Finger dilation — what happens
The normal physiologic response to finger penetration is for the vagina to quickly go through a relaxation response making penile entry possible. This is what would be expected and happens in the vast majority of women. For women with vaginismus, the opposite is true in that the vagina goes into spasm as a protective reflex to avoid intercourse. When I examine my patients who have been properly sedated, one of two things are observed.
- The vaginal muscles are so tight that finger penetration is not possible until the patient is under anesthesia.
- The spasm noted quickly disappears
These findings are related to the severity of vaginismus. Those with more severe vaginismus are likely to maintain their spasm.
Botox Treatment Post Procedure dilation
During anesthesia, the Botox is injected into the spastic muscles, a long acting local anesthetic is injected and the vagina is progressively dilated to the larger dilators. This is followed with post procedure supervised dilation allowing the patient to become comfortable moving the larger dilators in and out. There is no discomfort because of the local injected.
Botox Treatment Post Procedure Educational Counseling
The need for continued dilation at home is discussed. Once the vaginal muscles begin to relax as a result of the combination of Botox injections and the dilators, we now have a situation where the vaginal muscles begin to function more normally. At this point, these muscles will respond as they should; namely, by dilating in response to finger penetration. Since the finger is smaller than a medium sized dilator, finger penetration becomes an excellent stimulus to help the vagina go through its natural dilation process setting the stage for progressively larger dilators and later penile penetration.
Your finger or his?
It is normal for vaginismus patients to be averse to self-penetration. This is one reason we teach mirror exercises, because 
here, too, women have divorced themselves from their pelvic anatomy to the degree they will not even look at themselves. Since the partner is encouraged to participate in the dilation program he (or she) can help the process by beginning with finger dilation. Once this is comfortable, the patient can progress to two fingers and advance to further stretching by gradually and gently pulling the entry vaginal muscles in opposite directions much as physical therapy pulls the muscles away from each other. (3 o’clock is pulled away from 9 o’clock and 12 away from 6 o’clock.) These maneuvers are quite helpful in setting the stage for both becoming comfortable with finger penetration and preparing for progressively larger dilators.
Warm up and final thoughts
Some of my patients are so eager to get through the dilation program that they start with the larger dilators. This is never a good idea in that the vagina needs to go through a gentle “warm-up” cycle by being dilated with a smaller dilator before advancing to the larger dilators. Once the vagina responds normally to the dilation process this takes only seconds to accomplish and is essential for the comfort of the woman preparing for intercourse.
For women who continue to have anxiety about finger penetration, the smaller dilators are a good substitute to begin the dilation process. It is noted that as women become more comfortable with the dilation process, less time is needed with the smaller dilators.
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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.
