His and Her Health

Niva

Your patients that you treat that have vestibule pain and levator spasms, are they taking any nerve pain meds and if so, which one works best in your experience? Also, did any have botox done and was the vestibule pain better?

Yes, I do have patients who are prescribed meds by their physicians. Honestly, many have reacted differently to meds. Many of them are taking valium (not a nerve med though). Lyrica (nerve med)seems to be helping some too. Some are still having success with Elavil/Amytriptyline.
Yes, botox has helped my patients.

Hi Ms Herzig

Can you please tell me how long after the botox shots do your patients see a decrease in the vestibule pain? I do have pain and have been in physical therapy that is not yielding the results I had anticipated. Do most of your patients that do not see results with pt ( I have been in pt 4 months now) do the nerve blocks or the botox. I have pain on contact at the bottom of the vestibule and when I press that area, it seems to radiate into a deeper vaginal pain that spans to the rectum where I experience a knawing, throbbing feeling.

Please let me know if you have seen success with nerve blocks or botulism toxin for this sort of scenario,

thanks much

Some paitents see a decrease immediately, but most it takes a few weeks and continues to improve after that time.
I can't say most patients do these as they fear of an invasive procedure or bc of cost.
You may need more time in PT; it may take longer than 4 months. Have you seen any improvement? Also, is PT the only current treatment (ie meds, other therapies)?
Is the PT doing any rectal work with you?

Does anyone know a website to locate Doctors that treat VVS ?

Through NVA.org or can try pelvicpain.org

Ms Herzig

Thank you very much for attention to my emails.
No I actually feel worse since I have been in pt.
Yes, she does rectal work. Not as much as vaginal. No improvements, if anything- I must say I feel worse. I am ready to pursue the botulism toxin despite the cost, so I do value your input. Do you think 4 months in pt that it is premature to think it not effective? I am not taking any nerve pain medication as my physician feels it is all pelvic muscles, in your opinion, do you feel that I should be requesting nerve pain meds? If so, which one? Why if it is the muscles would pt not be effective

Well I would hope that in 4 months you would start feeling some improvements. I would continue with PT or maybe a sencond opinion from another PT. I cannot suggest medications bc it is out of the scope of a PT, but there are medicines that work on muscles too; perhaps having that discussion with your MD. Botox is also another good option, but again you need to discuss with your MD.

Hi Niva,

Are there pelvic floor muscles on the anterior part of the vestibule (around the urethera)? I have pain pressing up against the urethra and was wondering if there are muscles in that area? I'm assuming there are, but am trying to figure out where they would be b/c when I look at a diagram of the anterior part of the vestibule I see the urethral opening, vaginal wall, and then the vaginal opening, so just not sure where pelvic floor muscles would be, if any, in this area?

Thanks

Micky
Many women complain of pain near the urethra like yourself. You probably have tenderness also in the Bulbocavernosus muscles, which is part of the urogenital triangle.

Thanks Niva

Interesting, although I have pain on touch on the urethral opening itself and the skene's glands as well as in the anterior vaginal wall. So am thinking that it's not just a muscle problem.

It feels like a severe hypersensitivity that never lets up.

Than also be atrophy in the area and connective tissue restrictions. There is still possibility that the deep muscles are also affected, but would have to evaluate to know.