It's been a couple weeks since I got the Botox injections in my Pubococcygeus and my Puborectalis muscles. It is really hard to tell what's happening down there, but I think that it has made my muscles more relaxed. It's easiest to feel this when either the PT is working down there or my husband is helping me dilate. When I do it myself it's harder to tell any difference, but when they do it, I (and they) can tell that the muscles aren't as resistant. So that's good news and hopefully a good sign for things to come.
My therapist recently went to a seminar for sexual pain and among the doctors there were Dr. Goldstein and also Dr. Pacik. She spoke to both of them about me. I have never seen Dr. Pacik, but she wanted his opinion on what to do after getting botoxed. His procedure is very different from Dr. G's. Dr. Pacik puts the patient to sleep to administer the Botox and when she wakes up she has a dilator in her vagina. Now this is usually for cases that are much more extreme than mine - I can get a dilator in my vagina with no problem and no anesthesia. However, Dr. Pacik feels strongly that women with any level of pelvic pain should have a dilator inside for many hours each day. I believe his theory is that having the dilator inside for that long will help to retrain the muscles and get them used to having something in there. He feels strongly that this is part of the process. Dr. Goldstein, on the other hand, thinks this is a bunch of malarkey. But my therapist thought there was no harm in giving it a try so I talked to my PT about it and she said to go ahead and try it (my PT had never heard of doing these extended dilations before).
The longest I've been able to stand having the dilator inside is about 40 minutes. It's actually harder than I thought it would be. I thought I could just lay there and keep that dilator in there for a long time with just slight discomfort. But it actually becomes more and more painful the longer it stays in. At first I tried it with the largest dilator, but it pushes in the top spot that is very tender for me (12 o'clock on the inside - basically where the G-spot is, where the urethra is as well). So I tried going a size down. This helped a little, but it's still painful. Another problem is that it really hurts to pull it out after having it in there for so long, even though I've lubed it up like crazy. It's like my body absorbs the lube and by the time I pull it out there's really none left. Yesterday I tried relubing every 5 minutes or so, but it still felt painful every time I pulled it out. I guess I'll try the extended dilation a few more times, but as of right now I feel like it's causing more pain than actually helping.
My hormones were retested a couple weeks ago and my testosterone is finally within the normal range. However I have to keep using the Androgel - 1/2 gram rubbed on thigh each day - indefinitely. Dr. G's nurse said that some people have to keep using it forever to maintain the right levels, while others are able to wean off of it eventually. I didn't realize this, and although it's not a huge deal, I really don't like the idea of having to put T gel on my legs every day for the rest of my life. It makes me hairy and pimply. If it actually gave me a sex drive I might say that it's a fair trade, but it doesn't so I'm not feeling the motivation to do this forever. Hopefully it won't be forever.