Vaginismus Treatment

Vaginismus treatment includes the use of dilators, physical therapy, sex counseling, psychotherapy, cognitive behavioral therapy, biofeedback, hypnotherapy and the use of the Botox multimodal program under anesthesia [1,2]. Some treatments can be more effective than others depending on the severity of vaginismus. It is therefore helpful to self-evaluate the severity of vaginismus. A woman with less severe vaginismus is very different than a woman with severe vaginismus because a woman with less severe vaginismus can follow a number of different treatment options including self-treatment with dilators whereas a woman with severe vaginismus has so much fear and anxiety to penetration that they are often unable to follow the suggestions of their clinician.       


Women with less severe vaginismus can often treat themselves using vaginal dilators.

A one-hour film (“Understanding and Treating Vaginismus” by Peter Pacik, MD) is available to better understand vaginismus, how to self-evaluate the severity of one’s vaginismus and appropriate methods of treatment including dilation recommendations. 

Techniques of dilation are also described in the book "When Sex Seems Impossible. Stories of Vaginismus & How You Can Achieve Intimacy" by Peter T. Pacik, MD, FACS. The book and its Kindle version can be ordered from

Pacik Glass Dilators are all 3 1/2 inches in length and range in size from the small #3 to the extra-large #8. The common dilator sizes are #3 (similar in size to a slim tampon or the pinky finger), #4 (size of a regular tampon or the size of the index finger), #5 and #6. Women with less severe vaginismus generally start with the #4 and advance to the #5 or #6 (depending on the size of the partner) before advancing to intercourse. Advancing to the #7 is helpful for women who have large partners. The #8 dilator is rarely needed.

Availability of the Pacik Dilators

Dr. Pacik’s Dilators Dr. Pacik’s Dilators are medical grade Borosilicate and are now available through the company that manufacturers them — Crystal Delights. The Pacik Glass Dilators can be ordered as a set of the #4, #5, and #6 dilator or as individual dilators (#3, #4, #5, #6, #7 and #8). The #3 dilator is ideal as a starter dilator for women who have severe fear and anxiety for penetration. The #7 and/or #8 glass dilator is ideal for transitioning to intercourse when the partner is larger than the #6 dilator.

How to Use Vaginal Dilators

It is important to understand how to use vaginal dilators. Many women use dilators incorrectly and often a clinician who suggests the use of dilators does not suggest enough of a dilation program. When starting with the smaller dilators it is important to dilate about two hours a day. 

It is also important to use lubricants during the dilation process to help prevent irritation. Silicone lubes should not be used with silicone dilators because “like dissolves like”.

For any woman the progression of moving from dilation to actual intercourse can present with many challenges especially anxiety and the fear of failure. 

Moderately severe VAGINISMUS

Moderately severe vaginismus can be treated by a physical therapist who specializes in pelvic floor dysfunction and incorporates the use of dilators. A sex counselor with vaginismus experience can help reduce anxiety and fear of penetration. When combined with the use of dilators success is common. Because vaginismus is both a physical and a psychologic problem it is helpful to use a multidisciplinary treatment approach consisting of physical therapy, dilators and sex counseling. 


Severe vaginismus can be treated using the Pacik Multimodal Botox Program Under Anesthesia using a combination of Botox injected into the spastic muscle, a long acting local anesthetic and progressive dilation all done under conscious sedation (similar to colonoscopy). This is followed up with post procedure counseling and support to help women overcome their fear and anxiety to penetration. This technique has been published by Pacik [Reference 1, 2]. 


  • Pacik PT. Understanding and treating vaginismus: A multimodal approach. International Urogynecology Journal  2014; 25 (12), DOI: 10.1007/s00192-014-2421-y
  • Pacik PT. (2011) Vaginismus: review of current concepts and treatment using Botox injections, bupivacaine injections, and progressive dilation with the patient under anesthesia. Aesthetic Plast Surg. 35:1160-1164
  • Pacik, PT, Geletta, S. Vaginismus Treatment: Clinical Trials Follow Up 241 Patients Sexual Medicine Open Access (free publication) April 2017, DOI: 10.1016/j.esxm.2017.02.002