, dilators and post procedure counseling, or dilators alone with counseling in less severe cases. Though the hymen may be a problem, and sometimes I find the need to release the hymen (fairly rare), hymenectomy in of itself will not cure vaginismus. Feeling your muscles going into spasm when kissing confirms your diagnosis of vaginal spasm. This is much like suddenly getting a “Charlie horse” when other muscles in the body go into spasm. “Hitting a wall” is also a very common complaint. All this speaks to muscle spasm and therefore the diagnosis of vaginismus. The inability to have a GYN exam further confirms the diagnosis. A doctor who is able to insert only one finger (or usually no finger when the muscle looks and feels like a tightly closed fist) could be an indication of a tight hymen, but when combined with the proper history, the diagnosis should be muscular spasm rather than the need for a hymenectomy. (A recent patient had both a hymenectomy and an episiotomy (cutting into the vagina) which is sometimes done during childbirth to widen the canal). Of course none of this helps because the diagnosis of spasm was missed. When women are anesthetized to have a GYN exam, the spasm disappears and they are told “everything is normal” which doesn’t help anything other than creating more confusion. I would love to hear from some of the others further discussing these points.

We routinely send brochures to any patient requesting them to give to their doctors and I often speak to other doctors to help them understand. The treatment needs to include the psychologic manifestations in that it is not so easy to overcome the fear and anxiety of penetration in patients with severe vaginismus. This is why Botox alone does not cure the problem because vaginismus women need much more than just injections. I hope this helps. I would be happy to review your questionnaires and discuss my thoughts with you.

[Heather34]

Hi ladies. There is an excellent new blog posted today concerning the importance of distinguishing vestibulodynia from vaginismus.

Excerpts include:

“Women are often told that vestibulodynia is what causes the pain on attempted penetration when the real culprit is vaginismus and associated vaginal spasm.”

One of my patients writes:

“I self-diagnosed that I had vaginismus. I never considered myself to have vulvodynia or vestibulodynia, but I can see how my doctor could misinterpret this pain during a GYN exam because of my high level of anxiety. I mentioned vaginismus to my doctor and she thought I was talking about vulvodynia or vestibulodynia and seemed unaware of vaginismus.”

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

“Dr. Pacik continues to have in excess of 90% cure rate using Botox for vaginismus and has noted that associated vestibulodynia disappears, as the patient is able to achieve intercourse.”

Ladies, I believe this is a very important thread. Were you ever misdiagnosed with vulvodynia or vestibulodynia when you, in fact, had vaginismus?

[Heather34]

JoNel Aleccia, senior writer for NBC News, wrote an excellent article about Dr. Pacik’s Botox Treatment Program for vaginismus.

http://bodyodd.nbcnews.com/_news/2011/02/25/6125525-botox-for-your-bits-shot-may-smooth-over-sex-problems?lite

Excerpts from the article include:

“To treat [vaginismus], Pacik injects the muscles at the entrance of the vagina with Botox, which works as it does in the face, interrupting nerve impulses and allowing the muscles to relax. “When I inject them, I put them asleep,” he said. “You would not be able to approach these people with a needle.” When they wake up, the women find that they are relaxed enough to allow penetration and, soon, to have normal sex with their husbands or partners.”

The article goes on to further reference the successful use of Botox to treat another sexual pain disorder, vulvodynia:

“[Pacik’s] work was echoed this week by a new report in the journal Archives of Dermatologythat said a 26-year-old woman was cured of vulvodynia, an excruciating, persistent burning vaginal pain, with the use of botulinum Toxin A injections.”

This is an excellent article about Dr. Pacik and his Botox treatment for vaginismus that was written by the senior writer for NBC News ladies. Amazing!!! I would welcome your comments and feedback concerning this important article.

[Heather34]

Hi ladies. I was thinking about more helpful tools for those transitioning to intercourse. One thing that may be very helpful to do is to use the regular dilators for a while (an hour or two) and then, after dilating, to also use the Lelo. It’s very comfortable and even smaller than the pink dilator. It also has many different speeds and controls which can serve as a wonderful distraction and also a great source of relaxation for even the most anxious patients.

Concerning the distraction part of using a vibrator, Dr. Pacik writes:
“Clitoral vibration makes both dilation and intercourse easier (and more fun). If the clitoral stimulation is too strong, the vibrator can be placed on the lower abdomen. When I give Botox injections into the facial muscles, I routinely use a dental vibrating toothbrush (without the brush) to help distract my patients during the injections.”

