Hi everyone! If you're new to our blogcast, welcome! If you're returning after joining us for our previous blogcasts, welcome back! 


On February 24th, our live conversation will be hosted by Aimee Goldman, RWHNP, Nurse Practitioner, and Kimberly C. (Former Botox Patient). They will be answering your questions about Vaginismus.


Vaginismus is a condition where a woman can’t get a penis (finger, or tampon!) into her vagina. It can be mild… so mild that often-time she can get a penis in the vagina for very short periods but it’s unpleasant and painful. Or it can be severe, so severe that she can’t touch herself near her vagina, can’t have a gynecological exam, and can’t insert a tampon.


We want to help you understand more about Vaginismus: symptoms, diagnosis, treatments, and post-Vaginismus. Submit a question, or multiple questions, for our panelists to answer about Vaginismus!

The blogcast is rapidly approaching, hurry and submit your questions!  

Hello everyone and welcome to our third blogcast! This time around, our blogcast is focusing on Vaginismus. To everyone who submitted questions: THANK YOU! We received so many great questions.


We're all very eager to get started and answer as many questions as we can, so lets get to it! 


First question: "Can vaginismus miraculously disappear??"

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Hi all. Thank you for letting me participate in the Vaginismus Blogcast. I had vaginismus all during my 20s and into my early 30s. I prayed so hard that it would miraculously disappear and tried with different partners, going away on romantic getaways, drinking for relaxation and none of it worked. I tried so hard to “will” relaxing during any attempts at insertion and also ob/gyn exams but it never happened unfortunately.     

I do not think that Vaginismus can go away on its own. Vaginismus is an involuntary tightness of muscles in the vagina. Since it is involuntary, Vaginismus can only be treated with dilation and Pelvic floor physical therapy. With the right treatment, it can nearly always be helped. It doesn't just "fix itself".

Next question: "What is the best way to find an OBGYN who is familiar with vaginismus?"

This can be so difficult but is not impossible. A good resource is checking out the National Vulvodynia Association (NVA) page and they have a section with physician recommendations. While this is for vulvodynia, these doctors may also be experienced with vaginismus. Another idea is to call any potential ob/gyn doctors in advance and talking to the nurse to ask if they have experience treating vaginismus. One of the Maze forum members suggested this in the past and I think it is such a good idea because it makes you feel more confident to have a dialogue in advance of the ob/gyn appointment. 

The best way to find an obgyn who is familiar with Vaginismus is by searching the internet and looking at potential physicians web pages. If they are involved with sexual dysfunction then chances are they are aware of Vaginismus. If you are a patient at maze we have a list of referring obgyns who are educated and aware of vaginismus.

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  1. It seems like we're having a bit of a technical difficulty posting our answers. If you see some blank posts don't fret! Your internet is working fine. We will ensure every question has an answer before moving on to the next one.

  2. Next question: "What is the best way to incorporate your partner into your treatment?"

The best way to incorporate your partner in treatment is to educate them on vaginismus. Many of our patients bring their partners to a few of their visits here at Maze so we can educate and answer any questions they may have. We find when the patients get comfortable dilating themselves they can then allow their partner to help them dilate. At first we tell patients to dilate in front of their partners. When they are comfortable with this, we advise allowing their partners to insert the dilators.

I found this impossible to do while going through vaginismus and am so, so thankful that my husband was a very important part of the Botox treatment program by my side during and after. For the first time, I felt like we were a team going through this together as for so long, I felt like it was my issue to fix. During my procedure, he was by my side. Then, afterwards, he was by my side while I practiced inserting, removing and reinserting the dilators of different sizes. I felt so awkward in the beginning having him participate but the team talked to me and I realized for the first time that it was our problem to go through together and he was a very important part of the recovery. For me, having him involved with the dilating helped me to trust him that much more and even brought us closer. For him, it helped him to realize that something was able to be inside of me pain-free and didn’t hurt like everything had in the past. He then knew that he wouldn’t hurt me when we tried intercourse in the future. I think a great way to incorporate your partner is to have him help or be there for you with dilating.

The next two questions are very similar so I'm going to post both of them: "What are ways to conquer avoidance? / How can I get over my avoidance of sex?"

    1. It is so difficult to come face to face with Vaginismus. By educating yourself and knowing that you are not suffering alone you are better able to accept the diagnosis. I think it is vital to be kind to yourself and not judge. 

