Pain Treatment Under Anesthesia

Many of us are familiar with the use of medical injections as a treatment for cosmetic reasons; it stops the muscles from contracting in the face so that smile lines and deep wrinkles do not appear. But it is this very action of “freezing muscle tension” that has led to its successful use in treating vaginismus. The injections are administered to the muscles in the vagina, which makes the muscles unable to tighten and as a result, “the wall” that many vaginismus patients experience disappears. The patients who report pain from the tightening of the muscles experience significant relief after the injections.

This treatment is used in cases of vaginismus where the more conservative treatments have not been successful, or, even more frequently, where the first steps are not even attempted because the pain or the fear is so great.

We believe that every woman should be able to choose to put in a tampon, have a complete gynecological exam and experience intercourse if she so chooses and these are our goals with treatment.

The injection of medication inhibits the muscle spasm that causes the tightening of the vagina. It is these spasms which cause pain during intercourse. In a surgical center a patient is put under conscious sedation for the short procedure. The doctor injects both a topical anesthetic and the medical substance into the vaginal canal and then massages the muscles to relax them. The anesthesia and massage allow the muscles to release so that a large dilator can be inserted. Immediately following the procedure, the patient awakens having achieved the hardest first step, the insertion of the first dilator. The anesthesia that was injected works to ensure that her first experience with the dilator is not painful.

The success rate, in our experience, is well over 90%. What has been observed in research on the vaginismus treatment under anesthesia procedure is that there is a 75% rate of success (meaning pain-free intercourse) within two-to-six weeks of the treatment. In our experience, the other 15-25% may take longer but achieve the same end result, complete relief from their symptoms, usually within 8-12 weeks. However, it is important that you understand that there is still work to be done after the procedure with dilators – you have to dilate daily and work on having our brain “reconnect” to your vagina. Although the effects of the medication only last 2 to 3 months, once the vagina is dilated and intercourse is comfortable, additional injections are generally not necessary.

On procedure day, the patient is prepped for surgery and given an IV and placed in a hospital gown.

Once in the surgical suite, the patient is put under conscious sedation for the procedure which takes approximately 20 minutes. When the patient is under anesthesia, a full pelvic exam is performed and a pap test is obtained if indicated. Next, dilators are inserted into the vagina; this dilation starts the process of lengthening and relaxing the pelvic floor muscles. After the progressive vaginal dilation, a speculum is inserted and the injections begin. The medication is first injected, a total of 100 units, into the tense muscles. The doctor then injects a local anesthetic in the vaginal walls and vaginal entrance. Once the injections are completed, the largest vaginal dilator is inserted. The patient awakens with the dilator in place. There is a recovery and rest period after the procedure. During that time the patient is taught to remove and re-insert the dilators, and she is sent home with the dilators and instructions. It takes 2-5 days for the medication to take full effect so the patient is encouraged to continue to use the dilators as much as possible for the first few days. There is a follow-up visit the next day and an individualized follow up treatment plan is developed.

The treatment does not make a woman instantaneously comfortable touching her genitals, or comfortable inserting the dilators. The treatment by itself does not ensure a smooth and easy transition to intercourse with her partner. That is all work that has to be done after the procedure through dilation and therapy.

But we’re here to help you with all of that.

There is a mandatory follow up visit 24 hours after the procedure. At this visit we will work on continued dilation, discuss progress toward intercourse and help address any unanswered questions you may have.  It is at this point that we start to work on having “your head connect with your vagina”. We help you to understand that you are in control of your body, that you can make decisions about what can and cannot go into your vagina and that your genitals are your friend and not your enemy. This procedure is a first step towards getting you there.

Further follow up visits are variable, based on patient’s ability to travel to the office, need for continued counseling, and need for continued guidance with dilation.

We have some local patients who come in for a weekly visit for the next few weeks until we achieve our three markers of vaginal health: ability to insert a tampon, pain-free intercourse and a complete gynecological exam. 

For those who come in for the procedure from farther away, we continue the support by phone or refer them to a local treatment option.

Located out-of-town? No problem! We’ve treated 100’s of women suffering from vaginismus, many of whom reside in various countries throughout the world. Since you’re only required to be in New York for 3-4 days, most patients find the treatment very manageable. Learn more about our treatment plan for out-of-town patients.

• Vaginismus Treatment Under Anesthesia: A Case Report
• Treatment Protocol for Vaginismus