Physical Therapy for Vaginismus Is Not Always the Answer
Though physical therapy for vaginismus is a well-established form of therapy for vaginismus, patients who have a very high level of anxiety and fear related to any touch in the pelvic area often fail to make progress with physical therapy. Therefore, there has been inconsistency in the efficacy of physical therapy for vaginismus mostly because of the lack of stratifying patients according to the severity of vaginismus. Lumping every patient into the same generalized category of vaginismus, without understanding the severity, allows some patients to benefit from treatment whereas others fail to make progress.
I have seen this with some of my patients who are a Lamont/Pacik level 5 vaginismus and have never had any form of penetration. I have treated physical therapists themselves, who work in the field, and were unable to achieve success with physical therapy. These women were able to achieve intercourse after treatment with Botox and dilators.
A Patient’s Personal Account of Physical Therapy for Vaginismus
Recently, a VaginismusMD Forum member shared her experiences regarding physical therapy both pre and post-procedure. She writes:
“Hi all – I thought I would write a quick post about PT post-procedure in case it may be helpful for someone else. Before my procedure with Dr. Pacik, I was seeing a PT once a week for almost 2.5 years. I was using the white silicon dilators on my own; and with my PT, I was doing several exercises to release tone in my pelvic floor muscles. My PT was also using her fingers to manually stretch the inside of my vagina and used lidocaine to “numb” the PC entry muscles. During our sessions, my muscle spasms would eventually relax enough to let her do her “thing” but I would still feel initial pain upon entry. Over time, the pain would go away quicker, but the initial pain upon entry was still there. I am happy to report that after this procedure, my PT appointments are SO much easier and there is absolutely zero pain upon entry. The lidocaine is not even used anymore (just lube), and I have absolutely no issues whatsoever. Everything is just so much easier, and my PT can tell this as well. She did notice some tone on the right side still but she thought that the right side could be overcompensating for the left side – as my left side was always way worse in terms of spasm and tone over the span of the 2 and a half years I saw her. Either way, the tone has decreased drastically, my PT has absolutely no issue at all getting past the PC muscles, and I can experience the whole appointment pain-free now. I never thought in a million years I would get to this point. If you are like me and feel like you need an extra push to get you over the hump after a few years of physical therapy for vaginismus, I greatly, greatly encourage you to have Dr. Pacik’s procedure. You will never regret this decision, I promise.”
Crisley, failed Physical Therapy for Vaginismus twice
More severe vaginismus patients have considerable difficulty with Physical Therapy for vaginismus because of their underlying fear and anxiety with any form of penetration. It is for this reason that many fail to progress with dilators or can only advance so far, but not enough for intercourse. More severe vaginismus is characterized by spasm at the entry to the vagina, which is the “wall” women complain about.
Crisley, a treated patient, failed two separate physical therapy programs, one year apart. At that time, Erika, Crisley’s physical therapist in Manchester, New Hampshire who specializes in pelvic floor disorders, referred Crisley to our office for Botox treatment plus progressive dilation under anesthesia.
Crisley was able to achieve pain free intercourse six days after treatment as she continued her physical therapy treatment with Erika. I asked Erika the following question: When you continued working with Crisley after her Botox treatment, what did you observe were the differences pre and post treatment, and what type of therapy did you do and for how long?
Erika replied: The major difference I saw with Crisley was her ability to tolerate intravaginal treatment post Botox. Prior to her Botox she was very guarded and couldn’t relax, but post treatment she presented so differently. She was relaxed and more comfortable with her body – it was obvious she had been compliant with her dilators. She was also able to tolerate an intravaginal sensor for EMG, which was impossible pre-Botox. Prior to Botox, I had to use a retal sensor (intravaginally) b/c it was so much smaller in diameter than a vaginal one.
“Vaginismus – A Patient’s Experience”
For those who would like to hear Crisley’s story, please visit my YouTube Channel. She had the courage to go public and even translated the interview into Portuguese. Her interview generated more than 10,000 hits and has empowered many other women.
- Crisley YouTube Video “Vaginismus – A Patient’s Experience” Part 1
- Crisley YouTube Video “Vaginismus – A Patient’s Experience” Part 2
Crisley is still dear to my heart and continues to do well now more than four years post treatment.
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If you have any questions about our Botox treatment for vaginismus and progressive dilation under anesthesia, please contact us via our contact us form.