    2. Once patients are aware of the many other patients who are managing Vaginismus, they then feel empowered to seek help. Questioning then accepting are the very first steps in overcoming Vaginismus.

One can easily avoid sex when they are suffering from Vaginismus. There are many other types of intimacy that do not involve intercourse. 

I think that becoming a sexual person starts with the self. Masturbating and using vibrators can be both pleasurable and help while going through the treatment of Vaginismus.

Eventually you can transition from self to partnered sex when you feel comfortable doing so.

    1. This is a very good question. I had vaginismus through my 20s and into my early 30s. I wanted more than anything to “fix” it but I did avoid it altogether at times as I would try one thing (i.e. dilating on my own, visiting a doctor who did not understand, etc.) and I would get discouraged that it didn’t work. One thing that I did do and would suggest is being a part of a vaginismus forum. At the time, I belonged to a yahoo forum for trying to conceive with vaginismus. I never ever posted but even at my most discouraged moments and when I was actively avoiding everything vaginismus, I still took the time to read the posts and in the back of my mind, it gave me hope that I would still be able to overcome someday. It also led me to discovering the Botox treatment program as another member talked about her success with it. Another thing that has helped others is to have a vaginismus email buddy (even one friend who has or is going through this). You don’t have to talk constantly but by having this outlet to vent to really helps so much.

I 100% have had avoidance of sex. While having vaginismus, any attempts (i.e. finger, penis, etc.) caused excruciating pain and their literally was a wall of resistance. I wanted more than anything to “will” it to happen but it didn’t until I received the Botox treatment program. After this, the great wall (as my hubby called it), did dissipate and I was able to insert the dilators and later my husband. Then, once this pain/negativity was no longer associated with intercourse, we both no longer avoided trying and later even enjoyed it. 

Nest question: "What are a woman's options when vaginismus is impeding her ability to get pregnant?"

This is such an emotional question and one that my husband and I went through while having vaginismus. We wanted to start a family so badly but I had vaginismus and we couldn’t have intercourse. I had the Botox procedure in 2011 and we conceived in 2014. I had the level of vaginismus where I couldn’t insert a thing (even the smallest tampon). Without the Botox procedure, I wouldn’t have been able to become pregnant. If there is any possible way to work with Maze and have the Botox treatment, I would do this. If this is not possible, if you are able to achieve some insertion (i.e. using the dilators), you may become pregnant with artificial insemination. My husband and I tried natural intercourse for so long and weren’t having luck. We then tried the artificial insemination method (he came in a sterile cup, I coated a 10ml needless syringe with preseed lubricant, I then removed the sperm from the cup and inserted it inside of myself; I then stayed in the same position with my legs propped up for 30 minutes). It ended up working and our little man is now 21 months old. For anyone interested in learning about this, there is a thread of success stories that I used to read while contemplating trying it. http://babyandbump.momtasti...

“Pregnancy and Vaginismus” is a topic we regularly receive questions about here at Maze. I think it is vital to overcome vaginismus before attempting pregnancy if this is an option for you. Pregnancy involves multiple trips to the obstetrician to assess both maternal and fetal well-being. Although some visits do not involve internal exams as the obstetrician is just listening to the baby’s heartbeat, measuring maternal vital signs, and measuring the size of the uterus to make sure the baby is growing well, many visits do.

In the beginning of pregnancy, an internal vaginal sonogram is standard in order to measure size and dates to confirm a due date and to check for fetal viability. If you have vaginismus, this internal sonogram can be difficult and potentially cause a good deal of pain and emotional trauma.

As patients head into the last few weeks of their pregnancy, weekly internal exams are sometimes necessary to check for cervical dilation and fetal position.

If Vaginismus is impeding your ability to get pregnant, you can opt for IVF or IUI but these are still difficult to do and very costly.

On to the next one! "How does Vaginismus affect child birth and delivery?"

I overcame vaginismus in 2011 and had our son in 2015 via c-section. Throughout the pregnancy, I was diagnosed with a low-lying placenta which means we could not have intercourse and I had limited internal exams. If you are suffering from vaginismus and become pregnant, a tip would be to search online to find an OBGYN who understands vaginismus. I would also talk to their office in advance via the nurse and explain the situation and see from this dialogue if they have the experience and if you feel comfortable with them. I also wanted to direct you to a Forum thread from a member who became pregnant while having vaginismus: http://www.mazewomenshealth...

