title: Subjective and objective outcomes of botulinum toxin type A treatment in vestibulodynia: pilot data.
abstract: OBJECTIVE
  To collect pilot data on the efficacy of intramuscular botulinum toxin type A (BTX/A) injection into the levator ani muscles to relieve coital pain, reduce pelvic floor tension and instability, and reduce vestibular hyperalgesia in vestibulodynia.
  
  
  METHODS
  Two subjects meeting diagnostic criteria for vestibulodynia were treated with 20 units and 40 units of BTX/A at 12-week intervals. Outcomes included a visual analogue scale (VAS), weekly coital pain diaries, surface electromyography (sEMG) and a vulvar algesiometer.
  
  
  RESULTS
  BTX/A modestly reduced coital pain in 1 patient and was ineffective in the other. Pelvic floor hypertonicity and variability were markedly reduced in both patients, but negligible changes occurred in vestibular hyperalgesia. The patient with greater pelvic floor tension had more of a reduction in diary-rated coital pain 2 weeks after the injection (29% vs. 9%) and on the VAS at 12 weeks (15% vs. 3%).
  
  
  CONCLUSIONS
  BTX/A injections may be effective in reducing coital pain in vestibulodynia with levator ani tenderness but have little effect on vestibular allodynia. The relationship between pelvic floor hypertonicity and decreased coital pain suggests that vestibulodynia may be a variant of chronic regional pain syndrome. The dose and volume of BTX/A injected may be related to the degree of relief.
authors.affiliation: Department of Pharmacy, University of Tennessee Health Science Center, Memphis, USA. csbrown@utmem.edu
authors.forename: Candace S
authors.initials: CS
authors.lastname: Brown
authors.forename: Howard I
authors.initials: HI
authors.lastname: Glazer
authors.forename: Val
authors.initials: V
authors.lastname: Vogt
authors.forename: Daniel
authors.initials: D
authors.lastname: Menkes
authors.forename: Gloria
authors.initials: G
authors.lastname: Bachmann
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002908:Chronic Disease; D003075:Coitus / Q000502:physiology; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D017773:Pelvic Floor / Q000473:pathology*; D010865:Pilot Projects; D016896:Treatment Outcome; D014845:Vulvar Diseases / Q000188:drug therapy*
chemical_list: D019274:Botulinum Toxins, Type A