Does Botulinum Toxin A Injections Into The Pelvic Floor Muscles of Women with Chronic Genitopelvic Pain and Vaginal Spasm Improve Pain and Sexual Functioning?

OBJECTIVE: The objective of this evidenced based medicine review is to determine whether or not botulinum toxin A injections into the pelvic floor muscles of women with chronic genitopelvic pain and vaginal spasm improve pain and sexual functioning. STUDY DESIGN: Review of two double blind randomized controlled trials and one case series from peer reviewed journals published between 2006-2011. DATA SOURCES: Two randomized controlled trials and one case series were found using PubMed, Google Scholar, and Cochrane Library. OUTCOMES MEASURED: All three studies measured pain and sexual functioning using selfreported surveys including the visual analog scale for pain, Female Sexual Functioning Index, and Sexual Activity Questionnaire. RESULTS: Petersen et al. determined that botulinum toxin injections into the vulva did not improve pain or sexual functioning in vestibulodynia patients when compared to the control group. Similarly, Abbott et al. found that botulinum toxin injections into the pelvic muscles for chronic pelvic pain did not improve pain or sexual functioning when compared to the control group. In the case series conducted by Pelletier et al., botulinum toxin injections into the vulva reduced pain and improved sexual functioning for vestibulodynia patients. CONCLUSION: Botulinum toxin type A injections into the pelvic floor muscles are not an effective form of treatment for chronic pelvic pain or vestibulodynia. Both randomized controlled trials contributed the improvement in the control group to the placebo effect, among other theories. In the future, randomized controlled trials should use a larger sample size and include a nocebo group to further elaborate on the above results