Feeling hopeless post botox – could use some advice.

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    Hello – I had never been able to use a tampon and finally after 2 years of trying I saw an OB at age 14 who did not diagnose my vaginismus and did a hymenotomy on me under anesthesia. The OBGYN said my anatomy was 100% normal. Hymenotomy did not fix the problem. 3 years later after much concern and frustration with tampons — I met a wonderful caring boyfriend and after dating for a year we attempted sex and it did not work due to me having pain with entry, we tried multiple times, ended in tears and embarrassment and so much frustration. I figured out my problem by reading online about vaginismus and found a pelvic floor physical therapist near my home. She is very fun, caring and told me she had this problem herself when she was younger.
    After 2 months of pelvic floor physical therapy things were progressing very slowly — with continual pain and frustration with even the smallest dilators. I had read about Maze and felt so ready, anxious and excited to try your program. My boyfriend was wonderful and supportive but I just wanted it resolved so so badly. I worked extra shifts at work to save up the money to see a board certified OBGYN in my state who offers this procedure– since I live in New Mexico and could not get to Maze – especially during a pandemic. The OB injected 150 units of botox, inserted a large dilator under light sedation, and sent me on my way. I am now three weeks from having this done and initially I had no difficulty using the smallest dilator — and felt so happy and hopeful. I kept thinking about how botox takes 2 weeks to set in so things would only get easier. However — this was not the case — on attempt to progress to larger ones it feels just as painful as prior to the botox. The middle sized dilator goes in with some pain on entry — takes me at least 20-30 minutes and I have to lie in a certain position and do deep breathing. This is about where I was prior to the botox. so now I feel even more hopeless — so am I the 2% where the botox does not work? If pelvic floor physical therapy doesn’t work and botox doesn’t work — I am so afraid I will have to live with this forever. It is causing daily stress in my relationship — not because my boyfriend isn’t supportive but I Just feel so awful about myself and for him. I’m devastated. I also have seen very few failure stories after botox — which is wonderful — nobody should have to live with this –but I’m just really depressed. I have no prior depression/anxiety/medical issues. I seem to have primary vaginismus for no reason. It’s weighing on me night and day because I always assumed if conventional therapy didn’t work — the botox would save me. So now I am feeling super hopeless. Thanks for your advice.

    mmHelen Leff, LCSW

    Hi Staci,
    I hear your frustration, confusion, and “hopelessness”. I do not believe that this is a hopeless situation and I applaud all that you have been doing. Perhaps some things need to be tweaked: What is your dilation protocol? Are you sleeping with any of the dilators? Are you currently getting Pelvic Floor PT which may be very helpful while the Botox is active…. The Botox breaks up the muscle spasms but it is consistent dilation that is key to overcoming vaginismus.
    Don’t give up!!!
    Keep us posted,


    I agree with Helen, finding a PT that can help you while the botox is working is a great idea.

    If you were able to have the large dilator inserted after the procedure, I believe that you can work back up to it.

    I would try to move the smaller dilators side to side and in and out for stretching.

    I also recommend sleeping with dilators as well, sleep with a small size, and then in the morning after sleeping with the smaller size, try to move up to the next size in the series. Having the dilator inside the vagina overnight can really help move up to the next size in the morning.


    Thank you both so much for giving me hope. You are right that I think somehow I hoped/thought Botox would just solve it all instantly. In theory having the muscles relaxed seems to be a quick cure. However the more I have read on this forum – the more I see it takes a lot of work and sometimes for weeks to months. I need to keep working with the dilators and it’s not necessarily an overnight fix after the Botox. I am going to try your suggestions. I do have a pelvic floor physical therapist who I worked with before the Botox – I wasn’t sure it was helping but maybe you think it would help more now that the Botox is in there. Thanks for your help. Also do you think 150 units is the correct amount of Botox for this procedure? Thanks again for being supportive.


    Yes…150 units of Botox is a correct dosage.

    We use 100 units of Botox for our procedures.

    So you received more Botox than our standard protocol.

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