Fee Reduction and Retirement
As the first newsletter of 2015, I would like to wish everyone a Happy New Year. This newsletter will discuss ways to reduce the cost of vaginismus treatment as well as my retirement.
Botox Treatment for Vaginismus Fee Reduction
The treatment program for vaginismus includes the use of Botox (weakens the spastic entry muscle that prevents penetration) as well as progressive dilation under anesthesia (stretches the muscle). The post-procedure counseling is of importance in understanding the dilation program, transitioning to intercourse and overcoming the fear and anxiety of penetration.
Because Botox adds considerable expense to the treatment, I have been wondering if we could eliminate the Botox from the treatment program in order to lower the cost of treatment. I have 
had several patients who did not want the Botox injections because of the expense and more importantly because of their desire to start a family as soon as possible. These patients were treated using long-acting local anesthesia injections as well as progressive dilation under anesthesia and waking up in recovery with a large dilator in place. Though many of my patients can “feel” the benefit of the Botox within a week to 10 days, the ones I did not use Botox also did well and were successful with penetration and intercourse. The fee reduction for the elimination of Botox injections would be $800. In addition, I would expect insurance companies to provide better coverage if Botox is not included in the treatment since they often argue that the use of Botox is still “investigational”. The elimination of Botox from the treatment protocol would require that I review your forms and discuss this prior to treatment.
It is important to note that for those women who have considerable fear and anxiety to penetration or those who have failed multiple treatment programs, the full Botox treatment program plus progressive dilation under anesthesia may be needed. In addition, the full Botox treatment program has been reported to have a greater than 90% success rate.
Using dilators to develop your own treatment program
Many women who are able to dilate using small dilators but cannot progress to larger dilators or intercourse have ordered our silicone or the shorter glass dilators and our DVD“The Ins and Outs of Dilating”. These vaginismus aids have been helpful in developing their own treatment program. My book “When Sex Seems Impossible…” has also been helpful to many. Remote counseling is another tool that has been effective for those patients that have been screened. If you find you are not able to advance with the above suggestions, the costs of the silicone dilators, DVD and book will be applied to the fee for full treatment.
Pacik Glass Dilators
Since Dr. Pacik retired on September 1st, 2015, we are not selling the Pacik Glass dilators through our office anymore but we do have a web page with the manufacturer Crystal Delight where you can still order them. You can order the dilators as a set or individually with or without a pouch.
Retirement
I have had a wonderful professional career since graduating medical school 50 years ago this coming June 2015. As of January 2015, I made the decision to retire from performing major 
plastic surgery cases.
The women I have treated for vaginismus have been a great inspiration to me showing courage and determination beyond description. I have had great joy working with so many patients over the many years with a wide variety of concerns. I feel blessed to have been a part of so many lives.
I am not sure how much longer I will be doing vaginismus treatment and will make some important decisions by this summer. For any patient I have treated, I will continue to follow them even after retirement.
For More Information
I urge you to explore our website dedicated exclusively to vaginismus patients on VaginismusMD and our Plastic Surgery website for more information. We also encourage you to sign up for the private VaginismusMD Forum and to introduce yourself, where you can share your questions, concerns, and stories with others coping with the same condition as well as patients who have completed their treatment. It is a wonderful community of women that helps to remove the feeling of isolation that is so common with vaginismus.
We look forward to speaking to you and provide a complimentary phone call to discuss the completed questionnaire.
Sincerely,
Peter T. Pacik, MD, FACS