When a patient has gone through the necessary steps to cure vaginismus we find that pregnancy and childbirth are not very difficult.

We do think that patients should probably continue dilation throughout their pregnancy unless dilation is medically contraindicated.

Great answers everyone! Next question: "Can vaginismus be hereditary?"

We do not think that Vaginismus is hereditary, although we do sometimes see it occurring in mothers and daughters. However, this might be due to high levels of anxiety in the family. We just don’t know.

Vaginismus is not related to genetics. Inheritance of Vaginismus refers to whether the condition is inherited from your parents or "runs" in families. The level of inheritance of a condition depends on how important genetics are to the disease. Strongly genetic diseases are usually inherited, partially genetic diseases are sometimes inherited, and non-genetic diseases are not inherited. 

Okay, this is the last of the shorter questions, after this, they start to get a little longer/more detailed! "Is vaginismus a form of anxiety?"

I believe anxiety goes hand-in-hand with vaginismus. For me, every time we attempted any form of insertion (i.e. finger, penis, dilating, etc.), I felt and he felt like there was a wall up. This caused intense burning pain which led to anxiety. The anxiety surrounding vaginismus for me also always consisted of constantly worrying about how to find a cure for it, if there was a way I could “will” it to work even one time (never happened) and concern for the future (how would we have children). I overcame the physical wall of resistance/pain with the Botox treatment program and along with the resistance and pain going away, my anxiety surrounding vaginismus went with it. 

Vaginismus is not a form of anxiety. It is defined as the involuntary tightening of vaginal muscles. With that being said, many patients with Vaginismus do suffer from some form of anxiety. Whether the Vaginismus has caused the anxiety is often discussed.

At Maze our patients have a very thorough psychosocial intake before meeting with the medical providers. Patients can have a history of sexual and emotional abuse in conjunction with Vaginismus.

The majority of our patients present without any history of abuse and just have tight muscles which causes Vaginismus


Question 10! Keep submitting your questions here!


"I am curious about sex for the first time, and would like any tips/tricks you may have! I used something and my first cycle is almost finished, and then we'll try having sex. I'm nervous, but yet exited that I may be able to! So, any tips on first time sex."

Sex for the first time can be both exciting and scary. We suggest dilating before having intercourse.

We also recommend 2 positions for the first few attempts because they simulate the insertion of dilators. Lie on the bed with your legs apart and your feet propped up on chairs with your partner standing between your legs. Have your partner insert the largest dilator so that he can adequately gauge the appropriate angle. Then using his or your hands, slowly insert his penis into your vagina.

Another position is the missionary position. Have your partner kneel between your legs as you are lying on your back. Again have your partner insert the largest dilator so he can adequately gauge the appropriate angle. Then using his or your hands insert his penis.

Once your partner is fully inside and you are relaxed enough and you are not experiencing any pain, let him start to move slowly and gently.

Remember to use adequate lubricant to make insertion easier

When my hubby and I had sex for the first time, I had a ton of involuntary leg-lock. To work around this, he tried the doggy-style (from behind) position and this worked well for us. Others have also had a lot of success with the spooning position for a comfortable first time position. 

  1. Next question: "They (doctors, friends, select family) say that it's all in my head and that I need to relax or use a lubricant. I have tried meditation, dilators, several brands of lubricant, and toys. I have had no trauma sexually or gynecologically, and no births or terminated pregnancies. I need help and don't know where my next step lies."

I am so sorry that doctors and others have told you this and it’s seriously not fair. I was told this while having vaginismus as well and it was so frustrating. I tried to use dilators along with a workbook, drinking heavily to relax, pelvic floor PT and so much more. Nothing was successful as I could not get beyond the pain/resistance/blocked feeling for any insertion. I had the Botox treatment and this finally worked for me when nothing else had. There were several aspects that made it successful but, so importantly, the Botox took the wall that I describe above away and I was able to insert the dilators right up for the first time in a standing position and later my husband. 

Friends mean well. Sounds as if you need help with dilation. Doing dilation alone can be quite overwhelming. At Maze we use dilators too. We gradually move up in size every week or every other week depending on the progress. We are here to guide you through all stages of dilation. Before we begin dilation, we do a very detailed history and physical exam. We rule out Vulvodynia and assess the degree of vaginismus. We guide you through the entire process and offer tips along the way to help make dilation a lot less overwhelming.

