Peek Inside the book:

A chat with the authors:

  • Have fear and pain stopped you from having intercourse?
  • Are you unable to use tampons, or feel like they won’t fit?
  • Do you physically withdraw or panic during gynecological exams?

If you answered “yes” to any of these questions, you may be suffering from vaginismus, a condition that affects millions of women worldwide.

NOTE: Dr. Pacik is now retired. Please ignore all references to the website PlasticSurgeryPA and the contact email and phone number on the above video as the practice is now closed.





“When Sex Seems Impossible,” a vaginismus book, offers important medical information and first-person vaginismus stories. It stands apart from other vaginismus books, in that it includes a new treatment option that has helped over ninety percent of my patients with severe vaginismus. This treatment of vaginismus allows women to overcome this condition to go on to have pain-free, intimate relationships. Vaginismus stories and support can help to put you at ease. 



Chapter Summaries

Chapter 1
Wedding Bell Blues… and Other Fearful Firsts

On a hot, Southern California evening in July, 1983, Theresa discovered that she couldn’t have sex. It happened to be her wedding night. “I felt like I was going to implode if he put his penis in me,”

Theresa described the sudden fear and panic that overcame her. “I felt like it was going to be awful. My body shut down. My mind was telling me “It’s going to be painful. You’re not big enough down there.”

Chapter 2
What is Vaginismus?

Vaginismus is a condition marked by uncontrolled, involuntary spasms of the vaginal muscles, brought on by the fear of vaginal penetration. The result is that any attempt at intercourse, or even penetration with a tampon or speculum during an internal gynecological exam, is not just severely painful, but virtually impossible. Vaginismus is the leading cause of unconsummated marriages.

Chapter 3
V is for Vaginismus, and Other Painful Disorders

Vaginismus is often confused with other painful disorders in the vulvar area, such as the more commonly diagnosed vulvodynia, in which pain is often brought on by underwear or clothing rubbing against the vulva, and may be intensified during sexual activity. Fortunately, a few simple tests can help distinguish vaginismus from these related conditions to assure you receive the proper diagnosis and treatment.

Chapter 4
Getting the Right Diagnosis

Most patients presenting with pain in the area of the vulva have not been examined under anesthesia. Yet, without the benefit of sedation, it is almost impossible to determine the source of pain, and whether it is caused by vaginal spasm. This chapter discusses the importance of examination under anesthesia to determine vaginismus, as well as the severity and exact location of the vaginal spasms that are creating that “wall” that prevents intercourse.

Chapter 5
Why Me? The Causes of Vaginismus

One patient shares, “As I was growing up I often heard stories about first-time intercourse, how painful it is, the bleeding, my hymen breaking. I never thought it would affect me so badly.” Like this woman, many vaginismus sufferers report a history of traumatic psychosexual events, or recall negative messages about sex. While the exact causes of vaginismus remain uncertain, it is felt that vaginal spasms appear to be a protective reflex to in response to the fear of anticipated pain.

Chapter 6
How Bad is Bad? The Five Levels of Vaginismus

Women with vaginismus may report symptoms from manageable to severe, such as one patient’s account, “Whenever we would attempt to make love I would have panic attacks, tremors, cry, and a fear would overtake me.” Determining the level of vaginismus is critical in setting a course for treatment, and can be done so with a simple self-evaluation system developed by Canadian doctor J.A. Lamont, and first published in 1978 in the American Journal of Obstetrics and Gynecology.  (Self-evaluation is also explained in and the one-hour video made by Dr. Pacik.)

Chapter 7
A Comprehensive Treatment Program

Over the last five years, our practice has developed a comprehensive program that represents a breakthrough in treating severe vaginismus. The three aspects to treatment include:

  • A thirty-minute procedure under light anesthesia, in which we administer vaginal Botox injections to prevent the involuntary spasms, and progressively dilate (stretch) your vagina, leaving a dilator in place so that you actually wake up experiencing pain-free penetration.
  • In-office dilation training and coaching.
  • At-home progressive dilation and supportive follow-up.

Chapter 8
Botox for Vaginismus: The Missing Link?

Botox has been effectively used for decades to weaken over-active muscles in patients with cerebral palsy or stroke, as well as for cosmetic purposes, and was first used in 1997 for the treatment of vaginismus. When administered properly, Botox is as safe as aspirin, and one treatment appears to be sufficient in overcoming the pain and fear of vaginismus. As one patient writes, “... I can’t tell you how glad I am I took the decision to use Botox. All the stress and frustration my husband and I went through are gone…”

Chapter 9
Behind the Scenes in the Surgi-Center: One Woman’s Procedure

The heart monitor beeps steadily in the surgical-center, as thirty-one-year-old Maria is placed under anesthesia. Soft music is playing in the background. Maria’s boyfriend holds her hand throughout the examination and thirty-minute procedure… This chapter takes you inside our surgical center for a close up view of how the Botox is targeted to alleviate spasms in specific vaginal muscles, and the process of dilation under anesthesia.

Chapter 10
Waking Up to a New You…and Painless Penetration

In January 2009, I was walking with my wife, Janet, along the beach on Honeymoon Island, discussing how patients still remained fearful about dilation, even after they had been effectively treated with Botox to prevent vaginal spasm. That’s when Janet suggested that dilation (necessary to continue to stretch the tight muscles for comfortable intercourse) could actually begin under anesthesia, as a way to jump-start the process and overcome mental blocks.

