Do I need a second Botox treatment?

[Nakitalab]

I’m 60 years old and had Botox treatment with Dr Pacik 11/2012. The procedure was successful in that I could have a pelvic exam, and full penetration intercourse. I have always had to dilate with lidocaine right before being intimate. About 6 months ago I started to experience pain again even after dilating with lidocaine. In June of this year I had post menopause bleeding and had a D&C. The biopsy came back with cancer and within a week I had a full hysterectomy. Because of the surgeries I went 10 plus weeks of no intercourse. I was prescribed vaginal estradiol 2x a week. When I was cleared to be intimate I started dilating 2x a day every day and had difficulty getting the smallest one in. After two weeks my husband tried penetration and it was extremely painful. I’m continuing dilating 2xday and have been able to move up to the large size but only with lidocaine. I’m thinking I should have the procedure again. Has anyone had to have a second treatment? Those old feelings of being inadequate have come back. I’m tired of having to dilate right before intercourse and still having pain. Lidocaine doesn’t seem to help anymore. Is this from being post menopause and/or surgeries?

[recessivegenequeen]

Hi Nakitalab – I’m so sorry to hear that your pain has returned. This all sounds very hard and you’re brave for having endured it all, including cancer! I’ve only ever had botox once but it sounds like it could be a good idea for you, especially since some of the emotions associated with vaginismus are coming back. Although it also sounds like you are also having success with dilating, so you may just need more time to heal from the pain of your surgeries and medical issues. I’m sure one of the doctors on this forum can tell you more about what they think is going on medically, but botox could well be an option for you once again!

[mazemelissa]

Hi Nakitalab,

I am not sure if you will need a second botox treatment. I think your body went through a significant trauma, and it is taking time to heal. But it could be an option, if traditional restart of dilation doesn’t work.

I would recommend continuing dilation, as well as focusing your estrogen cream to be massaged into the vaginal opening prior to dilation.

What is different now is that your vagina has the full impact of menopause, which I believe is different than when you had your first procedure.

Menopause makes the vaginal tissue more dry & sensitive, less stretchy, and harder to dilate. The entrance actually can become smaller. So you need to use the estrogen cream at the entrance to the vagina, probably more importantly than the deep pocket of the vagina.

Many women are prescribed estrogen and told to insert the estrogen deep inside the vagina, but the problem area is really the first few inches into the vagina.

It might take some time to get back up to the large size without pain, but I think you can get there.

You could also look into doing physical therapy to help with the dilation.

And if that doesn’t work…we can repeat the procedure, but that will only impact the muscles…it will not help you if the vaginal tissue from menopause is the primary issue.

You can always give us a call for a free 10 minute consultation.

Melissa

[Nakitalab]

Thank you for the encouragement recessivegenequeen. I’m so hoping I can figure this out. I don’t want to continue dilating for the rest of my life. 🙁

[Nakitalab]

Hi MazeMelissa. Thank you for responding. That is great information and I will start using the estrogen cream at the entrance prior to dilating and not insert the cream all the way back but more in the middle when applying the prescribed amount. There seems to be two places that are hard to get through; right after the opening and then a little further back. It will be a challenge for me because I have yet to be comfortable touching myself and in fact have never done that. Do you think it would be helpful to purchase the largest dilator and work with that one once I am able to accomplish the medium and large one without using lidocaine and insertion is not painful? I have been dilating with lidocaine prior to intercourse ever since the procedure. It would be so nice to get to a point where I don’t need to dilate because it makes intimacy non-intimate and more like a job. 🙁 I had been wondering if part of my problem is due to post menopause and being too dry. Your information made alot of sense. I so wish I knew if it was one or the other or both. Also I’m wondering if I should try the laser treatment. Would it be possible to do both the Botox treatment and the laser treatment at the same time? Living in Arizona makes traveling to New York expensive but definitely worth it but financially I wouldn’t be able to go three times in a year. Thanks again for getting back to me it means alot to me.

[mazemelissa]

If you are interested in laser treatment for vaginal dryness, you can probably find a practitioner in your area to do that. The Mona Lisa Touch and the Femilift laser would be what your are looking for.

We would not do botox and the laser in the same day.

I do think getting the larger dilator could be helpful, especially if your husband’s penis is larger than the dilator you are currently using.

[Helen Leff, LCSW]

Hi Nakitalab,
So glad that you posted on the forum and are able to get solid answers to your questions. There are treatment options out there and being informed so that you can make choices is important. Thank you for sharing your story as I know it is helping others as well as yourself. Let us know how you are feeling.
Thanks,
Helen

[recessivegenequeen]

Hi Nakitalab – how have you been doing since you got this advice? I hope you’re feeling less hopeless! There’s a lot of good information here!