Pacik Dilators for vaginismus treatment exhibited at 2017 AASECT meeting

Pacik Dilators for vaginismus treatment exhibited at 2017 AASECT meeting

Pacik Dilators Exhibited at the 49th AASECT Annual Meeting

The Pacik Dilators, used for vaginismus treatment, were exhibited at the 49th AASECT annual meeting. The American Association of Sexuality Educators, Counselors and Therapists (AASECT) meeting was held June 15-18 in Las Vegas, NV and promotes sexual health by the development and advancement of the fields of sexual therapy, counseling and education. The AASECT Annual Conference averages 600+ conference attendees from around the world in disciplines such as sexuality education, counseling, therapy, social work, psychology, sociology, nursing, medicine and more.

Pacik Dilators

The Pacik Dilators were developed by Dr. Peter T. Pacik out of the need to make dilation more comfortable in the treatment of vaginismus. Dilators range in size from the #3 small dilator (2.5 inches circumference, beginning dilator) to the #8 dilator (6.25 inches circumference, for women with large partners). Most women with vaginismus are able to achieve intercourse after dilating to the #5 (4 inches circumference) or #6 (5 inches circumference) dilators. All dilators are 3 ½ inches in length with an ergonomic fit against the vulva making it easier to maintain the dilators for longer periods of time. This is in contrast to commercially available dilators, which are 5-6 inches in length for the larger sizes. In a number of publications based on data from my FDA approved study, it was found that it is necessary for women to dilate for longer periods of time to help overcome vaginismus. A free publication about vaginismus treatment summarizes my approach. 

Pacik Dilators are made of borosilicate which is similar to the commonly known Pyrex and resistant to breakage. These dilators were developed during my FDA approved study using the Botox multimodal program for the treatment of vaginismus. This program includes the use of Botox and dilation under anesthesia in association with sex counseling, support and follow up.

Resources helpful for women seeking vaginismus treatment:

A one hour video by Dr. Pacik titled "Understanding and Treating Vaginismus" can be purchased from our website for $25.00. A 15 minute sample of this video is available for free. This video explains vaginismus, self-evaluation of the severity of one’s vaginismus and a dilation program and appropriate treatment programs. 

PacikVaginismus You Tube channel

Purchase of Pacik Dilators from PacikDilators.com

Dr. Pacik’s book titled "When Sex Seems Impossible. Stories of vaginismus & how you can achieve intimacy" explains vaginismus and is available in paperback and Kindle from Amazon

Lady’s Sparrow Foundation

Lady’s Sparrow Foundation

Lady’s Sparrow Foundation (LSF) Mission

Lady’s Sparrow Foundation (LSF) is on a mission to provide patient advocacy and public education in women’s sexual health. Through the founder’s own journey, she discovered how truly widespread sexual issues are involving women suffering from vaginismus, vulvodynia, and other sexual health issues. These women are your daughters, mothers, sisters, and best friends. The lack of easily accessible resources, help, and understanding results in the feelings of isolation, worthlessness, shame, embarrassment, being broken, and hopeless. LSF is here to end the silent suffering and connect women to the right resources so that they can be empowered by their bodies instead of being repressed by them. 

5 programs within Lady Sparrow's Foundation

 

Vagi-What?” Tours

There are 5 programs within LSF that work together to solve the issues these women face. The first is the, “Vagi-What?” Tours”. This program is designed to go into colleges, universities and our military to begin the conversation of women’s sexual health. By starting the conversation that many are afraid to have or are too embarrassed to discuss, educating the audience, and revealing the truth that these women are far from alone we break down the walls of isolation and begin to build a world of understanding and qualified resources.