We sometimes refer to Pelvic Physical therapy in conjunction with dilation exercises.

Here's the next question: "Hello! I'm beginning treatment for secondary vaginismus. At this stage, I would like to determine whether I also have a vaginal infection that has triggered the vaginismus. Besides BV and yeast infections, are there any other types of infections or medical conditions that might be an underlying cause for vaginismus?"

Recurrent yeast infections and recurrent bacterial infections are often associated more with vulvodynia than vaginismus. Sometimes though, they go hand in hand.

 

In treating both Vaginismus and Vulvodynia we see recurrent yeast and bacterial vaginosis. Rarely, but every now and then, we do see both lichen planus or lichen sclerosis which are both associated with Vulvodynia as well.

I have heard of yeast infections triggering vaginismus but do not know of any others. 

Next question: "I have had vaginismus my entire life. My exams must be done under heavy sedation, and I have never been able to progress beyond the smallest of the dilators despite therapy. I am 42 years old and have never been able to have intercourse because of this problem, and I feel as if there is little I can do about it. I don't even know if this is a question- it seems more like a statement or a plea. I want to be normal."

I am so sorry that you have suffered for so long. It is very important to get a definite diagnosis of Vaginismus and seek help with providers who really know how to treat Vaginismus.

 

At Maze, we treat every degree of vaginismus. We begin with a gentle dilation program. We often prescribe vaginal valium to help relax tight muscles and we offer a ton of encouragement every step of the way.

 

If we are not successful with dilation we do offer vaginal Botox. You are not alone and we can help you.

I am so, so sorry that you are going through this. Please know that there are treatments out there for vaginismus and you can 100% overcome. I often felt very discouraged while going through it. You have already taken an awesome step by participating in the Blogcast here and talking about it. If you have had difficulty with dilation as you describe, I would definitely suggest considering the Botox treatment program. This worked so well for me personally because I could finally insert the dilators without hitting the wall of pain/resistance. Then, I was also able to move up in dilator size as the Botox took affect and, again, the normal excruciating pain with all attempts at insertion was gone. 

"Are there birth control options for women with vaginismus that do not require pap smears how do other women handle this when it is traumatic to have a pap smear. How do you have that conversation with a doctor?"

There are birth control that are available to you that do not involve a pap smear. Your age determines whether or not a pap smear is necessary.

The only form of birth control which could be difficult for a patient with uncured vaginismus is an IUD as it needs to be inserted into the uterus in your gynecologist’s office.

 

As far as birth control, there are many options. You can take birth control pills, get the depoprovera shot, use the orthoevra patch, or use male or female condoms.

 

Condoms prevent Sexually transmitted diseases and do not require a prescription.

In terms of discussing Vaginismus with your Gynecologist, this can be tricky as many gynecologists do not know how to counsel women regarding Vaginismus.

 

I suggest finding a gynecologist who does treat female sexual dysfunction. These gynecologists are generally well versed in vaginismus and can see you through a pap smear. If you are already dilating, I suggest dilating before the gynecology visit and Pap smear.

While having vaginismus, I could not undergo an exam despite trying and I did deal with some very rude providers who suggested to “just relax”, etc. It was so frustrating for me. I have some thoughts that may help regarding starting the conversation with a doctor. Vaginismus.com has an absolutely excellent script that is very helpful as a means of talking to your physician about vaginismus:


Sample Script: Self-Guided History of Sexual Pain

1. Introduce the problem:
“I have been having problems with pain during sex and hope you will be able to help me.”

2. Provide a description of the pain (be specific):
•It happens when …”my husband tries insert his penis in my vagina” or “once he is inside and starts to move I feel burning and tighten up”, etc.
•The pain is located …”at the entrance to my vagina. My vagina is like a wall; he just cannot get it in.” or “after he is inside I feel burning around the penis just inside the entrance”, etc.
•The pain lasts …”as long as he keeps trying, especially if we try forcing it in. Once he stops there is no pain.”
•This has been happening since …”our honeymoon two years ago and has continued to happen every time we try to have sex” (primary vaginismus) or “my hysterectomy eight months ago”(secondary vaginismus), etc. [Note: Inform your doctor if you have been able to previously have sexual intercourse without pain.]
•It feels like …”burning”, “stinging”, “like he’s hitting a wall”, “tightness during/on entry”, etc.
•I have tried to reduce or eliminate the pain by …”using lubricant, changing sexual positions, relaxing more.”
•I am able / unable to …”insert a tampon or complete a gynecological exam.”

