Wednesday, April 20, 2011

I've Been Botoxed

Yesterday was the big injection day.  I wasn't very nervous leading up to it.  I only really got nervous when I was laying on the table with my legs spread and looking at needles.  The idea of having someone put needles into your vagina is quite frightening.

The bigger hole is the vagina and the smaller
hole is the anus.
 First Dr. Goldstein did a short exam to pinpoint the muscles that were the most tense.  I had 100 units of Botox and he decided to split it like this: 50 units in the Puborectalis (6 on the pelvic clock) and 25 each in the left and right Pubococcygeus (around 4 and 8 on the pelvic clock).  My 6 o'clock muscle was definitely the most tender, which is why he put 50 units in that muscle.

As for the procedure itself, I'm not gonna lie.  It was painful.  Fortunately it was a very short-lived pain.  I was afraid of the pricking of the needle, but I actually hardly felt that.  The pain came when he injected the Botox into my muscles.  It felt like fire was spreading through my vagina and all the way to my anus.  It was intense, but it only lasted a couple minutes.  Within 5 minutes I only felt a slight soreness and no fire, so all in all, not bad if you can deal with a couple minutes of fire.  He told me to squeeze and release those muscles at least 100 times that day to make sure the Botox got spread around the muscles.  Now we just wait to see what happens - I'm supposed to do aggressive PT and see if it made a difference.

A side note: while we were sitting in Dr. G's office after the procedure he mentioned that my therapist is the best patient advocate he has ever encountered.  He actually said, "She's a pain in my ass, but that's not necessarily a bad thing."  She will call him until she gets a response and she demands answers.  My husband and I feel very lucky to have her in our corner and we agreed that we love that she is a pain in our doctors' asses.  Dr. Goldstein referred to her as our quaterback.  Now I do know that the quarterback is a very important position on the football field, but that's where my understanding of this metaphor ends.  However I'm sure my husband appreciated the sports reference.  I'll have to get him to explain to me exactly why our therapist is the quarterback.  And now I'm wondering what position our other doctors play.  Is Dr. G the tight end?  Our PT the kicker?

So getting the Botox was pretty much a positive experience.  I had intense pain for a couple minutes, but it subsided quickly.  I just hope it helps.


Husband said...

Congrats on finally getting your botox!! I hope you get the relief you are trying for.

I’m wondering has you tissue fully recovered by using the Estradiol and now you are just trying to get the muscles to relax or do you have other issues you are also still working through. You and my wife have been on similar paths since we found your blog and decided to go to Dr G, with the exception that we are several months behind you in Dr G time.

Anonymous said...

My issues are incredibly similar to yours and I am going for botox in a few weeks. However, I am going to be under anesthesia for the procedure. Did your doc give you that option? My gyn didn't--said the pain without it would be unbearable. I'm impressed you made it through!

I hope this helps you and that you're able to get back to normal soon. How long are you slated to do PT for, post-injections?

the girl with pain "down there" said...

I think that different doctors have a different procedure for Botox. I have heard that some will put you under and when you wake up you have a dilator inside you. This is not what Dr. G does. He just injects the Botox and then you work with dilators on your own. The pain was intense, but very short-lived. I don't think that anesthesia would have been necessary. I'm really not sure how long I will have to do PT at this point. I've been going for 2 years already - there's really no telling how much longer it will be. Plus, sometimes you have to get more than one Botox injection, so who knows.

Husband: I'm pretty sure my tissues have healed from using the Estradiol gel. I still have burning, but Dr. G thinks that it is due to tight muscles (and it is much less than it was before). I guess we'll see as the Botox starts to take effect.

ann said...

good luck!! let us know how it goes!!

i just found your blog tonight, i am working on pain down there too, and started a blog about my problem. it's great to find others who have similar problems to know that i'm not alone, even if it's not the same thing.

also?? our blogs are twins :) just something about soft pink watercolor that we women with vaginal pain tend to be drawn to, i guess :)

Jeliza said...

*I am curious who your doctor is*, since there are a limited number of vaginal and pelvic pain specialists who use botox. (
My email is if you would like to respond privately)I have recently gotten injections into my pubococcygeus (45 U on each side) and also the mucosa of my vestibule. The last injection, which was when most of the muscle injection was done, will be a week ago tomorrow. I can't say I'm feeling any better so far, accept that my vagina seems slightly less tight, and , oddly burning of my labia is less. MY pain level has actually been a little worse (and i have had for 2 years now pain in my buttocks and thighs as i have new pain in the tops of my aductors, but at least for now I attribute any increase in pain to injections into the vestibule (which always seem to make everything hurt worse for 2 or 3 weeks). I do think it's very likely that my puborectalis, at least, also needs to be botoxed, and my doctor says he won't do that because there is risk of infection since it's a deep muscle, if I can't talk him into it, i'll need another doctor who will. I saw Dr Goldstein a couple years ago, and we did not have a good communication, plus he doesn't take insurance so there's no maximum allowable charge or in network discount for things. I may go back to him if i can find noone else. I live in Richmond, Va and prefer a doctor within a couple hours driving distance (I cannot sit, so my friends drive and i lay in the back of my minivan)

"Girl with the pain down there" are you feeling any changes yet, How long did Dr G think it would take to feel something?

