Are Methodological Approaches to Botulinum Toxin Effective for the Treatment of Chronic Pelvic Pain, Vaginismus, and Vulvar Pain Disorders?

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Are Methodological Approaches to Botulinum Toxin Effective for the Treatment of Chronic Pelvic Pain, Vaginismus, and Vulvar Pain Disorders?

The botulinum toxin (BoNT) can be safely injected into pelvic floor muscles in women as an out-patient method as described in a study issued in 'International Urogynecology Journal'.

Botulinum toxin (BoNT) offers pain relief, particularly in a muscle spasm. Karp BI and the investigators described the methodology for BoNT treatment of chronic pelvic pain (CPP) in women and placed it in the context of the literature on methods for this use. The database search was performed using the terms "pelvic pain," "botulinum toxin and "vaginismus." The "vaginismus/vulvar pain disorders" (V/VPD) comprised of reports on vaginismus/vulvodynia/vestibulodynia (considered if pelvic floor muscles were injected). The study investigators examined the type of report, condition, toxin serotype/brand, dose/dilution, muscle selection, guidance process, and anaesthesia. The publications from the same authors without unique information were combined for particular analyses. Although many reports lacked complete information, 38 reports had analyzable information. Most of them were open-label prospective reports; 4 technical reports, 1 randomized comparison of doses and 1 placebo-controlled study of efficacy. The pelvic floor muscles were approached transperineally, transvaginally or transgluteally. The BoNT brand/dose/dilution varied throughout. The muscle localization methods comprised of anatomical landmarks only, electromyography, electrical stimulation with/without ultrasound, and fluoroscopy/CT scanning. The papers examining analgesia used general anaesthesia, conscious sedation with/without topical/local anaesthesia, topical/local agent alone or pudendal block before or after the injection.  It was found that 58-100% of patients with CPP and 71-100% of patients with V/VPD improved cumulatively. Serious adverse events example transient faecal incontinence/constipation, urinary incontinence/retention was more frequently observed with the higher doses.

"This study recognises methodological factors to be considered in future studies and the critical need for high-quality clinical trials for this emerging treatment", noted the study investigators.


International Urogynecology Journal


Original title of article:

Methodological approaches to botulinum toxin for the treatment of chronic pelvic pain, vaginismus, and vulvar pain disorders


Karp BI et al.

: Exploratory, Botulinum toxin (BoNT), Anesthesia, Analgesia, Chronic pelvic pain, Vaginismus, Vulvar pain disorders, Transvaginally, Transperineally, Transgluteally, Injection, Transient faecal
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