3. Mention any past problems:
Have you previously had any sexually transmitted diseases, yeast infections, bladder problems, or any pelvic pain outside of penetration?

4. State what you think the problem is: “I think it may be vaginismus. My symptoms are similar to those outlined in an article I read. However, I have read there are other things that can cause pain during sex and would like to have them ruled out.”


Another idea would be calling a doctor’s office prior to going to see one. In an excellent post, a Maze Forum member suggested this: “One thing I did when I was looking around is calling the office and asking to speak with a nurse. When I got the nurse, I explained my situation and asked if the doctor knew what vaginismus was, and if she’d had any experience with it. It’s hard to talk about, especially to a complete stranger who may just think you’re crazy, but I much preferred doing that to having to make appointment after appointment trying to find a good doctor. I just don’t have the time or the money to bounce from one doctor to the next.”

With only about an hour left, we're going to pick up the pace a little! Next question: "Why go do Dr and Gyn's ignore vaginismus? Why is the medical community so insensitive so vaginismus suffers?"

I so, so, so wish I knew and had the answer. I hate how insensitive some doctors are regarding vaginismus and how some don’t even know what it is. On the Maze forum, there is a category dedicated to Vaginismus Advocacy and talks about so many different ways to help make vaginismus more known. http://www.mazewomenshealth.com/forums/forum/vaginismus/vaginismus-advocacy/ Suggested ideas include talking about vaginismus in colleges, teaching it in medical schools and so many magazine and media outlets discussing it. 

I think that many gynecologists were not trained in vaginismus during both medical school and residency.

 

I feel that this is a major problem in terms of the training that they receive.  I am hopeful that this will change in the near future as Vaginismus is no longer a condition that is not talked about by both the media and by patients themselves.

"What causes it? Is it caused by sexual trauma? What is the best form of treatment? Is there a permanent cure? Are there resources available for my spouse? How do I educate my PCP?"

The exact cause of Vaginismus remains unknown and unclear. It is usually not the result of sexual abuse but occasionally we see vaginismus in patients who have suffered from abuse.

 

The treatment we use at Maze involves determining the degree of vaginismus a patient has. We use a gradual vaginal dilation program with a series of dilators that increase in size weekly or every other week. We often prescribe vaginal valium to help with tight muscles in the vagina; we sometimes recommend Pelvic Floor Physical therapy to help massage tight vaginal muscles. In severe cases, we offer vaginal Botox which works wonders on patients.

 

At Maze, we try and include partners as deemed appropriate by our patients. Unfortunately most primary care providers do not really know or understand vaginismus. Hopefully this will soon change as more people are becoming educated about Vaginismus.

I do not know the cause of vaginismus but wish I did. For me, receiving the Botox treatment program was the only thing that ended up working. I tried so many other things prior and had no success as I couldn’t get beyond the wall of pain/resistance for any insertion. Resources for your husband can include having him view the Men’s Category on the Maze Forum: http://www.mazewomenshealth.com/forums/forum/vaginismus/vaginismus-for-the-men/ An excellent idea to educate your PCP about vaginismus is providing educational resources about it. In the past, I gave pamphlets to both my ob/gyn and PCP and explained the Botox procedure to them. 

  1. Next question: "I am trying to treat my vaginismus with 6 dilators that vary in size however I can't seem to adjust to the 5th dilator no matter how much lubrication. Any suggestions you have for me is greatly appreciated."

Moving up a size can be hard but is possible. I think some suggestions would be to move the 4th dilator in and out and in varying ways. Then, after dilating with it for a while, try to remove and insert the next size up. When I used the Pure Romance dilators, I had a difficult time moving from pink to blue and I found that by leaving pink in for 30 minutes and then removing and inserting blue, it helped. Another idea is to try inserting the #6 dilator after waking up from sleeping with a dilator overnight. A further idea would be to try a dilation set that offers half sizes. There are companies, like Syracuse Medical (see link below) that have half-sizes.

