A Story About Vaginismus
My wife Janet and I were cycling, enjoying the crisp cool New Hampshire air of an early morning ride. My mind began to wander as I thought of vaginismus as such a formidable powerful opponent. A few weeks ago I wrote about the 1,2,3 punch of treating vaginismus. I began to think of David and Goliath, and how David was able to overcome his powerful opponent. Though the “1,2,3 Punch” describes the basics of vaginismus treatment, there is much more to the program. There is so much more that is needed to overcome the adversarial powerful opponent known as vaginismus.
The many steps in the Botox program to treat vaginismus
1. The first step in the program is a thorough review of the comprehensive questionnaire that patients are asked to fill out. “Listen to your patient, she is telling you the diagnosis” is a refrain often heard in medical school.
2. Speak to the patient. I value each and every conversation I have with my patients before treatment. It helps them understand, helps them overcome some of their anxiety and sets the stage for good communication after treatment. It always gives me some additional insights into what is going on for the patient, and once again I learn something about the struggles of vaginismus or a concept that is re-enforced. Slowly, even at this stage we are beginning to “know the enemy”. Knowledge is power.
3. The first strike comes in the operating room. Under anesthesia, Goliath has been rendered hel
pless as the anesthesia takes effect and reduces the muscular spasm to nothing more than an easily stretchable muscle. The power of spasm becomes jelly. The tightly closed fist of the entry muscle disappears. Botox is injected while the enemy is unconscious. Before Goliath regains consciousness, the muscle is dilated to one of the larger dilators and a long acting local anesthetic is injected to keep the powerful enemy weak after he wakes up. This results in a crippling blow . . . BUT
4. The enemy wakes up, and though weakened, Goliath can still rear its ugly head. The fight is now a balance between the dueling dilators of David and the powerful muscles of Goliath that have been weakened but not yet controlled. David fights on knowing that once the arrows delivering the Botox become effective he will be able to continue to weaken his opponent. The long acting anesthesia allows the patient to continue dilating for several hours after treatment, without fear.
5. During this time David is further coached on how to overcome the enemy. Hours are spent learning how to prepare daily logs for continued follow up, how to transition from dilators to intercourse, how to become erotic once again, positions of pelvic floor relaxation to make intercourse more comfortable and how to prepare for GYN exams. Much more is taught, but these are the basics leading to victory. More knowledge, more power. Goliath is held at bay, and weakened he begins to fall.
6. Knowing that Goliath has been weakened gives David the final determination to throw more dilators at the monstrous muscles. Continued daily logs are showing greater comfort using the dilators as anxiety diminishes. The battle at times feels long, but the powerful Goliath is weakening. It is hard to believe, but the end is in sight.
7. David conquers and the story ends as it should. The underdog wins. Intercourse is suddenly possible without pain. It takes David a little longer to overcome the stress of the battle. “I need to catch up emotionally to where I am physically” simply indicates that any of us need to get beyond stressful times, and this may take awhile.
8. We tell our patients to shout their success from the rooftops. This is why we created a section of the Forum titled “Success Stories” and encourage our patients to post here. There are successes after dilating, after intercourse, long-term successes and starting families. All of these stories empower other women waiting to do battle with the monster.
By now my bike ride is almost over as I was transformed into an arena many ages ago. I think I missed some of the scenery, but, it was a great ride. David was victorious.
The Story of David and Goliath
Goliath was a nine-foot-tall soldier from Gath. He bragged that he could beat any Israelite soldier who would fight him. But all the Israelite soldiers were afraid to fight him.
David was a young shepherd boy who believed in God. He said, “The Lord who delivered me from the paw of the lion and from the paw of the bear, will deliver me from the hand of this Philistine.” David took his sling and five smooth stones from the brook. Then he went to fight Goliath.
King Saul wanted to put his heavy armor and helmet on David. He also tried to give David a big sword, but David said he could not wear them. He knew that his strength and protection came from God.
Goliath cursed the boy coming out to fight him. David said to the Philistine, “You come against me with sword and spear and javelin; but I come against you in the name of the Lord Almighty, the God of the armies of Israel, whom you have defied.”
David threw a stone with his sling at Goliath. It hit Goliath in the forehead and the giant fell face down. Without a sword in his hand he struck down the giant and killed him.
David believed in God, and God helped him win over the giant.
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