Hi Melodi,
We often will do a hymenotomy procedure at the same time as the botox injections. For many of our patients the exam under anesthesia is the first time they are having any penetration, so it is not uncommon for us to see a fully intact hymenal ring. We make two small incisions in the hymenal ring to release the tension, and leave the incisions open. This then allows for the largest dilator to be inserted without causing any tearing.
For some women it can make the first 2-3 post op days more tender and sore. But the discomfort is tolerable, and as long as you stick with the smaller dilators for the first week, until the area is more healed, patients are usually fine.
Melissa