The Birds and The Bees

The second program is “The Birds and The Bees”. A child’s sex talk from their parents create building blocks for the relationship with their bodies and sex. For most individuals, they think back on their sex talk and remember awkwardness, disgust, embarrassment, fear…. or they do not remember having one. This has bigger consequences than just when or how an individual discovers sex. A child needs to feel completely comfortable going to a parent for questions or concerns so that they know what is normal, what is not, and to be able to receive help if needed. Vaginismus can be triggered if a child is taught to fear sex or sees it as shameful. It is imperative that we teach our children to build a healthy relationship with their bodies and sexual health.

Support Groups

The third program is the “Support Groups”. We get it… suffering from a sexual health disorder can feel extremely isolating, daunting, and scary. The therapy programs require dedication and are often mentally and physically exhausting. Even the most qualified physician cannot provide all of the emotional support needed in a person’s journey. The Support Groups are there to help individuals through the healing process. They will provide a community where these women feel safe and not alone. They will teach them ways to cope with the stress and emotions that these women will go through. They will also be there to help with accountability so that women do not give up before a full recovery.

The Mentorship Program

The forth program is “The Mentorship Program”. Suffering with vaginismus, vulvodynia, vestibulodynia and sex after cancer provides a whole set of problems that is hard to turn to your friends and family for help. We pair mentors that have fully recovered or are well managed with mentees who are getting ready to start their healing process. They interact through email, phone conversations, or if location permits in person. Having a someone you can safely talk to, vent to, or ask silly questions takes away much uncertainty, fear and embarrassment. We have also found that not only does the mentee receive incredible help from this program but so does the mentor. By the mentor using what was their pain in a way to help another individual and requiring them to talk about it gives them a new-found confidence and empowerment.

build relationships with qualified healthcare provider

Finally, at LSF we work hard to build relationships with qualified healthcare providers so we can confidently refer women who come to us for help to the right resources. Currently the average women will have to go to ten gynecologists before being diagnosed with a sexual disorder. This results in desperation or hopelessness. Our referrals provide quicker diagnosis and treatment plans resulting in healthier women both emotionally and physically.

For more information please visit our website www.ladyssparrow.org or email us at info@ladyssparrow.org. Your donations and efforts are crucial for Lady’s Sparrow Foundation to build and continue our programs for the millions of women suffering. 

Causes of Vaginismus

Causes of Vaginismus

There is little in the scientific literature documenting the specific causes of vaginismus yet women with vaginismus appear to share certain aspects of a common history. In an unpublished review of internal data derived from the evaluation of more than 500 women with vaginismus, it became obvious that certain types of past history were noted to be in common.

Causes of Primary Vaginismus and Secondary Vaginismus

When the past history of primary vaginismus women (always had penetration difficulties, also known as “lifelong vaginismus”) was compared to women with secondary vaginismus (those who developed vaginismus later in life after having penetration without pain) differences were noted between the two groups. Primary vaginismus women were noted to more likely have a history of strict sexual upbringing (57% vs. 36%), strict religious upbringing (57.3% vs. 40.8) and parental teaching related to delaying intercourse (66.1% vs. 38.8%).  Additional variables included fear of sex, fear of first sexual encounter likely to report a history of genital trauma including accidental physical injury, radiation, childbirth or as a result of sexual abuse. 

So often women asked me “Why me?” Though we cannot always be certain of the causes of vaginismus, by understanding that women with vaginismus share certain aspects of a common past history, one can better understand that vaginismus can occur in women for reasons that are not always clear.

When Sex Seems Impossible, a book by Dr. Peter T. Pacik

The personal stories of women struggling with vaginismus were published in the book “When Sex Seems Impossible. Stories of Vaginismus & How You Can Achieve Intimacy” by Peter T. Pacik, MD, FACS which can be purchased both in paperback and Kindle through Amazon. This helps women understand that many causes may be responsible for the development of vaginismus. Effective treatment is available to help overcome vaginismus.

 

How to use Vaginal Dilators

How to use Vaginal Dilators

Introduction

Dilators are the mainstay of most vaginismus treatment programs yet little is available for women to understand the effective use of dilators.

