[mazemelissa]

Hi Moe213,

Non hormonal vaginal moisturizers that I like are Via and Reveree, they both have hyaluronic acid in them.

I also often recommneded estradiol cream for the vulva and vaginal entrance as a moisturizer. That is a prescription.

There is also an over the counter DHEA moisturizer that is called Julva that is an option.

[mazemelissa]

Hi Dizzie, Welcome to the forum.
It does sound like vaginismus you are struggling with.

Anxiety is often a central component of vaginismus, your body’s involuntary fear/phobia of penetration, which then creates tension and spasm of the vaginal muscles which make it painful and often impossible to penetrate.

The core of a home treatment program will be working on anxiety reduction, and slow penetration with dilators, learning to desensitze yourself and continue to reduce fear surrounding the penetration. This can take a while, but often once you start with the smallest dilators, and can have some success, continueing to work up in size gets easier. Anxiety medications can be helpful as well.

If a home program is unsuccessful, and you can not get even the smallest dilator sizes inserted, than you can consider coming to Maze for our procedure using Botox injections and progressive vaginal dilation under anesthesia. The procedure helps to treat the muscle tension with the botox and the dilation, but also help with the anxiety and fear, as we will insert a large dilator into your vagina while you are asleep under anesthesia, and then you wake up from the anesthesia with the dilator inside of you. We also numb the vaginal area, so you don’t feel any significant pain. When you wake up from the anesthesia, you are quite relaxed, as the medicaitons used are great for anxiety, and we then guide you and educate you on how to do dilation exercises. This has been very powerful for our patients who have never been able to dilate before. It really helps them connect their mind and body. Something that was once impossible, is now possible.

Another benefit of the procedure, is that we often find women have unusually thick or tight hymenal rings. And we are able to cut these and create a wider more open vaginal entrance, which helps tremendously for ease of penetration.

For women who feel like they have tried everything, this procedure can be a game changer.

Melissa

[mazemelissa]

I have been meaning to reply to this question!

MargarettS is spot on and I agree with everything she wrote.

Everyone is individual and there are several factors that will determine how one’s hymen will tear or stretch. It’s not the same for everyone.

I think slow dilation can be very helpful, and I encourage anyone who is struggling with penetration to consider starting a home dilation program.

Home dilation programs can also be a wonderful way to prepare for first intercourse.

[mazemelissa]

Dear ABCD2024,

You are in the right place, and we totally understand what you are going through.

It does sound like you have vaginismus. Which is a fear of vaginal penetration combined with the muscles of the vagina tightening making it difficult/painful/impossible to have anything inserted into the vagina easily and painless.

With the right treatment, you will be able to overcome this.

You can start with a home dilation program. Or looking for a pelvic floor physical therapist in your area. If you are in the NY area, please make an appt at Maze and we will help you through the process. You are also a candidate for our Botox procedure if more traditional treatment options are not successful for you.

Melissa

[mazemelissa]

Hi CeeLeak,

Progressive dilation can tear one’s hymen as you move to through to the larger dilator sizes.

There isn’t a specific technique, as in my experience, it just happens when you reach the size that will cause the hymenal ring to fissure from the pressure of the dilator.

I often recommend using lidocaine cream to help with pain. You can purchase 5% lidocaine cream over the counter.

I would apply the lidocaine cream to the vestibule/vaginal entrance and let that absorb for a good 10 minutes before passing the dilator through.

You can also use smaller dilators to apply the lidocaine directly to the entrance hymen tissue.

The vagina is very vascular, so even a small fissure of the hymen can bleed heavy bright red blood. So don’t be alarmed if you see more blood than expected. But it will also heal quickly as well.

It can sometimes be helpful to have a partner or a clinician help with passing the dilator through.

Hope this helps!

Melissa

[mazemelissa]

Hi Pinkygirl,

I am so sorry for your pregnancy loss. I understand your hesitation to want to try intercourse again after having pain since your first attempt.

I do think you have vaginismus, and dilators would be so helpful.

Since you do not have access to dilators, I think you need to improvise and try to work with what you can find that could mimic shapes of a dilator, start small and work up.

Can your husband insert his finger? If you can have him insert one finger, he can slowly try to massage the vaginal opening to stretch it, then he can try to insert two fingers.

Sometimes lidocaine cream or gel can also help with the pain and that is usually sold over the counter, you can also try that.

You also sound like a great candidate for our Botox procedure her in NY, if you can make the trip. (Here is some more information for patients outside of the New York area).

Melissa

[mazemelissa]

I know that this is an old post, but I feel so many women are trying to figure out next steps.

I think our website is a great place to start to learn about vaginismus and read about treatment options.

Here is a link to our page:

Vaginismus

You can also always call for a free ten min phone consultation to learn more about Maze!

Melissa

[mazemelissa]

Yes you can.

You can safely use the lidocaine at the vaginal entrance 10-15 min before having any penetration, including intercourse.

Using a condom would prevent any transfer of lidocaine to your partners penis, as there could be potential for the lidocaine to cause some numbing sensation to his penis.

