Treatments other than Botox for Vaginismus
Treatments other than Botox for vaginismus can be effective for less severe vaginismus but frequently fail to correct the more severe forms of vaginismus. There has been inconsistency in the efficacy of treatments mostly because of the lack of stratifying patients according to the severity of vaginismus symptoms. 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. In addition, there is almost no scientific data to support the concept of “evidence based medicine.” Studies describing treatment and cure rates are almost non-existent. Most of the patients I see have the more severe form of vaginismus, and it is for this reason that I have become a proponent of the Botox and dilation vaginismus treatment program. The FDA approved this program for continued research in 2010. Our center is the only facility that has received this stamp of approval.
The following alternative treatments for Vaginismus can be effective, especially for the less severe forms of vaginismus:
- Kegels and Dilation Using a series of Kegels and combining this with dilators can help women who have minimal anxiety and the ability to tolerate some forms of penetration.
- Vaginismus.com is a website devoted to educating women with vaginismus. They offer a book and dilators for women who feel they can progress on their own. For the more severe cases with high levels of anxiety, patients order the dilators but too often are unable to open the box.
- Hypnotherapy works by allowing patients to reduce their levels of anxiety and work toward penetration. It may also be helpful in cases of childhood molestation.
- Sex Therapy addresses methods to achieve more intimate relations progressing to intercourse. Although sex therapy may not work in the more severe cases, I find this useful post-procedure to help patients overcome their continued fear of penile penetration and libido issues they may have. Couples counseling is also helpful after the Botox vaginismus treatment procedure to help patients with relationship issues.
- Psychotherapy is designed to help patients overcome the anxiety of penetration. CBT (cognitive behavior therapy) has its advocates. Less severe cases of vaginismus respond to this form of treatment. Therapists are generally uncomfortable recommending dilators.
- Physical Therapy is helpful in moderate cases of vaginismus by incorporating manual stretching. Dilators are often recommended as part of the treatment. This may be combined with Biofeedback to help women lessen pelvic floor tension.
- Biofeedback teaches patients how to lessen pelvic floor tension. It can be valuable in the less severe patients with vaginismus, but requires a probe in the pelvic area which may make the more severe cases of vaginismus uncomfortable.
- Anti-depressants and anti-anxiety medication may be of help, but too often patients complain of an altered state of mind.
- Excess alcohol use has been used by a number of my patients feeling that this will help them relax enough to tolerate intercourse. Since most of my patients don’t smoke, and very few drink, this is a path that goes nowhere. Even if they manage to have penetration, they continue to have high levels of anxiety without the alcohol. The same is true of hallucinogenic drugs. Excess alcohol is NEVER recommended.
- Hymenectomy rarely cures vaginismus. Some of my patients have had two hymenectomies. The second one doesn’t help either.
- Vestibulectomy, in which a cuff of vaginal mucosa is removed surgically, is done in the more severe cases and appears to give good results. This however is a major surgical procedure and requires six weeks of healing. Some patients continue to have pain in the scar tissue.
Summary: Alternative Treatments for Vaginismus
Though there is very little scientific literature proving the efficacy of the above treatments, there appears to be enough experience that they could work for the right person. Even when the Botox treatment with dilation is used, patients may need additional support after the procedure. Some patients do fine and make rapid progress, while others may struggle with continued fear of penile penetration, relationship issues, and low libido. The partner sometimes struggles with erectile dysfunction. A therapist is essential for these more difficult cases to achieve the goals of comfortable intercourse. Botox by itself without post-procedure support is likely to fail, and this is why we are so adamant about maintaining communication with our patients. I have a number of patients that needed repeat treatment with Botox for vaginismus when other centers did not support them after treatment.