History

Dilators have been used for the treatment of vaginismus dating back to at least 1861 when Dr. Sims used glass dilators [Ref 1]. He is credited with first using the term vaginismus. In 2010 Dr. Pacik received FDA approval for continued research using a multimodal program for the treatment of vaginismus which included the use of Botox, bupivacaine (a long acting local anesthetic), dilators, post procedure counseling, support and follow up.

New to dilation

Perhaps the biggest stumbling block to using dilators is the fear and anxiety related to their use. Vaginismus is more than having severe pain with attempted intercourse. Women struggling with vaginismus have pain with most aspects of penetration including tampons, cotton tipped applicators, fingers, GYN exams, dilators and intercourse despite a desire to do so. As a result of severe pain with attempted penetration it is normal to have considerable fear and anxiety related to penetration. More severe vaginismus patients order the dilators but are unable to open the package. Male partners have little patience for this and typically accuse these women of not trying hard enough, yet for these women it would be similar to ask them to jump off a high bridge. It is simply impossible.

Getting started, overcoming fear and anxiety

It is important to assess the severity of vaginismus which can be done by viewing a one hour film created by Dr. Pacik. In this film, one is given the tools to self-assess the severity of their vaginismus and how to incorporate dilation as therapy to overcome vaginismus.

Styles and materials of vaginal dilators

Dilators are made of plastic, silicone or borosilicate glass and come in a variety of sizes. Pacik borosilicate dilators are available in sizes 3-8. In contrast to other dilators (which are too long in the larger sizes) the Pacik vaginal dilators are all 3 ½ inches long and were designed to help women dilate for longer periods of time during which time they can be mobile. Dilators longer than 3.5 inches interfere with mobility. Candles are not recommended.

Getting started

Less severe vaginismus patients are often able to progress on their own by following the recommended dilation schedule noted in the one hour film and the Table below. More severe vaginismus patients progress more slowly or not at all without some outside help such as physical therapy by a pelvic floor specialist, psychotherapy and sex counseling. Severe vaginismus may need to be treated using the Pacik Botox multimodal program. Centers using this technique can be found by linking to resources.

For those who wish to dilate on their own, patience is key. As with physical therapy (PT) for tight muscles it takes time to stretch muscles that are either tight or in spasm. A minimum of 6-8 weeks will be needed and for some at least 2-3 months. This is no different than the length of time needed for PT for other musculo-skeletal conditions.

Start by using your own finger or your partner’s finger. Start with the smallest dilator in the set to determine if this can be introduced without pain. The size that is not painful is your starting point. In the beginning use this dilator for at least thirty minutes before advancing to the next size. Sometimes the next size can be tolerated for only 5-10 minutes. If this is so, remove the larger dilator and finish the amount of time with a comfortable dilator for a total of about two hours: one hour in the morning and one hour in the evening or two hours during the day. On the next day always start with a small dilator before advancing. It is a mistake to try to insert a large dilator before using a small one. Then every few days see if you can advance to the next larger dilator for a longer period of time, understanding that this process may take several months. Dilation for two hours a day and sleeping with a comfortable sized dilator every second night seems to be of great benefit for women struggling with vaginismus. Keeping a daily log of your dilation allows you to see the progress you are making and holds you accountable to yourself. The log is of value when there is a regression. An example of this is the woman who does not dilate during menses and then further misses another few days. In this situation, it is important to return to the smaller dilators and dilate back up as possible. Never force a larger dilator, it does not work, causes pain and results in a setback. Always use plenty of lube.

Anxiety control

It is expected that women will struggle with fear and anxiety as well as performance pressure to please a loved one. There are a number of tricks that women have used including soft music, lighting candles, having unrushed time, dilating in a warm bathtub, drinking a glass of wine, turning off the cell phone and the use of vibrators to help relax the pelvic floor. Any device or thought that is joyful or relaxing is of help while dilating. Mindfulness and yoga can be helpful. One woman thought of the smell of freshly baked chocolate chip cookies as part of her dilation process. Any form of relaxation is of great value while dilating.

