Treatment of Dyspareunia with Botulinum Neurotoxin Type A: Clinical Improvement and Influence of Patients’ Characteristics

Abstract

The treatment of chronic pelvic pain (CPP) with botulinum neurotoxin type A (BoNT/A) has increased lately, but more studies assessing its effect are needed. This study aimed to evaluate the evolution of patients after BoNT/A infiltration and identify potential responders to treatment. Twenty-four women with CPP associated with dyspareunia were treated with 90 units of BoNT/A injected into their pelvic floor muscle (PFM). Clinical status and PFM activity were monitored in a previous visit (PV) and 12 and 24 weeks after the infiltration (W12, W24) by validated clinical questionnaires and surface electromyography (sEMG). The influence of patients’ characteristics on the reduction in pain at W12 and W24 was also assessed. After treatment, pain scores and the impact of symptoms on quality of life dropped significantly, sexual function improved and sEMG signal amplitude decreased on both sides of the PFM with no adverse events. Headaches and bilateral pelvic pain were risk factors for a smaller pain improvement at W24, while lower back pain was a protective factor. Apart from reporting a significant clinical improvement of patients with CPP associated with dyspareunia after BoNT/A infiltration, this study shows that clinical characteristics should be analyzed in detail to identify potential responders to treatment.

Botulinum Toxin for the Management of Pelvic Floor Tension Myalgia and Persistent Pelvic Pain

“…com/AOG/D419). 13,[34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] Prospective data showed significant improvements in patient-reported outcomes after botulinum toxin in all studies. Of the eight studies that reported the non-patient-reported outcomes of vaginal manometry or physical examination findings, seven reported significant improvements in vaginal pressure or pelvic floor hypertonicity at clinical examination.…”

“…Qualitative analysis was performed on 14 prospective and four retrospective studies involving a total of 600 and 204 participants, respectively (Appendices 2 and 3, available online at http://links.lww.com/AOG/D419). 13,34–50 Prospective data showed significant improvements in patient-reported outcomes after botulinum toxin in all studies. Of the eight studies that reported the non–patient-reported outcomes of vaginal manometry or physical examination findings, seven reported significant improvements in vaginal pressure or pelvic floor hypertonicity at clinical examination.…”

“…10,[29][30][31] This is supported by nonrandomized prospective and retrospective data and indicates that botulinum toxin is a safe treatment modality for the management of pelvic floor tension myalgia and persistent pelvic pain. 13,34,35,[37][38][39][41][42][43][44][45][46][47][48][49][50] Urinary incontinence and fecal incontinence were the most commonly reported adverse events, with an incidence of between 3.3% and 13.3% across the studies (Table 1).…”

“…Meta-analyses of randomized data examining sexual function contrast substantively with nonrandomized prospective data that universally describe improved sexual function for the chosen outcome measure. 35,[39][40][41][42][43][44]46 Although this may reflect a placebo effect, there are several confounders in existing RCTs that make these data difficult to interpret. First, all clinician-assessed measures to determine myalgia or tone involve internal manipulation in both the active and control groups, which may mimic physiotherapy interventions, reported to be an effective treatment of pelvic floor tension myalgia.…”

Trigger Point Injections Followed by Immediate Myofascial Release in the Treatment of Myofascial Pelvic Pain

“…The VAS score as used in this study is an effective pain assessment tool as it standardizes patient's pain perceptions. The VAS remains one of the most widely used quanti cation tools for pain in published studies and is an acceptable measure of subjective pain evolution [15]. However, the minimum clinically important difference (MCID) in VAS has not been de ned for pelvic pain.…”