As for side effects, the lidocaine can sometimes give a burning sensation with first application. But usually nothing more significant than that.

[mazemelissa]

Hi Leslie,

First of all I want to commend you on such great work so far. Getting started is often the hardest part!

I don’t think you have done anything “wrong” or caused any “damage”.

Sometimes a break, even a few days, can cause some back tracking. And that can cause a negative loop with your mind body connection, causing some more tension, anxiety, and then the penetration is more uncomfortable or painful.

I usually recommend going down a few sizes, and restarting the program. Trying to really get your whole body and mind relaxed prior to dilating, and using a size that you have mastered for a while, and then working back up. It could take a few days or weeks to get back to the size you were comfortable using before.

Now there is always a chance that you could have some kind of vaginal injection, like a yeast infection or BV that could be causing some irritation or discomfort, so if you are speaking with your gyn, or having an appt, I would rule that out.

Vaginal infections sometimes just happen, especially with frequent penetration.

If you can’t get back on track with just restarting the program, then I would recommned an eval with a pelvic floor PT, or a specialist in vaginismus, like our office at Maze.

You also sound like a great candidate for the Botox procedure, if you continue to back track every time you take a break.

Hope this helps, keep it up!!

Melissa

[mazemelissa]

Hi Vee,

That burning sensation is the feeling that is described by most women when they are stretching the vaginal opening.

The burning does usually improve with continued consistent dilation.

Sometimes using lidocaine 5% cream at the vaginal entrance can help reduce the burning and make the dilation more comfortable.

For some women if they still have an intact hymen, that needs to tear in order for dilation to be more comfortable.

I would try lidocaine and dilating more often and see if that helps move past the first two dilators.

You can always consider coming for the Botox Procedure here at Maze. That will significantly help speed up the dilation process.

Keep us posted.
Melissa

[mazemelissa]

I find that burning is a typical sensation for stretching the tissue and the muscles. I think your process to remove and insert multiple times will still be effective. I would predict that if you continue to do that practice, you will find eventually you can tolerate longer stretches of time with the dilator inserted. Keep it up!

[mazemelissa]

Hi Lulu1802,

I do see patients complain of both constipation and vaginismus secondary to pelvic floor hypertonicity.

The muscles of the pelvic floor support many organs and structures. So when they are chronically tense, we can see bowel, bladder and gynecological issues.

If you haven’t tried physical therapy, I would strongly recommend that you seek out a pelvic floor PT to help you.

Diazepam suppositories might also be helpful.

There is an online program called PelvicSense that is created by a PT that is also really great.

Melissa

[mazemelissa]

Hi Momma bear,

I’m so sorry to hear about your pain!

I think that your gyn giving you the estradiol cream was on the right track, as being on the pills for so many years will make the tissue at the vaginal entrance more sensitive to tearing and the lack of hormones is usually the culprit. When i give the topical estrogen (or usually I give a compounded estrogen/testosterone cream) i always direct my patients to rub the cream directly into the posterior fourchette and massage it into the area until the cream is absorbed. This helps with the mess factor and also helps to treat the problem area directly. Many of my patients are advised to insert the estradiol cream with the applicator deep into the vagina, but that doesn’t really help as much as just rubbing the cream right into the vaginal opening, and then you have the drip factor, which you avoid if you just rub the cream in.

You might also really benefit from dilation therapy to slowly stretch the vaginal entrance to help prevent tearing.

Botox would help with muscle tension, but won’t help heal the tissue if it is impacted by lack of hormones.

Hope this helps. Melissa

[mazemelissa]

All of the silicone sets seem similar in feel to me. Pure romance, inspire, Vwell, and intimate rose all have a firm enough texture to dilate, but don’t have the feeling of hard plastic.

The dilators need to be firm to push through the vaginal muscles, if the dilator is too soft, it would not be able to penetrate the vaginal entrance.

Our patients at Maze receive the pure romance dilator set with the Botox procedure. I have received a lot of feedback that this set of dilators is “much better than any plastic set”, and “very comfortable”.

I do like the intimate rose and vwell sets. Vwell also makes an XL kit which is great if you have a very large partner.

[mazemelissa]

I agree seeking out a pelvic floor PT or sexual health practitioner can be very helpful to confirm the pelvic floor dysfunction and vaginismus diagnosis, but to also evaluate and treat any other underlying problem that could also be impacting your pain. Hormonal changes can sometimes cause burning pain, as well as nerve sensitivity.

It is also my experience when my patients start to reach the larger sized dilators they will often feel a more intense burning discomfort or pain when stretching tight tense vaginal muscles. And that burning pain will linger, and not really resolve until they can insert even larger dilators. So for you, the #4 dilator in your set might not be pain free, until you are working with and inserting the #5 dilator.

You can also try using some local lidocaine cream to help with the burning with dilation. Lidocaine can be easily purchased over the counter or online at a strength up to 5%. Adding a little local numbing sensation to the entrance prior to dilation will help the burning and your fear of penetration.

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