Fingers and a mirror as a start

The normal vagina dilates in response to finger penetration. This is part of the natural process of the vagina preparing for intercourse. Use the different sized fingers using lots of lube to progressively dilate to a larger size finger. For those who are able, use two fingers for penetration. As you progress consider inserting a finger from each hand stretching the vaginal opening apart. Patients often do not understand their own anatomy making the use of a mirror worthwhile. Having your partner assist you allows the woman to give up control and begin the process of trust.

Mixing it up: Different positions

Try a number of different positions for dilating. This can include the "missionary" position, placing a foot on a chair and dilating while standing and using a squat position. As you become more comfortable having your partner assist, you can try "doggy style" or the "spooning" position which can be an excellent segway to intercourse. Gentle thrusting can be done with the dilators as comfort with dilation increases.

How much, how long?

This depends on whether the vaginismus is primary or secondary (such as menopausal painful sex or menopausal secondary vaginismus) and the severity of vaginismus. This is outlined in the film noted above as well as my book: PT Pacik: When Sex Seems Impossible. Stories of Vaginismus & How You Can Achieve Intimacy available as soft cover or Kindle.

For primary vaginismus, especially the more severe forms, two hours a day is recommended for the first month. As progress becomes more comfortable one can reduce this to about an hour and a half and then one hour. Sleeping with a medium #4 dilator every second or third night allows for passive night time stretch and easier progression to the next size dilator in the morning. Menopausal women struggling with painful sex (dyspareunia) or complete inability to tolerate penetration (secondary vaginismus) do well with about 30-60 minutes of dilation, especially before intercourse. Once a woman starts dilating it becomes obvious how much dilation time is needed. Primary vaginismus women should dilate for about a year because it has been observed that women can still regress after six months. Women with menopause should dilate on a regular basis and before intercourse. Your doctor can recommend creams such as Estrace or capsules such as Vagifem to help with menopausal vulvovaginal atrophy. See Table 1 for summary.

Menses and dilation

You can discontinue dilation during the menstrual cycle. During reduced flow, even five to ten minutes of dilation is of value for those who are able to do this. Start with the smaller dilators when resuming dilation after menses. For those who have advanced to the medium dilators this can be an excellent time to introduce slim tampons.

Advanced dilation techniques

Women have noted that combining vibration with dilation relaxes the pelvic floor and makes dilation easier. One such device is the Lelo Liv which is sized between the #4 and #5 dilator and helps remove the clinical aspects of dilation noted to be especially helpful when transitioning to intercourse.

Pacik borosilicate glass dilators come in larger sizes (#7, 8) to help women achieve the necessary stretch when attempting intercourse with partners who are larger than the #6 dilator.

Transition to tampons, intercourse & GYN exams

The goal of dilation is to be able to progress to comfortable penetration such as being able to use tampons, to be able to progress to intercourse, to undergo a GYN exam and for menopausal women to engage in comfortable sex. It is common for fear and anxiety to once again dominate during this transition. Generally, thirty minutes to one hour of dilation with a large dilator will set the stage for comfortable intercourse. Most women are able to achieve intercourse after dilating to the # 5 or 6 dilators. An erect penis is more comfortable than a large dilator. Dilation with a large dilator is of benefit in making a GYN exam more comfortable. Women can arrive with a large dilator in place which is removed by the doctor prior to insertion of a speculum. For those with discomfort during a GYN exam ask the doctor to use a pediatric speculum.

Reasons for saving your dilators

There are a number of reasons to save your dilators including regression, following childbirth and use during menopause.

Dilator hygiene

Mild soap and water for cleaning the dilators. A towel or wash cloth should be placed in the sink when washing glass dilators to avoid breakage if the dilator slips out of your hand. Pacik borosilicate dilators are dishwasher safe. Clouding from dishwashers does not affect the strength of the dilator.