Syracuse Medical:
http://www.cmtmedical.com/index.php?main_page=product_info&products;_id=551

My suggestion is to continue using the smaller dilators daily. Being consistent with dilation is key to success. Do not get discouraged. When the smaller dilators are going in without any problems then try and use the next size dilator. It takes time and patience.

  1. Here's a long one!: 

  2. "I have been dealing with secondary vaginismus for 7 years now. I have had multiple doctors either tell me to just relax, or actually care about and understand my pain and tell me we WILL get my pain level down so sex can be pain-free or almost pain-free again... but no matter what I try, the pain is still very much present. 

  3. My question is this: Are there women out there who just never will get "better" and always have very painful sex? I'd just like a straight answer; it seems no one wants to tell someone that they'll never beat vaginismus. It is mentally and emotionally exhausting to put myself and my partner through this, that and the other trying to find a "cure" when really maybe we just need to accept the fact that "normal" sex will never be a part of our relationship again. I truly appreciate your time, thank you!!"

Vaginismus is a very treatable condition. It is not in your head and relaxation can help but it does not cure it. At Maze we see patients with all degrees of Vaginismus.

 

We feel that consistent dilation works best. Sometimes we give vaginal valium to help with the dilation process. It does take time and patience but we have so many success stories here at Maze.

 

Every day I hear stories like yours where medical providers who are not familiar with Vaginismus tell patients to relax and have a glass of wine.  It is not all in your head... It is the result of involuntary tight muscle tone in the vagina.  We treat the fear of intercourse along with the actual pain due to tight muscles with dilation, Pelvic floor Physical Therapy and vaginal Botox. You are not alone and you can be treated.

Please know that I am so sorry for what you have dealt with while having secondary vaginismus. The woman who also had her Botox treatment on the same day as mine had secondary vaginismus and she was able to overcome with this treatment method.  

Next question: "I have gone to physical therapy for this and my hubby and I can't do intercourse even so due to his impotence (he has tried different things too). Is there anything else we can try?"

For me personally, the only thing that worked was having the Botox treatment program. At Maze, they can help you with overcoming vaginismus and they also have a physician, Dr. Werner, dedicated to helping men overcome their sexual issues.

I am so glad that you have been going to Pelvic floor PT.  As far as your spouse’s erectile dysfunction this is usually treated with Cialis or Viagra. I suggest that he see a physician who specializes in male urology.  We recommend Dr Michael Werner who works in both Westchester and Manhattan. We see erectile dysfunction in so many partners of women with Vaginismus.

  1. Another question:

  2. "Hi Ladies,

  3. I am new to this site so my questions are pretty general. I have tried to use dilators and my nerves and anxiety haven't helped that form of treatment. My question for you is what treatment has the most successful outcomes and how do I go about that. Also, how long do the treatments you suggested often take until you are pain-free during sex?

  4. Thank you!"

I had the Botox treatment on 6/27/11 and was able to have intercourse with my hubby for the first time on 7/4/11. To date, it has not come back and I have been able to have successful exams as well plus we have a 21 month old. 

The most successful and shortest treatment available is Vaginal Botox. We do Botox cases in the operating room under conscious sedation. When we do the Botox procedure many of our patients are able to have pain free sex within one week after the Botox. It is still very important to dilate daily after Botox but you are dilating with the largest dilator and it is much less painful than before Botox.

 

Anxiety and frustration are 2 common emotions we see in our patients with Vaginismus. Talk therapy in conjunction with dilation can be quite helpful to patients who have vaginismus and are feeling helpless and hopeless.

 

Another form of treatment we use in Vaginismus is Pelvic floor physical therapy. Pelvic floor physical therapy involves the practitioner massaging tight muscles that contribute to vaginismus. Most patients who are going to physical therapy have to go twice a week for it to be effective.

 

If you are interested in the Botox procedure you can call us at Maze and we can determine if this is the most appropriate approach for you. It is so hard to say how long it will take with any of the treatments we offer. Everyone is different. Every form of Vaginismus is different too

Here's a new question that was submitted earlier today: 


" Hi, what do you think could be hindering someone from intercourse post Botox treatment after being able to dilate with the largest dilator? I think the answer is the medical aspect has been treated but the psychological component needs to be more fully addressed/worked on? How should one address the psychological part with no idea where this road block is coming from?"

I totally agree with you. If you are able to use the largest dilator post Botox and it is not painful you should be able to proceed with pain free intercourse.

