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Review
. 2025 Apr:258:108336.
doi: 10.1016/j.toxicon.2025.108336. Epub 2025 Mar 26.

Chronic pelvic pain and botulinum toxin

Barbara Illowsky Karp  1 , Pamela Stratton  2
Affiliations
Review

Chronic pelvic pain and botulinum toxin

Barbara Illowsky Karp et al. Toxicon. 2025 Apr.

Abstract

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.

Keywords: Botulinum toxin; Chronic pelvic pain; Chronic pelvic pain syndrome; Chronic prostatitis; Endometriosis; Genito-pelvic penetration disorders; Pelvic pain.

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Conflict of interest statement

Declaration of competing interest The author is an Editorial Board Member/Editor-in-Chief/Associate Editor/Guest Editor for this Toxicon issue and was not involved in the editorial review or the decision to publish this article. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Karp is a Guest Editor for this journal. She has no competing financial interests related to this paper. Dr. Stratton has received royalties from UpToDate for a section about acute pelvic pain, from Frontiers in Reproductive Health as Specialty Chief Editor, Gynecology, participated in an Endometriosis Research Day at the Open Endoscopy Forum Cambridge, Massachusetts, and reviewed a book proposal on endometriosis for Elsevier.

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