Vaginismus Treatment Anesthesia

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    Hi all. There is an excellent new blog posted regarding vaginisums treatment anesthesia.

    Excerpts from the Blog include:

    Why anesthesia for vaginismus treatment?
    There tends to be considerable fear and anxiety to penetration because of the history of severe pain with attempted penetration. More severe vaginismus patients have often tried many different treatment programs only to fail again and again. Many of these women are unable to make any progress with dilators and have considerable fear that dilation is part of the treatment program. Typically these women avoid pelvic touch. For most of the patients it would be impossible to approach the pelvic area with a needle. Cooperation is simply not possible.

    Apart from the injections I have found that progressive dilation while under anesthesia allows me to stretch the area using progressively larger dilators that would not be possible without anesthesia. This makes it possible for patients to rapidly advance with their own dilation. The anesthetic also allows me to release a constricting hymen when this too causes difficulty with penetration. About 10% of patients are noted to have this problem during examination. A small snip on either side is all that is needed. Bleeding is minimal.

    What type of anesthetic is used?
    Patients are given conscious sedation which allows them to breathe on their own yet be able to sleep and be unaware of treatment. General anesthesia is not used, this is reserved for major surgical cases. Conscious sedation allows me to do the injections and progressively dilate the vagina with no pain. Generally the patient is asleep for only about 15 to 20 minutes and wakes up rapidly when the treatment has been completed. The sedation is similar to what is used for colonoscopy.

    How long does it take to recover from the conscious sedation?
    Generally one to a few minutes. Patients wake up quickly. A long acting local anesthesia (bupivacaine) will have been injected making the entire vagina numb so that you can wake up with no pain. This also allows you to work with the dilators during your recovery without pain.

    Risks and safety of anesthesia for vaginismus
    This type of sedation is used worldwide for procedures that require minimal anesthesia. Conscious sedation has a high level of safety.”


    In a recent post, Dr. Pacik commented on the Botox treatment program under anesthesia. Specifically, he wrote:

    “My experience is that when women have long term vaginismus and in addition do not respond to pelvic floor physiotherapy, the best course is to come to the US and have the Botox treatment under anesthesia. The anesthetic removes the fear and anxiety related to penetration allowing the woman to continue her dilation after she wakes up. This is often a turning point and a likely successful outcome.”

    I personally was terrified of being under anesthesia pre-procedure. To help with this, I talked and listened to Dr. Pacik and Ellen explain the incredible safety of this and I trusted them completely. I also had my hubby right there with me and he assured me it would be fine. But, like anything, the number one thing that helped was actually doing it and then waking up completely fine and vaginismus free. This was my best evidence that the anesthesia was safe. Without being under anesthesia, I don’t believe the procedure would’ve worked at all. At my one past attempt at a gynecological exam, I had such high anxiety that I almost passed out and could not even let the doctor near me (felt like jumping off the table, legs tightly involuntary closed, extreme dizziness). By being under anesthesia for this procedure and waking up with a dilator in place, for the first time I mentally knew I was not broken and something could be inside of me pain-free. Thereafter, I got used to this and it entirely changed my way of thinking and very soon after, my husband and I were able to make love. Again, I don’t believe this would’ve been possible based on my extreme level of anxiety without being under anesthesia for this procedure.

    What were your own experiences with anesthesia for your vaginismus treatment? What would you say to future patients reading this right now?

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