Chapter 11
Practice Makes Perfect” Miss Pink, Mr. Big Blue, and Beyond

This chapter offers techniques and tips to help patients use various-sized dilators to stretch and de-stress, as a “warm-up” to intercourse (similar to how you would warm up or stretch your muscles before any kind of exercise). The Q & A section of this chapter covers everything from the best schedule for dilation… to the best types of lubrication to make the process more comfortable and sensual.

Chapter 12
Inching Toward Intercourse

Minimal penetration—that is just one recommendation offered in this chapter focused on helping couples navigate those first attempts at lovemaking. The chapter also shares several first-person, intimate accounts from women describing the first time they were able to consummate their relationships. As one patient writes, when he was completely inside me, it was so weird, yet amazing! I couldn’t feel him much. And then we tried again. And this time, I even allowed him small movements…

Chapter 13
Beyond Botox: Complementary Therapie

For women who find the transition to intercourse challenging even after their vaginismus has been treated, there are a variety of complementary therapies that can enable a smoother journey from pain to pleasure. This chapter shares insights from experts in pelvic floor therapy and in sexual counseling, to help you overcome any remaining physical or personal issues standing in the way of intimacy.

Chapter 14
Vaginismus: It’s (Also) a Guy Thing

In the medical literature, spouses of women with vaginismus are often referred to as the “pain-free” partner, yet this is far from the truth. Although men may be spared the physical agony of this condition, vaginismus can be emotionally damaging to both partners in the relationship, resulting in stress, anger, depression, isolation, and lost libidos. This chapter shares stories of vaginismus from the male perspective, and the toll this condition often takes on both sides of the bed.

Chapter 15
Her Story: His Story

She writes, “We had waited until marriage to have sex because we are devout Christians, so we never knew there would be a problem…” He writes, “On our wedding night we were unable to consummate our marriage due to what I thought at the time was my blushing bride’s nerves…” So begins one couple’s heartfelt and riveting account of their difficult journey to overcome vaginismus, rebuild their relationship, and, ultimately, start a family.

Chapter 16
Putting the “Fun” in Functional

Consider just this one common misconception—that intercourse leads to orgasm in women. In fact, only 20 to 30 percent of women climax with intercourse. This chapter dispels many of the myths associated with sex, human anatomy, and the art of lovemaking. In addition, it offers practical tips on how former vaginismus sufferers can feel more sexually confident, discover their erogenous zones, and define intimacy on their own terms.

Parting the Curtain: The Voices of Vaginismus

If sex seems impossible and you are losing hope, let this book and the voices of the women who shared their stories within it speak to you loud and clear: You are not alone. You do not need to suffer in silence. And you can get the kind of support and help you need to overcome this condition.

About the Authors

Peter T. Pacik, MD, FACS, a recognized pioneer in treating patients with Botox for vaginismus, has been performing plastic surgery in Manchester, New Hampshire, since he completed his residency at SUNY Upstate Medical University in Syracuse, New York in 1972. He retired in 2015 and continues to advocate for women with vaginismus. He belongs to a small group of prestigious surgeons who are double board certified by both the American Board of Surgery and the American Board of Plastic Surgery. His practice had the honor of being the longest accredited surgi-center in the United States.


Dr. Pacik is the author of numerous scientific publications and is well known for his work on developing and researching pain control catheters used in breast enlargement surgery. He has been a long-time reviewer for a number of journals including the Plastic and Reconstructive Surgery Journal, and the Aesthetic Surgery Journal, and frequently presents scientific work at meetings and conferences. He has been a member of several organizations including the American Society of Plastic and Reconstructive Surgeons, American Society for Aesthetic Plastic Surgery, International Society of Clinical Plastic Surgeons, New England Society of Plastic and Reconstructive Surgeons, and the New Hampshire Medical Society. Dr. Pacik was a fellow of the American College of Surgeons. Dr. Pacik is committed to furthering awareness about vaginismus through ongoing research, publications, speaking engagements, and interviews.

Joni B. Cole is an author, editor, and writing instructor. Library Journal “strongly recommended” her book Toxic Feedback: Helping Writers Survive and Thrive; and American Book Review stated, “I can’t imagine a better guide to [writing’s] rewards and perils than this fine book.” Joni is also the creator of the acclaimed “This Day” book series, including Water Cooler Diaries: Women Across America Share Their
Day at Work. Listed as “One of the Year’s Notable Career Books” by the New York Post, the book was described as “both fascinating and eye-opening” by Publisher’s Weekly. Joni is a frequent speaker at writing conferences, and has appeared on CNN and been a guest on numerous radio shows around the country. For more information:

About the Illustrator 

Nicole Piar is a Los-Angeles-based illustrator. She is on a mission to awaken a sense of wonder, inspire wild flights of fancy and create a bridge between her inner world and yours. She received her BA in Art from Yale University and went on to be a professional illustrator for the last 10 years. Her magical art balances on the vivid intersection of intuitive visions, healing, storytelling, and dreams. She is the creator of the Spirit Cats Inspirational Card Deck and is working on a children's book.

About the Illustrations

The cover illustration depicts a woman enjoying her full luscious sensuality. She is at ease in her body and fearless in her sexuality. Women suffering from vaginismus often feel unfairly cut off from the sexual bliss that appears to come so effortlessly for some. The dark horizontal bands refer to this feeling of being barred off or separated from their own sexual fulfillment. The five black and white illustrations scattered across the book mark the journey of healing. A flower is the sexual organ of a plant. The slow blooming of the flower woman in the illustrations is a metaphor for emotional opening and blossoming sexuality.