updates on my wifes operation & dilating

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    Here is what I emailed my GP and pharmacist friends, whose medical opinions I trust, after my wife’s surgery with Dr. Pacik (edited for clarity):

    My wife’s operation went well on Day #1. Dr. Pacik and the anesthesiologist were quite professional. Anatomically there is nothing wrong with her. I was at Dr. Pacik’s side the whole ½ hour. She clearly had vaginal muscle spasms even after sedation, so vaginismus is truly a psychological and physical condition; I honestly thought she was having a seizure as Dr. Pacik penetrated with the speculum more deeply, but the anesthesiologist quickly increased the sedation. I later told that it was the craziest thing I’ve ever seen, but she was just glad she didn’t remember anything. 🙂 Dr. Pacik made me insert my finger before and after dilation to prove to me that dilation does work for stretching/relaxing the muscles, even before the Botox kicks in (which will probably occur 2+ days later). He also made me dilate to show me that there is more resistance initially, and then the dilator just “drops” in place with very little resistance.

    If I recall correctly, he injected 3 1mL syringes of 100 units (total) of saline-diluted Botox in quite a few points of the vaginal wall, to target the muscles diagrammed below:
    [This diagram comes from Dr. Pacik’s 2011 paper from here; I wish it were in his book, as it was very helpful, to me at least.]

    It’s not so obvious in that diagram, but my wife had more pronounced circular rings (looked like tendons or ligaments or some kind of connective tissue) on the inner vaginal wall which appeared as though they’d connect to the corresponding muscles shown in the diagram. Viz., her vaginal wall was not completely smooth. Apparently it smooths out more with age and more sexual activity.

    My wife was one of Dr. Pacik’s most severe patients, though, but this is due primarily to the anxiety she had post-op. She came off the anesthesia (which was really a strong sedative, but the amount she needed was strong enough that Dr. Pacik said he could do an operation on her) pretty content and alert, which was good. (The first thing she talked about was how she wanted to go to the mall haha). Quite a bit of blood did come out after she did the twisting and thrusting exercises with the largest dilator (6″ long and 5″ diameter) and finally removed the dilator, which was inserted before taking her off anesthesia; there was much blood because Dr. Pacik had to prick her at quite a few points to distribute the Botox evenly. She uses a 50/50 mix of surgical gel with 2% Lidocaine anesthetic on the dilators, which she is supposed to have inserted 2 hours daily, but she hasn’t been up to it due to her thinking the blood was from something ripping, even though nothing ripped, and to a burning feeling/pain, probably due to the needle pricks or salt of the Botox solution. So, although the surgery was successful, she has for the most part failed the dilation regimen so far, but it’s definitely not too late for her to make progress; it’s probably just a temporary setback. She has a good physical therapist she just started seeing before we left for Manchester who specializes in vaginismus, too.

    I have to admit that I’m not usually queasy, but maybe I was not used to breathing through a face mask, plus seeing my own wife instantly succoring to the sedative, and her being strapped to the operation table, and then that there was more blood involved than I thought! (I thought there wouldn’t be any…) I felt like I went through the surgery, too! I totally lost my appetite the rest of the day, and I usually have an appetite. Thankfully, she didn’t lose her appetite at all, though. Dr. Pacik is clearly a very experienced doctor, as he maintained such composure and steadiness and worked efficiently and kept everyone else in-line.

    Day 2, Dr. Pacik just talked to us all there and answered questions. Of course I ask about the female orgasm 😎 , but I’m actually really glad I did because he told me it is a peristaltic action like swallowing designed to draw the semen upwards (which sounds like a very good thing, esp. for my wife and I, as we’re trying to conceive), and this is completely different from the muscle spasms my wife often has midway through intercourse, which are more clenching.

    On a more positive note, I was just so amazed how beautiful the human body is! You would think that there wouldn’t be so much intricacy and beauty in such a seemingly simple organ as the vagina. I definitely encourage the husbands to observe Dr. Pacik’s operation. You will learn something new about your wife. The more you know about her the more you can love her.

    In my second email update to my doctor and pharmacist friends, I said (again, edited for clarity):

    Today is day #3, a backup day that only my wife needed to use. To the surprise of the nurses and the doctor, she was able to progress very rapidly with the dilation, and with much less anxiety. Everyone was amazed and quite impressed.

