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Questions For the Doctor?

Vaginismus occurs when penetrative sex or other vaginal penetration cannot be experienced without pain. It is a condition in which involuntary muscle spasm interferes with vaginal intercourse or other penetration of the vagina. 

Dr. Runnels has had a great deal of success treating Vaginismus with in-office procedures using multiple modalities, including Botox and PRP.

Vaginismus is a problem that is extraordinarily devastating and can be an extremely lonely condition to have. There are not really accurate numbers of women who have the condition, because many women suffer in silence and are ashamed or embarrassed to talk to their doctor about it or see a doctor about it. Many women don’t have anyone else in their circles that have the same problems, leaving them feeling abnormal, strange and handicapped in a way that can feel shameful and lonely. The problem can be so severe that a woman will have no ability to either use a tampon, tolerate a speculum or a pelvic exam by their gynecologist, or have intercourse or any kind of vaginal penetration, whether it’s with a penis or a finger with their partners, lovers or spouses. 

A huge problem is that the majority of providers that see and examine women often do not make the diagnosis or do not even recognize the patient’s behavior and symptoms as anything but “anxiety”. Patients can end up seeing multiple different doctors trying to get a diagnosis as well as treatment for their problems. Additionally,  once an accurate diagnosis is made and all of the other reasons for dyspareunia and pelvic or vulvar pain are ruled out, many doctors don’t know what to do with the diagnosis, or don’t have treatment options beyond things like pelvic floor therapy, physical therapy, vaginal dilators, topical anesthetics, or psychiatric medications. They will often tell patients “it’s in their head” and send them to a psychiatrist, psychologist, or prescribe muscle relaxers or sedatives to relax them enough to be able accommodate intercourse.

The FDA approved Botox to be used as a treatment for vaginismus in the 1990’s, and it can work very well when injected into the right muscles in the pelvic floor because vaginismus is a condition where the pelvic floor muscles are hypertonic and chronically contracted.  While Botox can be used to treat Vaginismus, there were not many doctors that knew how to use Botox in this manner, who knew specifically where to put the Botox in what muscles, and how to get it there. Also, patients often had to go to the operating room and be put under general anesthesia in order to get far enough into the vagina to inject the pelvic floor muscles with the Botox, which is not optimal.  

The problem with this form of Botox treatment is that once the patient is fully anesthetized under general anesthesia, then all of their muscles relax, and there is not really a good way to tell which muscles specifically are more of a problem than other muscles. In Vaginismus it is usually not every single muscle that is contracted in the same way, nor are they all equally problematic. There is usually a side or a group of muscles that are worse than others. To optimally treat a patient, it is beneficial to be able to have them be somewhat aware or conscious, so that they can communicate to the doctor or the doctor can feel on exam what part of the pelvic floor muscles are worse than others. This gives the doctor the opportunity to be more aggressive with those areas during the procedure.

What we do at the Scarlett Phoenix, which has been very successful, is something a little bit different than what many doctors are doing. Dr. Runnels uses Botox in the muscles of the pelvic floor, but she does the procedure in the office and under a light sedation. The patient is comfortable and aware of what’s going on, but able to tolerate the exam and able to maintain some of that hypertonicity to where Dr. Runnels can tell where the more problematic areas are. The doctor can focus more of the treatment in the muscles that are tighter, have more fibrosis to them and are more painful to the patient.

We also utilize PRP, platelet rich plasma, which is a regenerative modality that is used for many procedures at the Scarlett Phoenix. If you inject PRP into a part of the body that has some scar tissue or fibrosis, the PRP breaks up some of that fibrotic tissue and helps remodel that tissue into healthier new tissue. It promotes growth of new nerves, blood vessels, collagen. By combining the Botox with the PRP treatment in the areas that are identified as the more problematic parts of the pelvic floor, all while the patient is comfortable and somewhat sedated, but still aware and able to communicate, Dr. Runnels has been able to have some really amazing results.

Also, Dr. Runnels will then use a long acting, injected, local anesthetic in the pelvic floor musculature that will last for anywhere from a day to three days. By the time the anesthetic has worn off, the Botox will have has started to work, and the patient is able to utilize dilators at home comfortably to complete their treatment.

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