Episode 258: Vaginal Botox for Painful Sex: When Your Pelvic Floor Won't Relax

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She's been told to have a glass of wine. To just relax. That the pain is in her head. And she is still in pain — every time she has sex, every time she uses a tampon, sometimes just sitting at her desk. What she may have is a hypertonic pelvic floor: muscles stuck in a state of tension they cannot release on their own. In this episode, Dr. Carolyn Moyers sits down with Dr. Chailee Moss, board-certified OB/GYN at the Centers for Vulvovaginal Disorders in Washington, DC, and one of the country's leading experts in sexual pain — to talk about a treatment most women have never been offered: vaginal Botox. In this episode: • What a hypertonic pelvic floor actually is — and why it is so often missed • Why painful sex in midlife is not always "just hormones" • Who is a candidate for vaginal Botox, and what has to be tried first • What the procedure is really like: units, timeline, results, and side effects • Whether pelvic floor physical therapy is still necessary alongside Botox • Dr. Moss's current clinical study on incobotulinumtoxinA for pelvic floor dysfunction • Her published JAMA research on medical gaslighting in vulvovaginal care If sex hurts, tampons hurt, or exams hurt — and no one has been able to tell you why — this episode is for you. 🔗 Connect with Dr. Carolyn Moyers 📸 Instagram: @drcarolynmoyers [https://www.instagram.com/drcarolynmoyers/] 🎥 YouTube: @drcarolynmoyers [https://www.youtube.com/@drcarolynmoyers] 🌐 Website: www.skywomenshealth.com [https://www.skywomenshealth.com/] 🔗Connect with Dr. Moss 📸 Instagram: @drchaileemoss 🎥Podcast: https://podcasts.apple.com/us/podcast/vulva-talk/id1800293848?l=vi 🌐 Website: https://vulvodynia.com/ [https://vulvodynia.com/] Study refererenced: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2833711?__cf_chl_f_tk=OLsdlLvt_yGlGELQw_cAXUG3OvtyeWEIHUOmORJNnKg-1783169445-1.0.1.1-pul.JSpT5O0ZhZ3a2S4.ewkDiByn6Lwj3LUpBR3DIng [https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2833711?__cf_chl_f_tk=OLsdlLvt_yGlGELQw_cAXUG3OvtyeWEIHUOmORJNnKg-1783169445-1.0.1.1-pul.JSpT5O0ZhZ3a2S4.ewkDiByn6Lwj3LUpBR3DIng]

Episode 255: Your UTIs Might Not Be UTIs — What Your Bladder, Your Vestibule, and Your Hormones Have in Common

If you've ever had urinary symptoms that antibiotics didn't fix — and your cultures kept coming back negative — this episode is for you. A new 2026 study in the Journal of Sexual Medicine followed 253 women with recurrent UTIs and persistent urogenital symptoms despite negative urine cultures. What researchers found reframes everything: 85% of these women had hormonally mediated vestibulodynia, 75% had pelvic floor hypertonicity, and only 15% had a classic urologic cause for their symptoms. This isn't a bladder problem. It's a hormone problem — and the vulvar vestibule, urethra, and bladder are one integrated, estrogen- and androgen-responsive system. Whether it presents as genitourinary syndrome of menopause (GSM) in a postmenopausal woman or hormonally mediated vestibulodynia in a younger one, the tissue-level pathophysiology is the same. In this episode, Dr. Carolyn Moyers breaks down: • Why persistent urinary symptoms after negative cultures have a hormonal explanation • The shared embryologic origin of the vestibule, urethra, and bladder trigone — and why it matters • How androgen deficiency drives vestibular inflammation, pelvic floor guarding, and bladder dysfunction in a self-perpetuating cycle • Why this affects premenopausal women too — 98.9% of premenopausal patients in the study had below-range free testosterone • What the Rubin et al. 2025 data adds: vaginal prasterone (DHEA) was associated with meaningfully lower UTI rates in women with vulvovaginal atrophy — treating the hormone environment changed the urological outcome • What integrated treatment looks like — vaginal estrogen for GSM, compounded estradiol/testosterone gel for vestibulodynia, pelvic floor PT for hypertonic muscles • The honest limits of this research: selection bias, non-uniform hormonal evaluation, absence of long-term outcome data — and what prospective studies still need to answer This episode builds directly on Episode 149 — When Sex Hurts with Dr. Jill Krapf. If you haven't listened to that one, it is linked below and is essential companion listening. https://podcasts.apple.com/us/podcast/sky-womens-health/id1541657642?i=1000630939731 [https://podcasts.apple.com/us/podcast/sky-womens-health/id1541657642?i=1000630939731] 🔗 References & Resources: • Agrawal et al., Journal of Sexual Medicine, 2026 — Hormonally Mediated Vestibulodynia and Persistent Urogenital Symptoms • Rubin et al., Menopause, 2025 — Prevalence of UTIs in Women with Vulvovaginal Atrophy and the Impact of Vaginal Prasterone • Sky Women's Health Podcast — Episode 149: "When Sex Hurts" with Dr. Jill Krapf [link in show notes] • skywomenshealth.com [skywomenshealth.com] 🔗 Connect with Dr. Carolyn Moyers 📸 Instagram: @drcarolynmoyers [https://www.instagram.com/drcarolynmoyers/] 🎥 YouTube: @drcarolynmoyers [https://www.youtube.com/@drcarolynmoyers] 🌐 Website: www.skywomenshealth.com [https://www.skywomenshealth.com/]

14. juni 202622 min

Episode 258: Vaginal Botox for Painful Sex: When Your Pelvic Floor Won't Relax — with Dr. Chailee Moss

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