Early success after Botox treatment for vaginismus
This 22 year old woman was treated for Pacik/Lamont level 5 primary vaginismus present for 8 years when she discovered she was unable to use a tampon. For the past year intercourse has been impossible. She did well with the dilation program and was able to achieve full intercourse at 4 days.
Continued progress after vaginismus treatment
On day 43 she writes:
“I was pretty sore a few days ago while on my period but that’s calmed down a lot. Sometimes when I’m initially inserting the dilator, it feels like I’m pushing against some of the tissue fairly hard as it goes in. I tend to have a nagging fear that I’m going to tear something or hurt myself in some way, which leaves me feeling pretty anxious when we are having actual intercourse – I almost always get really concerned that the friction or moving too fast will rip or tear something.
But otherwise things are going fine, continuing with pink 1 hour and blue 1 hour. We have tried intercourse about 5 times now and I have experienced low to no pain 2 times – otherwise I do deal with some stinging and generally have trouble with any fast movements.”
I wrote back:
All this is related to your continued need for dilation and stretching. All aspects will continue to get more comfortable. Since everything was normal on examination there is nothing to fear in terms of ripping.
I asked her to send me a follow up. At six months she writes:
Ongoing burning
“I’m very happy with the progress that I’ve made over the past six months, and it’s steadily getting easier with time and continued dilation. I no longer have to dilate every evening in order to attempt intercourse – one hour with the pink dilator immediately beforehand now seems to be enough. I still do have a low level burning/tightness sensation with initial penetration, but otherwise I am almost completely pain-free!
My ongoing goal is to keep working past the low-level pain of initial entry. To date, I haven’t been able to have intercourse without at least a four day “recovery period” in between attempts, since I do have moderate soreness afterward. However, I really think this will continue to decrease over time as I get more used to it. I’m still working through feeling a little intimidated whenever we try, and I’m sure that also contributes…but the soreness is a minor issue and I’m extremely happy with the progress that I’ve made!
The Botox procedure has made a huge difference for me, and I’ve discussed it in detail with the Yale Health system so that the doctors here know that an alternative to endless PT sessions (or vestibulectomies) actually exists and is a non-invasive and permanent treatment. Thanks so much to you and your staff for all of the help!”
Post Botox Treatment for Vaginismus:
Important to Dilate for a Year
Although she achieved early pain-free intercourse after a lengthy duration of vaginismus, some patients may take up to six months to a year to become completely comfortable with intercourse. Some of her discomfort may be related to discontinuing her dilation program too early. She states that she just dilates with the pink 
(#5 of 6) dilator one hour before intercourse. This is likely not enough, and probably a reason that she still has some lingering burning after intercourse. I recommended that she resume her dilation schedule of about one hour a day, and to begin sleeping with a medium sized dilator about every two to three nights. This will re-establish the stretch of the vaginal muscles and allow her to be more comfortable. Most of my patients need to be dilating for some period of time for about one year after their Botox treatment program for vaginismus. Some do well with 15 minutes every day or two, others need more time with the dilators. By six months most of my patients should be having pain free intercourse.
If you have any questions about our Botox treatment for vaginismus and progressive dilation under anesthesia, please contact us via our contact us form.