Summary

The correct techniques of using dilators to overcome vaginismus is of considerable benefit to women who struggle with vaginismus. Little is taught by the medical community in this regard. It is hoped that these recommendations will be of value for the woman who is able to do this on her own.

More severe vaginismus women, including severe secondary menopausal vaginismus, benefit from treatment under anesthesia using the Pacik Botox multimodal program allowing them to wake up with a large dilator and shortening the process for achieving comfortable intercourse. Providers for this treatment modality can be found under our Resource Page.

References

1   Sims, JS. On Vaginismus. Transactions Obstetrical Society of London 1861;3:356-367

Table: Recommendations for effective dilation

First month

  • 2 hours a day divided if possible one hour AM, one hour PM.
  • Always start with a small dilator or finger and advance as possible.
  • Sleep with a small to medium dilator every 2-3 nights.
  • Use of lubricants.
  • Use of aids such as vibrators and small vibrating dildoes to overcome the clinical aspect of dilating and to help relax the pelvic floor. Orgasm helps relax the pelvic floor.
  • Use different positions such as squat, one leg on a chair etc.
  • Importance of keeping a dilation diary. This will keep you accountable for dilation as well as keeping the clinician informed.
  • No need to dilate during menses. Resume dilation as able.
  • Dilate to #5 or #6 if possible for 30 to 60 minutes prior to intercourse. Dilation to #7 and rarely #8 for partners that are large. Use the dilator as a “toy” or a similar size vibrating dildo.

Second month and third months

  • Reduce dilation to one hour a day, then 15-30 minutes daily.
  • Advance to larger sizes as able.
  • Continue some dilation during the day or 2-3 times a week for about one year. Setbacks were noted when dilation was discontinued after six months. Menopausal women do well with periodic dilation.

Vaginismus Treatment Clinical Trials Follow Up

Vaginismus Treatment Clinical Trials Follow Up

Publication: Pacik Vaginismus Treatment: Clinical Trials Follow Up 241 Patients

By Peter T. Pacik, MD, FACS

The Sexual Medicine Open Access Journal published a paper written by Dr. Peter T. Pacik on the experiences and outcomes of the treatment of 241 women using the Botox multimodal vaginismus treatment program. Pacik Vaginismus Treatment: Clinical Trials Follow Up 241 Patients is available as a download and can be shared with anyone.

This paper covers the history of vaginismus, vaginismus publications, vaginismus symptoms, vaginismus diagnosis and vaginismus treatments.

A section of the paper is devoted to better understand the severity of vaginismus and how this relates to available treatments that can be effective. The paper, based on FDA approval for continued research using the Botox multimodal program of vaginismus treatment, demonstrates the effectiveness of this form of treatment. In this study patients were able to achieve intercourse within an average of 2 months, which is especially noteworthy as most patients had severe vaginismus as noted by the Lamont and Pacik classification, had failed an average of 5 prior treatments and had the condition for a mean of 7 years.

Women are encouraged to read this paper. Though scientific in nature it is my feeling that most women and their partners will be able to comprehend the contents of this paper and in the process better understand vaginismus. This publication can also be shared with clinicians who are involved with your care as well as family members who often do not understand the complexities of vaginismus.

About Sexual Medicine

Sexual Medicine is an official publication of the International Society for Sexual Medicine, and serves the field as the peer-reviewed, open access journal for rapid dissemination of multidisciplinary clinical and basic research in all areas of global sexual medicine, and particularly acts as a venue for topics of regional or sub-specialty interest.

PacikVaginismus FaceBook

Women and their partners are encouraged to post remarks on our PacikVaginismus Facebook page.

Training in Vaginismus in Tulsa, Oklahoma

Training in Vaginismus in Tulsa, Oklahoma

Training in Vaginismus: Tulsa, Ok

Vaginismus Treatment using the Pacik Botox Multimodal program

By Peter T. Pacik, MD, FACS

 Dr. Pacik will be conducting a Botox multimodal vaginismus treatment training session for the treatment of vaginismus at Oklahoma State University, Tulsa, Oklahoma Thursday April 27 and Friday April 28, 2017. Openings to participate as a patient are available.

