In the minority of cases that are not responsive to physical therapy, we use pelvic floor Botox injections to cure sexual and pelvic pain. The injections are done in our office or using brief anesthesia.
We are confident in our ability to treat pain problems because we understand them and utilize a close collaborative approach with physical therapists which we believe is key to achieving a cure.
High tone pelvic floor disorders (tight pelvic muscles in the pelvic/vaginal area) are notorious for leading to issues such as:
- pelvic pain
- dyspareunia (painful penetration during sex)
- difficulty or pain with tampon insertion
- vulvar pain
- pain that occurs after intercourse or orgasms
- rectal pain
If you have already seen a health care provider, your condition may have been described as vaginismus or pelvic pain. You may have been told that “nothing is wrong” or to “just relax.”
Some women have been referred to a psychiatrist. While that support can be needed, we are firm in our belief that this is generally a curable anatomical issue and not a mental disorder in most women.
Using our rehabilitative approach, treatment outcomes are often life changing in terms of quality of life, sexual enjoyment and fertility.
While these pain disorders are still poorly understood and under-treated by many health care providers, it is something that our specialists treat on a daily basis.
At your initial consultation, we’ll take a thorough history that encompasses bladder, sexual, bowel and general pelvic symptoms.
Because all of our pelvic organs can affect each other, it is important to know how they are all functioning – even if you have an isolated complaint of, for example, sexual pain.
If you are over 18 years of age, we’ll perform a vaginal exam at your initial visit.
If you’re under age 18, we will delay the genital exam until your second visit.
We understand that a speculum exam can be painful for women with sexual pain and pelvic pain, so we can use just a finger to examine the pelvic muscles. If even that is too painful, we can do limited exams based on your tolerance.
To be sure there are no other issues, we may recommend tests such as:
- pelvic ultrasound
- sexually transmitted infection testing
- urine cultures
- vaginal infection tests
- cystoscopy and/or colonoscopy (depending on presence and severity of other symptoms)
If we find increased pelvic floor tone, the first step in the rehab process is for our physical therapist to work on your pelvic muscles through the vagina. In some cases, we prescribe lidocaine or muscle relaxers (oral or vaginal suppositories) to facilitate the therapy.
Physical therapy typically happens once a week for 8-12 weeks, with positive changes generally noted by around week six.
If you cannot undergo pelvic floor therapy via your vagina due to severity of your condition or plateaus during your treatment, we then recommend pelvic floor muscle Botox injections (under sedation in most cases).
We use Botox injections in more stubborn cases as a powerful tool to increase effectiveness of pelvic floor physical therapy.
In most cases, a Botox injection to the pelvic floor muscles is only needed once.
