Is this Vaginismus treatment right for me?

Many years ago we were working with a patient who was hyperventilating from fear during a dilation session. She sat up on the exam table and said “there has to be another way to do this.” And she was right.

We set out to find a treatment method for those women who are overwhelmed, fearful and panicked at the idea of inserting something into their vagina; for those women with a significant history of pain or those who have not been successful using traditional dilator therapy. In those cases, we will most often suggest the vaginismus treatment under anesthesia procedure. It takes much of the fear and distress out of the first few steps of treatment. The patient is put under IV sedation for the procedure which takes approximately 30 minutes. While the woman is “asleep,” the doctor injects a topical anesthetic in the vaginal walls and massages the introital muscles to break any muscle spasms. This procedure is then followed by the vaginal injection. The anesthesia and massage allow the muscles to relax so that a large dilator can be inserted. The patient awakens with the dilator in place.

This is the first step to achieving pain and worry free penetration, but it is only a first step. Once the procedure is over, the patient needs to learn to insert the dilators herself, feel comfortable with touching her vulva and vagina and to relax with penile penetration.

Why and how is the medication used?

Many of us are familiar with the use of medical injections as a treatment for cosmetic reasons; it stops the muscles from contracting in the face so that smile lines and deep wrinkles do not appear. But it is this very action of “freezing muscle tension” that has led to this elective procedure using the medication off-label to successfully treat vaginismus. The injections are administered to the muscles in the vagina, which makes the muscles unable to tighten and as a result, “the wall” that many vaginismus patients experience disappears. The patients who report pain from the tightening of the muscles experience significant relief after the injections.

Who is this procedure appropriate for?

This elective procedure is used in cases of vaginismus where the more conservative treatments have not been successful, or, even more frequently, where the first steps are not even attempted because the pain or the fear is so great.

We believe that every woman should be able to choose to put in a tampon, have a complete gynecological exam and experience intercourse if she so chooses and these are our goals with treatment.

How does the treatment work?

The injection of medication inhibits the muscle spasm that causes the tightening of the vagina. It is these spasms which cause pain during intercourse. During this short procedure that is performed right in our office, the patient is put under conscious sedation. The doctor injects both a topical anesthetic and the medical substance into the vaginal canal and then massages the muscles to relax them. The anesthesia and massage allow the muscles to release so that a large dilator can be inserted. Immediately following the procedure, the patient awakens having achieved the hardest first step, the insertion of the first dilator. The anesthesia that was injected works to ensure that her first experience with the dilator is not painful.

What is the success rate of vaginal injections?

The success rate, in our experience, is about 90%, where patients report significant improvement in vaginal penetration. What has been observed in research on the vaginismus treatment under anesthesia procedure is that there is typically a 75% rate of success (meaning pain-free intercourse) within four-to-six weeks of the treatment. In our experience, the other 15-25% may take longer but achieve similar results with minimal symptoms within 8-12 weeks.

However, it is important that you understand that there is still work to be done after the procedure with dilators – you have to dilate daily and work on having our brain “reconnect” to your vagina. Although the effects of the medication only last 2 to 3 months, once the vagina is dilated and intercourse is comfortable, additional injections are generally not necessary.

Can you describe the procedure?

The procedure is performed by Michael Werner, MD (Medical Director at Maze Women’s Health), with surgical assistance from Melissa Ferrara, FNP, at our offices in Westchester, NY.

On procedure day, the patient is prepped for surgery, given an IV and placed in a hospital gown.

Once in the surgical suite, the patient is put under conscious sedation for the procedure which takes approximately 20 minutes. When the patient is under anesthesia, a full pelvic exam is performed and a pap test is obtained if indicated. Next, dilators are inserted into the vagina; this dilation starts the process of lengthening and relaxing the pelvic floor muscles. After the progressive vaginal dilation, a speculum is inserted and the injections begin. The medication is first injected, a total of 100 units, into the tense muscles. The doctor then injects a local anesthetic in the vaginal walls and vaginal entrance. Once the injections are completed, the largest vaginal dilator is inserted. The patient awakens with the dilator in place.

There is a recovery and rest period after the procedure. During that time the patient is taught to remove and re-insert the dilators, and she is sent home with the dilators and instructions. It takes two weeks for the medication to take full effect so the patient is encouraged to continue to use the dilators as much as possible for the first few days. There is a follow-up visit the next day and an individualized follow up treatment plan is developed.