Concerning the relaxation part of using a vibrator, Dr. Pacik writes:
“The Lelo Liv is a very appropriate vibrating dilator for our vaginismus patients. We highly recommend the Lelo Liv because this vibrating dilator allows the vaginal muscles to be stretched while reducing stress and promoting relaxation. To use the Lelo Liv, make sure it is very lubricated, turn the vibrator down to the lowest setting and insert it slowly. Move the vibrator in and out being aware of which sensations you enjoy the most. Many of our vaginismus patients do well combining vibrators with dilation before transitioning to intercourse.”

For the veterans reading this, would you also recommend the Lelo? If so, why and how has it helped you?

[Heather34]

I personally found the blog to be very informative as I previously had Pacik/level 5 vaginismus. This definitely helps to explain the severity level (i.e. a type of phobic reaction with the fear of heights example). I still find the whole thing incredibly fascinating (i.e. how I could go for so many years of my life with such severe vaginismus and no insertion whatsoever to being able to make love to my husband within a week of the procedure). It’s just wonderful that Dr. Pacik can help those women who suffer from this most severe form of vaginismus and really give them their lives back!!!

In a blog in which Dr. Pacik discusses the spastic muscles, it provides an excellent explanation of how this program works to help patients overcome level 5 vaginismus and this is how it worked for me.

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

This is exactly how it felt every single time I tried to insert anything in the past (i.e. intercourse, speculum for ob/gyn exam, plastic dilators, and even a q-tip).

Next, he writes:
“The reflex of vaginismus: It is likely that the spasm of the vaginal muscles, especially the entry muscle, the bulbocavernosum, represents a reflex. The brain appears to perceive that penetration will be painful, and the vagina responds (protective reflex) with spasm which is equivalent to the body protecting itself by saying “no entry”.
Phobic avoidance: The reaction to penetration in vaginismus patients is much like any phobia. For the person afraid of heights, you have to practically drag them to high points, there is so much fear and anxiety. The heart races, they break into a sweat, they begin shaking uncontrollably and are sure they will faint. These same responses take place in vaginismus patients faced with penile penetration. This is the bodies way of avoiding a perceived threat.”

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

I know that I’ve written about this extensively but this was seriously the turning point for me in overcoming vaginismus. When I woke up with the largest dilator in place, I knew that something was able to be inside of me pain-free and it worked to change my whole mentality.

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

This, again, happened for me following the procedure. I was able to practice taking the dilators out and re-inserting them and each time, felt more and more comfortable and confident with this. Again, once I woke up with the dilator in place and knew that it had worked and I was able to re-insert it pain-free, I knew that anything would be possible. We made the transition to intercourse within 1 week. Thereafter, I had my first successful ob/gyn examination.

Dr. Pacik finally describes the home stretch:
“Now the brain realizes it has nothing to be afraid of and this protective reflex begins to disappear. Long after the Botox has worn off, the body appears to understand it no longer needs to protect itself against the perceived pain of penetration and the protective reflex appears to disappear.”

This is exactly what happened for me. Once I woke up with the dilator in place and practiced taking it out and reinserting it, my way of thinking changed from the fear/pain response to “this works and does not cause any pain.” The same thing occurred with both intercourse and ob/gyn exams.

Ladies, I had very severe Pacik/level 5 vaginismus and could never insert a thing without this fear/excruciating pain response. Today, I am able to have pain-free gynecological exams/tests and my husband and I are enjoying a pain-free and wonderful sex life, all something I never could’ve even dreamed of prior to this procedure.

[Heather34]

Hi K. Howard. I love the title of your post “renewed hope” and thank you so much for sharing your story. I seriously 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. You wrote “I am nervous yet extremely hopeful.” This 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 K. Howard 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.

[Heather34]

Hi ladies. There is an excellent new blog posted that thoroughly describes the three components of treatment (i.e. 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 is 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.

Ladies, what have been your experiences with the combined 1-2-3 program along with the aftercare component?