    Considering she wasn’t able to reinsert the largest dilator on Day #2, after she took it out on Day #1, and that she couldn’t even insert the tinniest dilator at all on Day #2, her rapid progress on Day #3 all the way up to the #5 glass dilator is quite impressive.

    Look at what she wrote before the operation here:

    Quote on July 5, 2014, 03:59
    Hello everyone,

    My procedure is coming up in a little over a week on July 14th. I will be traveling all the way from Arizona. I am happy that this may finally help me. But at the same time I have many worries. I worry that I don’t actually have vaginismus and that it really is all in my head. That the doctor will say that I am completely normal and just making it up. On the other hand I worry that my case is the worst ever and that my muscle will not react to the botox. That I will wake up with my muscle the same which would mean that I am so broken there is no way to fix me. I am even worried that the anesthesia wont work and and I will jump off the table that second I fee anything touch me. I know that this all sounds crazy but at this point I am just very anxious for the day to come so I can finally get thought it.

    The hardest parts for her were the IV needle and reinserting the dilators, but she did both those things!

    Dr. Pacik

    This is an important post for a number of reasons: There is great value to the partner to be able to observe the treatment. It allows the partner to better understand the pathology and realize “it is not her fault'”. Vaginismus is undesired and uncontrolled and this becomes clear during the treatment.
    It is normal to have some bleeding because of the multiple injections. It may seem like a lot, especially to some of the men, but actually there is a small amount of bleeding which responds well to pressure which is done before the progressive dilation. Some blood does accumulate around the cervix (as was pointed out-secretions move in an upward direction which is true) and sometimes is suddenly evacuated 1-2 weeks later. The patient gets alarmed and thinks she is bleeding, but this is normal.
    Lastly the post points out that some women have considerable difficulty with dilation. We skipped the dilation during the counseling to allow the couple to fully absorb the important points of the counseling. They returned to the office the next day, where without the “competition” she was brave to try #1 and slowly progressed to #5 that day, which was monumental for her considering her severe anxiety to any form of penetration. I was thrilled with her progress and feel sure that she will be successful with her goals.


    Yay! I am so happy for both of you, she is going to beat this! Hope you had a safe trip back to Arizona. I will be thinking of both you you!


    Geremia, thanks so much for posting this! It is so important to hear from the men who also suffer from vaginismus and who are there wholeheartedly for their partners! I am glad you sent those emails to your medical friends, and hopefully they can spread the word. I am so pleased that your wife is progressing and that you both had a pleasant [enough] experience at Dr. Pacik’s office! My boyfriend had a very similar experience to you in the exam room, and he said he was freaked out when my legs were twitching during the procedure even though I was under anesthesia, but that the nurses made sure to let him know I was fine. He learned a lot and had a great understanding (and appreciation) for what I was going through. Best of luck to you both! You WILL get through this! I am a secondary vaginismus patient and had my procedure on 6/16 and successfully dilate to 6 glass everyday, and my boyfriend and I were able to have sex within 3 weeks. The pain was a 2, which freaked me out because I thought it would barely hurt and was surprised, but compared to the 9-10 I used to have, I’d say that’s a great start!


    From my wife’s log for Day #4 post-procedure:

    I dilated with pure Surgilube and no Lidocaine. We had intercourse with Surgilube as a lubricant, but there was still a slight “brick wall” during the time he ejaculated, after which I had my first very good orgasm, though! Next time I will dilate to a #6 before intercourse.

    My update to Dr. Pacik:

    It’s clear that the Botox is doing something for the three muscles you injected, because we tried intercourse again yesterday [Day #5 post-procedure], and she didn’t dilate beforehand at all; it didn’t go as well as when she dilated up to the #5, though. That diagram in your paper [see above] showed a 4th muscle closest to the cervix. This muscle seems to be what is still creating the slight “brick wall”. I bet more dilating will help with that.

    She is making incredible progress, considering she apparently was Dr. Pacik’s first patient unable to reinsert any dilator on the day of the procedure!


    This is excellent news and I’m so, so happy for you Geremia and Mayra. :):):)

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