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 team carried out the present study to explore the effectiveness of BoNT therapy in women with chronic pelvic pain (CPP). 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).

Points examined:

• Type of report
• Condition
• Toxin serotype/brand
• Dose/dilution
• Muscle selection
• Guidance process
• Anaesthesia

For specific analyses, the journal papers written by the same authors with similar information were consolidated. Although many reports lacked complete information, 38 reports had analyzable information.

The analyzed reports included:

• Open-label prospective reports
• One randomized comparison of doses
• Four technical reports
• One placebo-controlled study of efficacy

The transvaginal, transperineal and/or transgluteal comparison of pelvic floor muscles was carried out. The BoNT brand/dose/dilution varied throughout. Some methods such as electromyography, anatomical landmarks, fluoroscopy/CT scanning and electrical stimulation with/without ultrasound were used as muscle localization techniques. The papers addressing analgesia used conscious sedation with/without topical/local anaesthesia, general anaesthesia, topical/local agent alone or pudendal block before or after the injection. There was significant improvement in 58-100% of patients with CPP and 71-100% of patients with V/VPD. With higher doses, severe adverse effects like urinary incontinence/retention and transient faecal incontinence/constipation were observed.

The present research recognises methodological determinants to be explored in further studies and the significant need for high-quality clinical trials for this forthcoming treatment approach.