The emotional side of Vaginismus must be addressed as well. At Maze, we do a lot of talk therapy along with prescribing medications as needed for anxiety.  This combination of Botox and counseling with a therapist addresses both the physical and the emotional component of Vaginismus.

I think talking to a therapist post-procedure could be super, super helpful. For me, post-procedure, it helped to talk to the hubby about all of our mutual feelings (i.e. fear of failing again, etc.) and helped us to move past it.

"What are common feelings post botox treatment that patients have had and what recommendations do you have to smooth the transition to intercourse?"

This is a good question. Following my Botox treatment program, I experienced so many feelings. I was elated that it had worked and I was able to now insert the dilators without the usual feeling of pain and resistance that had always been there. This elation also seemed to make me happy and more confident in other areas of my life as well. Some frustration did occur as I was excited to make the transition to intercourse and over-dilated on some days. This would cause soreness for the next day I tried. I had tremendous support from the Team post-procedure and would return to dilating less and the soreness would go away. I also had support from them while transitioning to intercourse. What helped us was for me to dilate in advance of intercourse and my hubby removed the dilator and inserted himself right in. We both couldn’t believe but were so, so, so, so happy that it worked!!! I also wanted to share a Maze Forum thread regarding other positions of comfort post-vaginismus:

“We ended up in the missionary position with my legs up in the air around his neck. We had a couple of few failed attempts at first but did not give up! In that particular position I didn’t feel as vulnerable as when I was in missionary with my legs/knees open (similar to the position for an exam or something) and leg lock set in. This way my legs were up and out of the way and I was able to insert his penis in the direction that felt most comfortable for me (angling to my left side).

Our favorite position so far is side by side, where he can start penetration slowly and increase the rhythm and depth as we go. We have learned that this position allows access to some other erogenous zones (i.e breasts) at the same time.”

There are many emotions that occur after Botox. Some that we see range from relief, joy, fear, sadness and ambivalence.

 

Many of the patients we see have been dealing with Vaginismus for years or even decades. I think validation of these feelings by providers and partners goes a long way. Some patients require talk therapy to help manage these feelings.

 

The transition from Botox to intercourse can be very scary to patients who have Vaginismus. We suggest dilating before intercourse with the largest dilator to help build confidence that intercourse will not hurt. A supportive partner during this transition period is so important.

 

As we tell patients, the first intercourse is often more complicated than you would think. Many times it has obstacles like am I lubricated enough, or can he maintain an erection.  It may not be the romantic moment you may have anticipated. Our advice is to remain positive and maintain your sense of humor. Remind yourself that first intercourse is usually awkward and may not go as you planned. Laughter and not taking yourself so serious can work wonders when attempting intercourse after Botox.

Next question: "I've read that sometimes vaginismus can be a cause of provoked vestibulodynia as well. For the botox treatment, how do you determine which muscles to inject? Are different muscles injected for just vaginismus, versus vaginismus and vestibulodynia? 


Do you use an ultrasound or other machine to determine what muscles are in spasm?"

Melissa has written an awesome post regarding vaginismus and spastic muscles: http://www.mazewomenshealth...
“When I examine patients in the operating room there is often intense anxiety that requires sedation before an examination can be done. In the very severe cases of vaginismus (Lamont grade 4 and Pacik grade 5 vaginismus) I can actually see the constricted mass of muscle at the entrance to the vagina, making it impossible to introduce my finger until they are asleep with an anesthetic. The spastic muscle is targeted with Botox injections. Any other tight or spastic vaginal muscles are also injected with Botox.”

During the botox procedure we inject 100 units of botox into the bulbocaverosus, pubococygeus and puborectalis

muscles. We inject about 20 different injections.

This is standard of care when using botox for vaginismsus.

No sonogram is necessary to determine which muscle groups are in spasm and need to be treated.


"Is there a difference between pelvic floor dysfunction and vaginismus? Or are they the same?"

In the past, Melissa at Maze has written: “Vaginsimus is a type of pelvic floor dysfunction.”

Agree with Kimberly-Vaginismus is a type of pelvic floor dysfunction.

"I've only been given the diagnosis of vulvodynia. However based on my own symptoms, and statements by my gynecologist and pelvic physical therapist, I believe a more proper diagnosis would be provoked vestibulodynia and probably vaginismus. Are the doctors at Maze able to determine a more accurate diagnosis? Or are we expected to see a vulvodynia specialist before talking to Maze about the botox treatment?"

