Pacik/Level 5 Vaginismus

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    Hi ladies. There is an informative new blog posted in which Dr. Pacik answers the question of what causes the most severe form of Pacik/Level 5 Vaginismus.

    Excerpts include:
    “[V]aginismus represents a protective reflex. The body is able to protect itself in a microsecond to avoid injury. The well known avoidance of an object approaching our eye does not have to be processed to prevent injury, There is a rapid turning of the face and strong blink that occurs far more quickly than if one were to “think it out’. In a similar way it is my thought that the brain has been programmed to think of vaginal penetration as being painful. In response there is an uncontrolled and involuntary spasm of the entry muscle to the vagina that in effect says “no entry”.
    [V]aginismus is [further] a form of phobia. People who are phobic may simply have an uncomfortable feeling when faced with a (perceived) stressful situation, while others may decompensate when faced with similar circumstances. Cases in point would be two people who have a phobia about heights. One may notice an increase heart rate while another has a complete meltdown with uncontrollable shaking and screaming, and has to be helped to a safer place. Fears of bridges, elevators, crowds, animals, spiders, and needles all share similar ranges of potential decompensation. It does not appear to be any different with vaginismus. Some patients are able to tolerate a GYN exam but not intercourse, while more severe forms of vaginismus decompensate with just the thought of having a GYN exam. It is my opinion that there is greater spasm in the more severe cases of vaginismus, causing the vagina to look and feel like a tightly closed fist. This is proving to be so in my data analysis of over 180 patients who have been examined and treated. The severe form of vaginismus is accompanied with a stronger level of spasm, usually at the entry muscle. Most of the patients I treat are level 5 severe vaginismus.
    In the same way some people have stronger phobic reactions to perceived noxious stimuli, here too, in severe level 5 vaginismus, the response is greater than what would be expected.”

    I encourage you to read the blog and would love to hear your comments and feedback.


    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.


    I too found Dr Pacik’s blog very interesting, and had previously never thought about it as a phobia, but it does make sense, and accounts for the power of the physical symptoms which are caused by anxiety. This idea of a phobia particularly rings true to me regarding finger insertion, rather than actual sex… I have always seemed to be particularly anxious about this kind of thing (both by doctors and my husband), and struggle to tolerate it. I feel queezy just thinking about it, and whilst I haven’t had a gyn exam, I reacted quite horribly to Dr P’s examination, uncontrably crying and struggling to get out of the chair, in a way I had not expected.. Even though I am using the dilators fine now (and didn’t ever really experience a high level of anxiety with them), I feel I have not yet begun to overcome this particular ‘finger’ phobia. My priority at the moment is of course to achieve intercourse. I hope after I am successful and comfortable with that I can begin to, but it can be quite a scary idea!

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