[Heather34]

Hi ladies. I have read so many of your stories and have my own story of seeking and receiving several failed treatments for vaginismus. How many of you have heard a doctor or clinician suggest to “just relax”, “don’t think about it”, or “just do it”? The pain associated with vaginismus is not “in the women’s head” and does not readily respond to these suggestions. Vaginismus is a ‘real’ physical pain and the Botox treatment for vaginismus works to address both this physical pain and to also diffuse the fear of penetration. First, the Botox injections work to weaken the tight vaginal muscles that often make penetration impossible. Second, waking up with the dilator already in place works very well to diffuse the fear associated with penetration. For some patients, such as myself, this was the first time that something was inside of me “pain-free” and, in realizing this, it entirely eliminated any anxiety associated with penetration. The uniqueness of this combined approach to vaginismus is what truly makes it work so, so well. I encourage your comments and feedback here ladies and look forward to reading your posts.

[Heather34]

Hi ladies. First, I’d like to sincerely congratulate all of the women who have succeeded with the internet-only counseling program. It is such a tremendous feeling and just one of the best feelings in the world to finally be free from vaginismus.

I had the Botox treatment with Dr. Pacik in June and know that this is the only treatment that would’ve ever worked for me because I was never successful at any form of insertion prior (i.e. tampons, dilators, even a q-tip). I was a Pacik/Lamont level 5+++ and, again, could not experience any insertion without this pain/anxiety response. Following my Botox treatment, I was able to have pain-free intercourse within 1 week.

Dr. P has written extensively on the Pacik/Lamont classification of vaginismus. Specifically, he wrote:

‘Grade 5 patients who have never had any form of penetration carry enormous levels of anxiety and often demonstrate extreme fear at the time of treatment. Treatment of these patients in a setting that incorporates sedation and anesthesia allows them to feel safe knowing they will not have to endure pain. Botox injections reduce the hypertonicity or spasm of the vaginal muscles while bupivacine injections and topical anesthesia allow the patient to wake up in the recovery room with a large dilator in place without discomfort. The combination of Botox and bupivacaine halts the physical pain and allows the patient to develop new emotional and mental responses both to dilation and to intercourse. The difference in behavior between the severe anxiety noted in patients with the higher grades of vaginismus pre-procedure verses their post-procedure demeanor is often profound. Tears, crying, and uncontrolled shaking pre-procedure are replaced by smiles and determination post-procedure.’

I, again, commend and congratulate the patients that are able to do this and succeed with the remote supported dilation therapy. I think it could definitely work and the statistics have proven that it has worked for those women who have been able to have at least some form of insertion prior (i.e. tampons, dilators, etc.).

What are your thoughts here ladies and Dr. P?

[Heather34]

Hi ladies. Recently, there have been some posts and 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 ladies 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.

This treatment was a life-changing experience for me ladies and I would love to continue to help other women to discover it as well. Today, Dr. Pacik’s blog further describes the use of Botox for the treatment of vaginismus and the limited availability at other clinics. He writes:

“[P]atients suffering from vaginismus are having difficulty finding clinics to do this work. We are honored to have received FDA approval for the continued research that we are doing using not only Botox to treat vaginismus, but a detailed program consisting of dilation under anesthesia, and 2-3 days of post procedure counseling. This portion of our comprehensive program consists of supervised dilation, counseling on the use of the dilators, progressing to intercourse, sex therapy to improve libido, and preparation for future GYN exams. Our success rate has been consistently in the high 90% range since 2006. We are the only clinic in the United States to have received this FDA approval.”

This is such a wonderful accomplishment Dr. P! For anyone reading this who may have inquired about Dr. Pacik’s treatment, trust me, it works 100% and is truly the BEST treatment out there and the true cure for vaginismus. 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?

[Dr. Pacik]

Emily has been great to work with and moved right along with all my suggestions. I asked her to comment on the complications she experienced with the Botox because nothing should be left unsaid. She did have a complication, and I have no idea where or how the Botox was injected. In my own series of 150 patients I have had two cases of minor stress incontinence (loss of a few drops of urine with straining) both of which resolved after four months. I have had NO major complications from the Botox, and my patients continue to be successful in well over 90% of those treated. The Botox treatment program for vaginismus takes into account many facets to help overcome vaginismus. These include 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 for as long as possible after the treatment. When any of these elements are omitted, there is less likelihood for success. Read Julisa’s story.
http://www.vaginismusmd.com/stories/success-in-51-days/ She was treated twice with Botox, both times without any post procedure support.