I wanted to share a Blog with you regarding vaginismus v. vulvodynia

http://www.mazewomenshealth...

From Dr. Pacik: Currently, the default diagnosis of sexual pain is vulvodynia. That means that when a physician is faced with a patient who is unable to have intercourse because of pain, the diagnosis is automatically vulvodynia or “vestibulitis” Very few clinicians think of asking about vaginismus and therefore most of my patients have been misdiagnosed as suffering from vulvodynia, when in actual fact the correct diagnosis was vaginismus. This is doubly unfortunate because not only is there a misdiagnosis, but also failure to treat. Of the many conditions responsible for sexual pain, vaginismus is the easiest to treat.

The word ODYNE means pain. Therefore vulvodynia is pain anywhere in the vulva. Vestibule means room and refers to the area just before entry into the vagina, inside the labia. This potential space (just prior to entry) is called the vestibule. Pain here is vestibulodynia, and the old term is vulvar vestibulitis syndrome, or vestibulitis for short.

When I test my patients with a cotton tipped applicator, “Q-tip test”, about 1/2 test positive for either or vulvodynia and/or vestibulodynia, These are mostly “false positive ” tests in that the woman does not have this condition, but rather it is a manifestation of fear and anxiety to penetration. It is “too close for comfort”. Many of my more severe vaginismus patients are unable to differentiate between pain and anxiety when tested and have a marked aversion to be touched in these areas. To date I know of only one patient who had true associated vulvodynia and she is the one whose article appeared in the November 2011 issue of Cosmo. 

From User 3. I’ve never considered myself to have vulvodynia or vestibulodynia, but I can see how this pain (which was purely down to anxiety) could be misinterpreted if a doctor did a gyn exam. While I was self-diagnosed, I did mention my vaginismus to a nurse once and she thought I was talking about vulvodynia or vestibulodynia (I can’t remember which) and seemed unaware of vaginismus. She suggested I see the nurse practitioner who could give me some numbing cream (I didn’t go to get this as I had a feeling it wouldn’t do much!). On another occasion I saw my doctor to ask if there was anything she could do or a specialist she could send me to regarding my vaginismus. I told her I was already working with dilators, although I had been working with them for about 4 years at the time and had not made sufficient progress . . . she said that as I was already doing that there was nothing else she could think of. It therefore took us (after a year or so of deliberating and saving) to take a trip over to the states from the UK to have a shot at proper treatment. Despite the NHS in the UK, we still had to take out a loan for the treatment, which we had to find by ourselves. Thank goodness we could and did!

At Maze we do differentiate between vaginismus and provoked vestibulodynia based on a comprehensive history and physical examination. 

There is no need to see a specialist in vulvodynia before being seen here at Maze.

This will be our last question for the day!: "Hi, I am really struggling with dilators even after botox treatment and find hard to overcome anxiety. Is there any vagina widening procedure at all?"

Thank you so much for letting me participate in this Blogcast. I think it may be helpful to do either Physical Therapy or Talk Therapy post-procedure (or both).

Melissa has written: Physical therapy after the botox procedure can also be very helpful for patients struggling to do the dilation on their own. PTs can work with you with the dilators.

Also, Dr. Pacik wrote that post-treatment “[t]here are many other problems that sometimes surface including poor lubrication, low libido, inability to orgasm and disgust issues. Getting support from a psychologist skilled in vaginismus counseling can be very helpful.”

Maze provides therapy and counseling to all patients (vaginismus and other) and their approach to all sexual dysfunction is a combination of medical and psychological treatment. See link describing Sex Therapy at Maze: http://www.mazewomenshealth.com/sexual-health/sex-therapy/

The emotional side of Vaginismus must be addressed as well. We do a lot of talk therapy here at Maze along with prescribing medications as needed for anxiety.  This combination of Botox and counseling with a therapist addresses both the physical and the emotional component of Vaginismus.

That's all the time we have for today!! Thank you for submitting your questions and I hope Kim and Aimee were able to address your concerns.


If you have further questions, please do not submit to the form. You may email us at info@mazewomenshealth.com OR fill out our contact form on our site.


We offer free information packets and free phone consultations. Remember, you're not alone and there's always help. We're here to help! 


Have a great day!

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