Botox questions!

[sryan32]

Could someone tell me more about the Botox procedure?
I just joined this forum recently and have been reading several of the posts, and am seeing a lot about the Botox. My physical therapist had mentioned it, but it sounded like something that I might consider if my case was more “severe”.
I am able to achieve penetrable sex, but it is almost always painful. The pain is variable, which I’m still confused by. There are times when it’s pretty much intolerable and I have to tell my husband to stop. There are times when it’s uncomfortable, maybe slightly painful, but definitely tolerable. And there have been a couple (literally just 2) times when there was no pain at all. I had thought maybe I was healed (the two painless times happened back-to-back) but the next time there was significant pain and it hasn’t been painless since (which was several months ago).
What happens in the Botox procedure and follow-up? How does it work? What type of person is a good candidate for it? What are the risks? In addition to vaginismus I have a diagnosis of vulvodynia – is Botox appropriate for someone with co-occurring vulvodynia? Is it appropriate for someone who is able to achieve penetrable sex?
So many questions! Any help is greatly appreciated.

[Jennifer Dembo, LCSW]

sryan32 – Welcome and thanks so much for writing! I’m sure you’ve seen lots about the Botox procedure here on the Forum, and for good reason. It has a very high success rate for women who experience vaginismus (tightening of the vaginal muscles that make penetration difficult or impossible, depending upon a variety of factors).

The Botox procedure is performed under anesthesia (which is administered via IV), and once you are sedated, local anesthetic and Botox will be injected into your vaginal muscles. Then, a large dilator will be inserted into your vagina. You’ll awake shortly thereafter and spend time in recovery until you are ready to go home (or wherever you are staying if do not live locally). You’ll keep the dilator in until you return to our office the following day (this follow-up visit is required). We’ll provide you with a customized dilation protocol at this appointment, and discuss best practices for future intercourse. We’ll also explore behavioral approaches to healing that allow for maximum comfort and stress-reduction as you help your body open.

I mention dilation protocol because this will be a CRITICAL part of your treatment. Botox relaxes the muscles for about 3 months, and you need to take advantage of this flexiblity so that you can train your vagina to stretch.

RE: vulvodynia – some Botox patients find relief from vulvodynia, but that is dependent upon whether the condition is caused by muscular dysfunction or not. We can offer alternative vulvodynia treatment accordingly.

Everyone is different. Some have tried dilation or pelvic floor physical therapy, relaxation exercises or lube or any and all of these in some combination. Other women feel certain they want to move directly to Botox.

Let us help you determine what might be the best course of action for you – give us a call and we’ll help you make an informed decision. Take good care and all our best from Maze!

[mazemelissa]

To add onto Jen’s response:

I don’t think a patient needs to be a severe case to benefit from the Botox procedure. If you have high pelvic tone that is not relieved by traditional treatments, then the Botox procedure can be extremely helpful. Some women just can’t resolve that last bit of tension at the entrance, and the Botox works great at relieving that.

The Botox will only address muscles tension, so if you have vulvodynia secondary to pelvic floor dysfunction, it should get better after the procedure. If the vulvodynia is related to other conditions (nerves, hormones) than the pain will possibly not change.

I believe that if your PT is still feeling muscle tension around the vaginal entrance, then the Botox will help.

[recessivegenequeen]

Just to add to what these wise medical professionals already said, I had the botox procedure to treat a 10-year case of vaginismus and everything they said is absolutely true, but the botox procedure is ALSO helpful to deal with some of the psychological issues that spring up around having painful sex. There can be a lot of fear and self-doubt that your vagina could ever really have a large object inserted without pain, and waking up from the anesthesia with a huge dilator inside me unlocked an understanding in my mind that my vagina COULD be normal, and I drew upon that knowledge when I was working through the dilation process. There were so many ways the botox helped me that I wasn’t ready to help myself without its help.

[mazemelissa]

Thank you for adding that comment.

For so many women with vaginismus they are totally detached from that part of their body. The botox procedure helps create a mind-body connection that empowers women to realize they can overcome vaginismus.

[sryan32]

Thanks for the info! That helps a lot.
I have another question – you said the botox relaxes the muscles for about 3 months. So is the goal that the dilation regimen following the initial botox procedure results in “cured” vaginismus by the end of that 3 months? I guess I’m wondering, do people go in for more botox repeatedly?

[sryan32]

Thank you for your reply!

[sryan32]

recessivegenequeen Thanks for your reply! I can imagine that being a huge stride emotionally.
As someone who has themselves had the Botox procedure, could you answer a few more questions for me?
What was the dilation process like after your procedure? I’m wondering about the frequency and duration, and also wondering about pain. Right now, using dilators is pretty painful for me, and I feel that’s a major reason I don’t use them like I should. Was dilation after the Botox procedure painless?

[mazemelissa]

Dilation after Botox is not always pain free, but pretty much all my patients will say that dilation after the procedure is easier and less painful.

What once was either impossible, or a significant struggle, that tension brick wall feeling, is gone, and the dilator will go in more easily.

Patients still need to put pressure on the dilators to insert, as the vaginal entrance is still smaller than the dilators you are inserting, but the muscles will give and the dilator will slide in.

As patients progress to the largest sizes, they might still experience a stretching sensation or even a little burning as the entrance is learning to open up more, but it is tolerable.

Patients often express, “this is so much easier”, or “this is definitely less painful”, even if they still feel some type of discomfort.

Even with the Botox, the muscles still need to be relaxed and stretched further, so that causes a sensation that is different, but one that most women can handle.

If a patient needs to have their hymen cut during the procedure, they might feel more pain with dilation for the first two weeks, but once that is healed, the pain is also much less.

[recessivegenequeen]

Hi sryan32 – to add to what Melissa said, there was definitely some DISCOMFORT when dilating as I was still getting used to it, but it wasn’t PAINFUL. There was the muscle-burning sensation after the session sometimes like Melissa describes, but pain definitely wasn’t the dominant sensation.

After my botox procedure, I dilated each day (for minimum 5 minutes a day but usually I’d try to leave in the dilators for more like half an hour). This often felt like a tedious chore, but once I got the dilator in and had moved it around a bit, I was able to just relax and play on my phone or watch something while the dilation was going on. I was able to have intercourse for the first time 20 days after my procedure even though I’d never been able to insert any part of a man except maybe a finger before. It was an amazing moment and I was stunned how quickly I was able to get there. It took me another couple months to really get used to sex and actually ENJOY it, during which I was dilating several times a week, but over a 3 or 4 month period I eventually stopped needing to use dilators and was able to enjoy pain-free intercourse entirely.

Everyone’s vaginismus journey is different (even for people using the same treatment methods), but I would highly recommend the botox procedure at Maze to anyone who feels stuck. It helped me so much, physically and psychologically, and 3+ years after the fact I have a really happy and positive relationship to sex, which I never could have dreamed of for myself before coming to Maze. So whatever you do, don’t give up! Vaginismus is curable and doesn’t have to define your entire sexual life!