Chronic pelvic pain and botulinum toxin.

Botulinum toxin is being explored as a treatment for chronic pelvic pain, a major cause of suffering and disability in both women and men worldwide. For chronic pelvic pain in women, botulinum toxin may be injected into pelvic floor muscles such as levator ani and obturator internus. For pain associated with genitopelvic penetration disorders (vaginismus, vestibulitis, and vulvar pain, bulbospongioussus and ischiocavernosus may be treated. There have been numerous uncontrolled studies of botulinum toxin for chronic pelvic pain in women showing benefit, however, the few randomized controlled clinical trials published to date have given equivocal results. Chronic pelvic pain in men often implicates the prostate gland, so that the condition is commonly called "chronic prostatitis/chronic pelvic pain syndrome." There are only a handful of clinical trials for male chronic pelvic pain, each using a different site of injection; some with promising results. This paper discusses the use of botulinum toxin in the treatment of chronic pelvic pain in men and women.