Most of the patients that we treat for vaginismus have a very severe form of vaginismus (Lamont grade 3,4; Pacik grade 5 — the most severe form) that have spent years trying different forms of conservative therapy and have failed to progress each time.
The benefit of treatment with Botox and dilators under anesthesia has allowed many of these patients to achieve intercourse in as little as 2 weeks. Nevertheless, the road to pain free intercourse is not always easy and is accompanied by continued fear and burning until adequate stretch of the tight vaginal muscles is achieved. Even after successful intercourse there is still a period of time that intercourse is accompanied by burning, especially the movement in and out, and this takes time before the muscles are sufficiently stretched.
For those patients who take longer to get through the set of dilators, their progress seems painfully slow to them and is accompanied by frustration.
The following communication was written by one of our patients with some advice for a patient struggling to get to the larger size dilators. I thought her words might be of help to other patients in the same situation.
Hi ________,
Dr. Pacik has asked if I would write to you with some advice on dilation. I wanted you to know that I am still here for you if you need any more advice or additional support. It really can take much time and patience before you see any progress as it did for me. Even now I still have to use the dilator before I have intercourse because my muscles still have to adjust and get used to the stretching. Kegel exercises can really help even if you do them throughout the day when you are not dilating.
I’m not sure what the environment is like when you are using the dilator but a good distraction can help, for example having the TV on or having your partner sit and chat with you. In the early stages of using the smallest dilator I made sure my husband sat with me so we could have a chat, it completely took my mind away from I was doing and before I knew it the dilator had gone in. Sometimes a relaxing room with dim lighting and gentle music can put TOO much focus on what you are trying to achieve and have the opposite effect. I’m sure it’s not the same for everyone I guess it depends on the person. For me I found that concentrating too much didn’t help.
Remember when you feel that sharp pain like your hitting a brick wall don’t push yourself to go further but don’t stop either, just hold the dilator in place until that pain becomes less and less. When you are feeling more comfortable just progress a little further. Even if it takes you all day it’s worth it.
I know you will get through this, just take your time and keep going.
Best Wishes
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