The treatment does not make a woman instantaneously comfortable touching her genitals, or comfortable inserting the dilators. The treatment by itself does not ensure a smooth and easy transition to intercourse with her partner. That is all work that has to be done after the procedure through dilation and therapy.

But we’re here to help you with all of that.

Are you loopy when you wake up?

Yes, you will feel sedated immediately upon wakening from the anesthesia.  Within 30 minutes you are fully awake and able to walk around. However, you will need a ride home post procedure, as you can’t drive for 24 hours.  You will feel tired for the rest of the day, and need to plan accordingly.

What is the follow up after the procedure?

There is a mandatory follow up visit 24 hours after the procedure. At this visit we will work on continued dilation, discuss progress toward intercourse and help address any unanswered questions you may have. It is at this point that we start to work on having “your head connect with your vagina”. We help you to understand that you are in control of your body, that you can make decisions about what can and cannot go into your vagina and that your genitals are your friend and not your enemy. This procedure is a first step towards getting you there.

Patients will continue with weekly follow up visits for four weeks, either in person or virtual, depending on where they are located. These visits offer the patient the opportunity to check in on the dilation process and review any questions they may have.

The goal of these sessions is to achieve our three markers of vaginal health: ability to insert a tampon, pain-free intercourse and a complete gynecological exam.

We will also schedule virtual follow ups to check in with the patient at three months, six months and one year.

What if I’m located outside of the NY area?

Located out-of-town? No problem! We’ve treated 100’s of women suffering from vaginismus, many of whom reside in various countries throughout the world. Since you’re only required to be in New York for 3-4 days, most patients find the treatment very manageable. Learn more about our treatment plan for out-of-town patients.

Medical articles on vaginal injections for vaginismus:

In a patient’s own words:

It’s so great to be a success story! The Vaginismus Treatment under Anesthesia really changed my life. I’m so proud of myself for deciding to get it done. After being unsuccessful with so many other treatments, I was at the point where I felt I would never be able to have intercourse. It wasn’t easy at all, but this time I decided to not give up no matter what. After only 15 days of treatment, I was able to have pain-free intercourse with my husband! If you are thinking of getting this treatment done just go for it, you won’t regret it.

- S, Age 28 -

10 Days After This Procedure, I Was Able To Enjoy Painless, Comfortable Intercourse

I am currently 60 years old. During and after menopause I developed vaginal dryness and dyspareunia that made intimacy uncomfortable and painful. I tried the usual techniques of lubricants, estrogen/progesterone creams, Mona Lisa laser, etc. but they only helped so much and didn’t help with the pain. The vaginal dilators became frustrating, so I gave up. As I was not married nor in a relationship at that time, I just became very discouraged. I stopped dating or even looking to date and gave up. Eventually the adage of “if you don’t use it, you lose it” came to be true and compounded the problem.

I had been looking into the vaginal Botox for several years, but the options were limited as no one local was offering it. It was also indicated primarily for vaginismus which was not my issue. Moreover, I was very embarrassed to address the issue, particularly at my age. This is not a topic that I was comfortable discussing with anyone. A few months ago, I met a great guy and decided I needed to address this issue once and for all and get back into life.

I live about 900 miles away from NY city but was fortunate that I had family in the area. The entire staff was exceptionally helpful in providing all of the necessary information before going to the first appointment. The appointments went great and any embarrassment I had was soon alleviated by the kind and professional approach of the clinical staff.

I knew I made the right choice during that screening visit. The practitioner found other issues that were contributing to the dryness and pain that hadn’t been noted with prior GYNs. These were able to be addressed during the Botox procedure. Part of the screening was that I speak with a psychologist who specializes in sexual health which I had initially thought would be awkward and even unnecessary. However, I’m very glad I met with her, and she helped me realize that I’m not alone in this problem and so many women suffer from significant dyspareunia.

The procedure went great. Outstanding clinical care. No pain, minimal if any discomfort, and no downtime. I kept up with the post op regimens which were no problem. About 10 days the procedure, I was able to enjoy painless, comfortable intercourse for the first time in years. It’s been about 3 months and I am still doing great and having no issues. Even when the Botox wears off, it won’t be a problem as I have kept up with the procedures needed to maintain patency and comfort.

I highly recommend Maze to anyone who is suffering from post-menopausal dryness and sexual dysfunction. I can’t tell you how much this has helped my self-esteem. I’m only sorry I didn’t do this years ago.

–M, 60 years old

Read more patient testimonials. 


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