On Thursday April 27, 2017 Dr. Pacik will be lecturing to the medical staff and medical students on the topic of vaginismus. The lecture will include an overview of vaginismus, vaginismus symptoms, vaginismus diagnosis and vaginismus treatment. It is important to understand the differences between vaginismus, vestibulodynia and vulvodynia ­-- all of which present as sexual pain as well as understanding different treatment approaches for varying levels of vaginismus severity.

Following the lecture, a group of vaginismus patients will be treated using the Pacik multimodal approach for the treatment of vaginismus. Vaginismus treatment will be done in an outpatient setting with the support of the anesthesia staff.

On the following day, April 28, counseling will be done to give women the knowledge to continue with effective dilation programs, to progress to comfortable pelvic exams and intercourse and to help overcome vaginismus.

This is time sensitive; therefore, please contact Dr. Babb if you are interested in participating in this program.

Contact for more information on the Vaginismus Treatment Program in Tulsa, Oklahoma

For more information and to participate in the vaginismus treatment program, please contact Dr. Corey Babb, Department of Obstetrics and Gynecology at 918 586 4500.

 

Vaginismus: Still a secret

Vaginismus: Still a secret

Vaginismus

Though vaginismus was described in 1861, this medical condition is still kept as a secret by many women who suffer from vaginismus. Women do not discuss this condition with their family, friends and even their doctors. In many cases, vaginismus is kept as a “private pain” secret. This causes distress and causes interpersonal problems such as keeping a woman from pursuing an intimate relationship or impacting their current relationship in a negative way. Women with vaginismus live in a world of isolation and have no support. Shame, emabarassment and feelings of inadequacies are the result of keeping this condition a secret. Open discussion about vaginismus is critical in overcoming vaginismus.

Vaginismus is described in the DSM 5 as a genital pelvic pain/penetration disorder [1] and as such is considered to be a medical condition for which insurance coverage is often available. I do not consider vaginismus to be a “mental disorder”. It is listed in the DSM 5 because of the marked fear and anxiety to penetration. It is also covered with ICD medical codes for insurance.

Vaginismus Resources

There are a number of resources that are helpful to women who want to learn more about this condition:

1.     Vaginismus symptoms, vaginismus diagnosis and vaginismus treatment are discussed on my website PacikVaginismus.com which gives the reader a good starting point to better understand vaginismus.

2.     It is important to understand that vaginismus presents as a spectrum from less severe to more severe. Women with less severe vaginismus are often able to treat themselves with a dilation program as outlined in my one hour video “Understanding and Treating Vaginismus”.  For women with more severe vaginismus, professional help is available using many treatment modalities. This is discussed in my book “When Sex Seems Impossible. Stories of Vaginismus & How You Can Achieve Intimacy”.            

3.      A number of scientific papers on vaginismus are available. Vaginismus Treatment programs that are effective include physical therapy, sex counseling and the Pacik Botox multimodal program. A combination of programs to treat both the psychologic (fear and anxiety) and the physical (vaginal spasm) is helpful. Please read the published Clinical Opinion “Understanding and Treating Vaginismus”.

4.     Engage with other women who have vaginismus by joining Vaginismus Forums. There are a number of private and public forums that allow for an exchange of information. These Forums will simply ask you some questions to make sure you are legitimate. The Maze Women’s Sexual Health group now maintains the VaginismusMD Forum that I started many years ago. This Forum has been instrumental in helping women open up to other women who have gone through the same struggles.

Vaginismus Summary

Begin your journey in vaginismus treatment by educating yourself using the resources listed, by being honest with those who care about you and seeking the type of treatment that will be most effective for you. After more than 100 years vaginismus should no longer be a secret.

Vaginismus References

[1] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Washington D.C. (2013)

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