I pop my head up from my gynecologist Dr. Deborah Coady's exam table and stare at her as she sweeps her finger inside me, poking at my pelvic floor muscles, finding the spots that make me cringe with pain.
"Botox," she says. "I think we should inject Botox into some of these really tight areas in your vagina to help them relax. I've had some success using Botox on patients with pelvic floor dysfunction, but they usually need three to six injections every three months."
She's crazy, I thought. "We" aren't going anywhere near my nether regions with a needle full of Botox.
For two years, my gynecologist and I had been coaxing my clenched vaginal muscles to relax with hormone creams and Valium pills I inserted into my vagina. A cure seemed elusive, yet I wasn't alone in the hunt for one. One-third of American women suffer from pelvic floor dysfunction (PFD), a condition in which the pelvic muscles and connective tissue are extremely weak or, in my case, extremely tight. PFD can occur as a result of injury through strenuous activities like Pilates, biking, and horseback riding. For other women, like me, the cause is unknown, and a few Kegel exercises certainly weren't going to help.
But I knew it was time for a more aggressive treatment plan. With six months left until my honeymoon, I had high hopes for a normal vacation with my new husband. I had bought a hot-pink bikini, ramped up my workout routine, dabbed hormone creams and numbing gels on my labia twice a day, and spent hours with a physical therapist who pulled at my pelvic muscles to train them to relax. Yet honeymoon sex still wasn't a guarantee.
Although my muscles gave more willingly than they did when I first lay in these stirrups, PFD still infringed on my daily life. I couldn't sit — 30 minutes into a meal with friends and I was wiggling around in agony like an impatient little girl waiting to be excused from the dinner table. Hard wooden chairs, road trips, and long airplane flights drove me crazy with pain — so much so that I had to quit my desk job as a copy editor. I couldn't ride bikes. I couldn't wear skimpy underwear or skinny jeans — or jeans at all, for that matter — because they rubbed my sensitive nerves the wrong way.
Worst of all, sex with my blue-eyed fiancé, Bjorn, brought on excruciating pain in my crotch. At times, his penis felt like a red-hot iron. Other times, regions I never knew existed throbbed torturously like a hidden charley horse. Mostly, our attempts at sex ended with me curled up in a ball while he ran to get an ice pack to numb my burning vagina. "It's not fair!" I grumbled to him. "All I want is boring, basic sex. Is that too much to ask for?"
However, every few months we achieved enjoyable sex. I was certain that no matter how many telemarketers I'd hung up on or elderly people I'd brushed by instead of offering a helping hand, I deserved pain-free sex, orgasms included. And so we kept at it.
As much as I wanted to replace my dysfunctional muscles with a smoother set, I wasn't ready to paralyze the ones I was stuck with. But I wouldn't be the first to use Botox medicinally. Long before the drug became a cosmetic sensation, doctors were injecting migraine sufferers with it to ease their symptoms. The wonder drug has helped relax muscles in children with cerebral palsy, and is currently being tested as a treatment for asthma.
But if Botox successfully loosened my vaginal muscles, would I have to rely on it every three months — forever? At $600 a pop, with little promise of coverage from my health insurance plan and no FDA approval, it wasn't an appealing prospect. What really scared me was that some women who repeatedly get the injections lose some control of those muscles, peeing and passing gas unexpectedly. Was that really better?
At home, I poured a glass of wine and read the research. Despite the potential drawbacks, it sounded promising. Women who receive the injections feel less pain. I'd been dreaming about fruity cocktails, swimming in the bright-blue sea, and lounging in bed with my new husband on our Caribbean honeymoon. I'd also dared to dream beyond that, of settling into a new normal, free of my handicap. I wanted to plan vacations on a whim rather than depending on how long the flight was. I wanted to sit comfortably at our dining table and talk until the tea lights twinkling in the mason jars burned out. I wanted to pounce into bed on a rainy Sunday and have spontaneous sex. Botox, I thought, might just be the key to this regular life I desperately craved. Maybe I was the kind of woman who gets Botox after all.
When I arrived for my first appointment, I told myself, It's like a normal gyno exam, except with needles. Dr. Coady held the needle, and used her finger to find the biggest knots of muscle. "Yeow!" I yelled as she slid the needle into my vagina.
"You may not notice any changes for 10 days," she said. "But the Botox will slowly seep into your muscles. If it works, it'll most likely wear off in three months, and we'll do this again."
At home that night, I lay on the couch and let self-pity wash over me. What had I done? "I'm so proud of you," said Bjorn. "I'm excited for you to sit and ride a bike and wear whatever you want."
After a few weeks, the Botox began to take effect. When my physical therapist pulled on the muscles, they let go. She said they felt like clouds, light and fluffy. "I think Botox may have changed your life," she joked.
She was right. For the first time during sex, I felt soft and inviting. I caught a glimpse of our honeymoon and, on the horizon, a beautifully ordinary life.(The trip was wonderful. We managed to have sex five times in 10 days — for us, that's a lot!)
I stopped taking the shots the day I found out I was pregnant, two years later. My doctor isn't sure why, but being pregnant and giving birth forced my muscles to relax enough to lessen the pain. Today, my sex life is rarely spontaneous, but it's better. Before Bjorn and I have sex, I rub a topical anesthetic on my vagina and take long, deep breaths to relax. However, the Botox took away the most agonizing pain and brought me sweet relief — and on the rare occasions I peak, orgasms that probably scare the neighbors.