(272) Botulinum Toxin Injection in Vulva and Vagina: Evidence from a Literature Systematic Review

Abstract

Abstract Introduction Vaginismus, vulvodynia and chronic pelvic pain are a group of pain syndromes that may have, in addition to pain, other types of symptoms. Often no specific etiology can be identified, and the choice of treatment is complicated. Although several treatment methods have been proposed, evidence-based therapies are limited. Therapies can be classified in medical, surgical and interventional treatment. Interventional therapy contemplates injection therapy with botulinum toxin, proposed in 1997 Objective To evaluate the BoNT injection in the comprehensive care of vaginismus, vulvodynia and chronic pelvic pain and to enhance the impact on the sexual arousal. Methods 1108 patients, Randomized Controlled Trials (RCT) were 7. The Retrospective Studies Without a control group were 4, With a control group: 1. Besides, the Prospective Studies Without a control group were, . 2 patients were With a control group. The BoNT Dosage Range was: Minimum: 12 UI Maximum: 500 UI Types of BoNT Products: Botox® (onabotulinumtoxinA): 14 Xeomin® (incobotulinumtoxinA): 3 Dysport® (abobotulinumtoxinA): 3 Unspecified BoNT Product: 1 EMG-Guided Injection: 5 I used as BoNT Administration Techniques, the Digital Palpation: 12, the unspecified Injection Procedure: 4. My methods were 17 patients in Intramuscular Injection, 3 patients with Vaginal Submucosal Plane, and one patient with Subcutaneous Injection. Results For Vaginismus, Significant improvement in sexual and orgasmic dysfunction Successful intercourse Reduction of vaginal muscle resistance Improved sexual function (evaluated by Female Sexual Function Index) Pain reduction and improved quality of life (Short-Form Health Survey) BoNT reduced muscular hyperactivity. Both BoNT and placebo improved sexual pain, function, and distress for patients with vulvodynia, Significant improvement in pain 4, improved quality of life 2 and increase of sexual activity due to the reduced pelvic hypertonicity. Other Study Results: Significant improvement in pelvic pain [22, 23, 31, 32] Reduction of vaginal pressure [32] Improvement in quality of life, sexual activity, and reduced pelvic floor muscles myoelectrical activity [31] Conclusions Different endpoints and different methods of analysis. Different types of participants. Various techniques and timing. Adverse events. For this reason, even though BoNT seems a promising treatment, a clear standardization in clinical guidelines is still lacking. A clear standardization is needed for practical guidelines. Future perspectives should address reproducible protocols for BoNT administration. Disclosure No.