To everyone, best of success with your recoveries, my heart goes out to anyone else dealing with his in their lives

Love and Health, Jeliza

the girl with pain "down there" said...


I live in Richmond too! Small world. Dr. G said that the Botox should take about 10 days to 2 weeks to take full effect and that it would last about 3 months. He was very clear that the Botox alone is not a fix for anything; it's merely an adjunct to PT - something that can help make PT more effective. It's been 2 weeks and I can tell no difference, but he also said that I probably wouldn't be able to tell - that my PT would be able to tell better, so hopefully that is the case.

I'm sorry you had difficulties with Dr. G - I've definitely heard that from others. As far as I know he is the closest to Richmond. I do know of another doctor named Dr. Steege at UNC who comes highly recommended ( I think they take insurance, but I can't say for sure. Our plans is to go see him next if the Botox does not work out. But you have to send in your medical paperwork to their office first and then they will decide which doctor is best suited for your issues before you can make an appointment.

I have rambled on - I hope this was helpful.

vfittan said...

Just found your blog, interesting that the botox treatment was the first I was going to find. I've done it as well and agree it was painful. I read above that some of the commenters would get anesthesia. I must say the pain wasn't that bad that I would've wanted that. It's the combination of pain, someone doing something in your vagina and your vagina being used to going into panic mode whenever something tries to enter it.

I hope the treatment works well for you, best of luck.

purplepetunia said...

Hi Again the Girl who Hopefully Will Soon Have Less or No Pain There :) Thank you for writing back, and so quickly, and sorry for my delay (pain and a determination to work on a painting just a little before I did other standing stuff.

That's cool that you live in Richmond, I bet we go to the same physical therapy place too ~ Women's Health PT on Hugenot? I work with Angie now mostly, though I've also worked with Cora and will be seeing her some while Angie is out of town for 5 weeks.

To be honest I'm doubting that, at least in my case, the botox is going to have a big affect on physical therapy, or that physical therapy is going to help me that much period, other than having someone who can palpate well to tell me what's tight and what's in pain (which is important). And to have someone to talk to, comfort me. And sometimes make suggestions. Maybe the trigger point and ultrasound help me a little bit, but not in a big way, I don't think.
I see Dr Guerette, who I like alot, other than that he is near impossible, though not totally impossible, to get on the phone (but Ryan, his office assistant is GREAT about calling me back and relaying messages etc.) Also, like I said, I'd like to have more muscles botoxed, both because in the successful studies I've read pubococcygeus was done, and because I'd like to have obturators and/or maybe piriformis done, and Angie suggested that, partly since I have hip and leg pain. I know there are a couple docs who do that , though noone near me so far, though if Dr Guerette won't I may call Dr Goldstein and see what he might be willing to do. (even though he bugs me out ~ kept telling me that I just didn't seem like I was in that much pain, including twice in his office when i asked if I could stand to talk because sitting caused me terrible pain (including after the somewhat pain increasing exam, and being squirted with vinegar, which was INCREDIBLY painful, and which he didn't even tell me he was going to do before he just squirted)
My theory about why botox my take awhile to help, and that it may take several treatments is that when a given part of the body has been in pain over an extended period of time, changes take place in the peripheral nerves, and often in the spinal column and/or the brain that cause them to cause pain regardless of the state of the muscle/fascia or skin tissue itself(this process called peripheral or central nerve *sensitization* respectively, so that once you take the mechanical stimulus for the pain away, or part of it (ie the tight muscles) it may take some time for the nervous system to become normal (or more normal) again. If I'm blabbering about things you already know please excuse me.

I go to see Dr Guerette tomorrow so I'll see what he says, and Cora on Thurs. Take care and keep in touch.

<3 Jeliza

purplepetunia said...

OMG the internet frustrates me ~ apparently I have two google user names, and had forgotten that....meant to log in as Jeliza ~ Anyway i'm the same person who spoke to you before as Jeliza ~ sorry for the mixup

the girl with pain "down there" said...


Yes I do go to Women's Health PT. I see Cora usually, although I have seen Angie before. Small world!

I think that the Botox is helping. My muscles do seem looser when I dilate or when I'm at PT.

Yes the vinegar was really painful at Dr. G's. He warned me before he did it though. I'm curious, when you went to Dr. G did you go alone or was someone in the room with you? There are hugely different accounts of how he treats his patients and it seems that all the women who went alone had bad experiences. My husband always goes with me and I really don't have anything bad to say about Dr. G. However, it is disconcerting that he might only be treating me better because my husband is in there with me.

Anonymous said...

That's pretty wild about Dr. G. I'm thinking of seeing him and am single (and have little patience for nasty doctors) LOL