Comparison of the Lamont/Pacik Vaginismus Data
In Lamont’s study of 80 women, the shortest duration of vaginismus was one month, and the longest duration was 18 years. The average patient suffered from vaginismus for about 3 years. Average age of the patients was 26-27, and the oldest patient was 58. Most of the patients were married. This is very similar to our own series. The average duration of failed treatments was 7+ years. 21 patients had vaginismus for more than 15 years and three patients had vaginismus for 37 and 38 years. The majority of our patients are the more severe grades of vaginismus as noted in the table below, yet appear to do just as well with the Botox program of treatment as do the less severe cases of vaginismus. Hymenectomy was not found to be helpful in either Lamont’s patients or my patients.
Table: Modified Lamont Classification of degrees of vaginismus
Treatment of Vaginismus: Controlled Environment in SurgiCenter
Because of considerable anxiety in most patients with vaginismus, they are examined in the surgicenter so they can receive sedation and then anesthesia for the Botox injections and progressive dilation. Any patient that has the more severe forms of vaginismus will not allow a GYN exam to be performed. Any attempt is usually accompanied by considerable fear and retreat. We find this to be true even when the patient is under anesthesia, and often notice elevation of the buttocks and retreat even after the anesthetic has been given. The patient remembers nothing about the exam. In these cases, the anesthesia is deepened before doing an exam and introducing the intravaginal Botox injections and dilators. This is also why we encourage a loved one to join us during the treatment so that he or she can see the involuntary behavior even under anesthesia. This provides an opportunity to better understand the struggles a patient is experiencing and allows the partner an insight that the inability to have intercourse is not done on purpose nor his fault. It is also a time of significant bonding. Husbands or partners who have been in the operating room with me leave with a renewed profound respect for the difficulties their wives have been experiencing.
The treatment of Botox together with a long acting injected anesthetic, and dilators coated with a topical anesthetic allow for the immediate conversion of a high level vaginismus to a lower level vaginismus. One can work with a grade 1-2 vaginismus but it is usually impossible to work effectively with a grade 3-5 vaginismus. You can give a grade 5 all the advice in the world, it just doesn’t happen, and too many women give up because of frustration.
The Lamont classification, modified by Pacik, continues to be used. It provides a common language among physicians and researchers who study vaginismus, and gives insight into an understanding of which forms of therapy would be suitable.
References
- Lamont JA. Vaginismus. Am J Obstet Gynecol. 1978 Jul 15;131(6):633-6. PMID: 686049
- Pacik, PT Vaginismus: Review of Current Concepts and Treatment Using Botox Injections, Bupivacaine Injections, and Progressive Dilation with the Patient Under Anesthesia. Aesth. Plast. Surg. 2011 DOI 10.1007/s00266-011-9737-5
- Pacik, PT and Cole, J. When Sex Seems Impossible. Stories of Vaginismus and How You Can Achieve Intimacy. Odyne Publishing. 2010 Ch. 6 pp 40-47
- Pacik, PT. Botox Treatment for Vaginismus. Plast. and Reconst. Surg: 124: 455e-456e Dec 2009 DOI: 10.1097/PRS.0b013e3181bf7f11