{"paper_id":"e3b9564d-06b2-48d0-af45-52caaa46fe67","body_text":"Original Article  | JOGCR. 2025; 10(3): 201-207 \n     Volume 10, March 2025       Journal of Obstetrics, Gynecology and Cancer Research \n Journal of Obstetrics, Gynecology and Cancer Research | ISSN: 2476-5848 \n \nThe Effect of Botulinum on Chronic Pelvic Pain and Sexual Satisfaction in \nWomen with Endometriosis \n \nFatemeh Davari Tanha1 , Mojgan Asadi2,3* , Faeze Mirbagheri4, Elham Feizabad4 , \nZahra Kaveh5,  Kazem Mousavizadeh 6 \n \n1. Vali-E- Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical \nSciences, Tehran, Iran \n2. Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical \nSciences, Tehran, Iran  \n3. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Ins titute, Tehran \nUniversity of Medical Sciences, Tehran, Iran   \n4. Department of Obstetrics and Gynecology, Yas Hospital Complex , Tehran University of Medical Sciences, Tehran, \nIran \n5. Yas hospital research center, Tehran University of Medical Sciences, Tehran, Iran \n6. Department of Pharmacology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran \n \nArticle Info  ABSTRACT \n  \n   10.30699/jogcr.10.3.201 \n \n \n \nBackground & Objective:  Endometriosis is a chronic gynecological condition \naffecting approximately 10% of women of reproductive age. Chronic pelvic pain is a \ncommon symptom of endometriosis which significantly impacts on a woman's quality \nof life, including sexual satisfaction. Botulinum toxin injection has been used as a \ntreatment for chronic pelvic pain in endometriosis, but its effect on sexual satisfaction \nis not well understood. The present study was conducted with aim to investigate the \neffect of botulinum on chronic pelvic pain and sexual satisfaction in women with \nendometriosis. \nMaterials & Methods: This randomized controlled trial study was conducted on 32 \nwo\nmen with endometriosis who were randomly assigned to receive either botulinum \ntoxin injection or placebo. The primary outcome was a change in chronic pelvic pain \nassessed using the visual analog scale (VAS) at one month after treatment. Secondary \noutcome included changes in sexual satisfaction assessed using the Female Sexual \nFunction Index (FSFI) at one month after treatment. \nResults: The botulinum toxin injection significantly reduced chronic pelvic pain \ncompared to placebo at one month after treatment (P<0.001). There was also a \nsignificant improvement in sexual satisfaction in the botulinum toxin group compared \nto placebo at one month after treatment (P=0.001).  \nConclusion: Botulinum toxin injection in women with endometriosis may be an \neffective treatment option for chronic pelvic pain and improving sexual satisfaction. \nKeywords: Botulinum, Chronic Pelvic Pain, Endometriosis, Sexual Satisfaction  \nReceived: 2023/05/12; \nAccepted: 2023/08/01; \nPublished Online: 22 Jan 2025; \n \n \nUse your device to scan and read the \narticle online \n \n \nCorresponding Information:  \nMojgan Asadi, \nDiabetes Research Center, Endocrinology \nand Metabolism Clinical Sciences Institute, \nTehran University of Medical Sciences, \nTehran, Iran \n \nEmail: asadim@tums.ac.ir \n \n \nCopyright © 2025, This is an original open -access article distributed under the terms of the Creative Commons Attribution-noncommercial \n4.0 International License which permits copy and redistribution of the material just in noncommercial usages with proper citation.  \n \n \n1. Introduction\nChronic pelvic pain is a common condition affecting \nmany women worldwide. It is characterized by \npersistent pain in the lower abdomen, pelvis, and \ngenital area lasting for more than six months (1). \nEndometriosis is one of the leading causes of chronic \npelvic pain in women. It is a condition where the tissue \nthat normally lines the uterus grows outside of it, \ncausing inflammation and scarring (2-5). \nEndometriosis can have a significant impact on a \nwoman's sexual health and satisfaction. It is associated \nwith pain that can make sexual intercourse \nuncomfortable or even unbearable. This can lead to \ndecreased sexual desire and satisfaction, which can \nhave negative effects on a woman's overall quality of \nlife (6). Botulinum toxin is a neurotoxin which acts by \nblocking nerve signals to muscles, reducing muscle \ncontractions and spasms. Botulinum toxin injection has \nbeen found to be an effective treatment for chronic \npelvic pain and sexual dysfunction. In a study \nconducted on women with vulvodynia, botulinum \n\n\nFatemeh Davari Tanha et al. 202 \n      Volume 10, March 2025       Journal of Obstetrics, Gynecology and Cancer Research \ntoxin injection was found to significantly reduce pain \nand improve sexual satisfaction (7). The other studies \nshowed that the injection of botulinum toxin into the \npelvic floor muscles reduced muscle tension and \nspasms, which are often associated with chronic pelvic \npain (8, 9). However, there is limited research on the \neffectiveness of botulinum toxin in treatment of \nendometriosis. Therefore, it seems necessary to design \na study to investigate the effect of botulinum toxin \ninjection on chronic pelvic pain and sexual satisfaction \nin endometriosis. The study will provide valuable \ninsights into the use of botulinum toxin injection as a \ntreatment option for endometriosis -related symptoms. \nIt will help clinicians make informed decisions about \nwhether to recommend this tr eatment to their patients. \nAdditionally, the study will contribute to the growing \nbody of research on endometriosis and its management, \nwhich can lead to improved patient outcomes. \n \n2. Materials and Methods \nThis randomized controlled trial study was \nconducted on women with endometriosis between July \n2021 and July 2022 at a tertiary care university hospital \n(Yas Hospital Complex).  \nThe study included 32 women with endometriosis \nwho were randomly assigned to receive either \nbotulinum toxin injection or placebo . The sample size \nwas calculated using the clinical trial superiority design \nformula and the reported values in the previous study \n(10), the study power of 80%, and the two -tailed \nsignificance level of 5%. The sample size was \ndetermined to be 16 in each gr oup. The inclusion \ncriteria for the patient group were age between 18 and \n50 years, history of endometriosis at surgery, persistent \npelvic pain for at least 6 months and pelvic floor spasm. \nThe exclusion criteria were other causes of chronic \npelvic pain in cluding gastrointestinal, psychological \ndisorders, infectious, fibromyalgia and chronic fatigue \nsyndrome, untreated severe cervical dysplasia, history \nhysterectomy and bilateral salpingo -oophorectomy, \nallergy to botulinum toxin, history of myasthenia \ngravis or Eaton -Lambert syndrome, history of urinary \nor fecal incontinence, pelvic prolapse, pregnancy, \nlactation, and menopause. The patients did not receive \nhormonal drugs for at least two months before the \nstudy. \nThe primary outcome measure was change in chronic \npelvic pain assessed using the visual analog scale \n(VAS) at one month after treatment. Secondary \noutcome measures included changes in sexual \nsatisfaction assessed using the Female Sexual Function \nIndex (FSFI) at one month after treatment. Before \nenrollment in the study, all participants underwent \nvaginal sonography or laparascopy for diagnosis and \nstaging of endometriosis (11) . They were excluded if \nthey had any contraindications to botulinum toxin \ninjection or if they had undergone previous surgery for \nendometriosis within the past 6 months. First, muscle \nspasm and pain in the pelvic region were evaluated by \nvaginal finger examination, and the presence and \nlocation of the spasm was recorded. Then, after \nrandomization by block randomization method, people \nwere placed in botulinum injection group (intervention \ngroup) and control group (saline injection). The women \nwere placed in the lithotomy position, and then single \ndigit palpation was used to assess the presence of \nmuscle spasm in the pelvic floor musc les. After the \nexamination and 20 to 30 minutes before the injection, \nup to 10 mg of diazepam was administered orally, and \n4% lidocaine cream was applied to the spasm site in the \nvaginal mucosa. In the intervention group, a vial of 100 \nunits of Anabotulinu m toxin A (Botox) was placed in \n4 ml of saline (final concentration of 25units/ml). A \ntotal of 100 units of botulinum were injected into the \nspasmodic muscles. The injections were made using a \n27-gauge needle at a depth of 5 -10 mm by a \ngynecologist with experience in the field of \nendometriosis using a sterile technique. In fact, a total \ndose of 100 units was divided among three to four \nmarked areas of muscle spasm. The researcher noted \nthat the injection method was well -tolerated by the \nparticipants. Bilateral injections in muscles including \npubococcygeus, iliococcygeus and internal obtrator \nwere performed through transvaginal. Participants \nwere followed up at one month after treatment to assess \nchanges in chronic pelvic pain and sexual satisfaction \nover tim e. Out of 50 participants assessed for \neligibility, 14 were excluded (10 did not meet criteria, \n4 declined), and 36 were randomized equally into two \ngroups: botulinum injection (n=18) and saline injection \n(n=18). Both groups were assessed for changes in \nchronic pelvic pain (VAS) and sexual satisfaction \n(FSFI) at 4 weeks, with 2 participants from each group \nlost to follow-up. Ultimately, data from 16 participants \nin each group were analyzed (Figure 1\n). \nIndependent and paired T-test was used in parametric \ndistribution and Wilcoxon and Mann -Whitney U was \nused in non -parametric distribution to evaluate the \ndifferences in means. All analyses were performed \nusing SPSS 24 (IBM Corp., Armonk, NY, USA) \nsoftware at a significant level of less than 0.05. \n \n \n \n \n \n \n\n203 The Effect of Botulinum Toxin in Endometriosis \n      Volume 10, March 2025       Journal of Obstetrics, Gynecology and Cancer Research \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nFigure 1. CONSORT flow diagram illustrating the allocation of patients to the study groups \n \n3. Results \nThe demographic characteristics of the studied \npopulation are shown in Table 1 . The results showed \nthat botulinum toxin injection significantly reduced \nchronic pelvic pain compared to placebo at one month \nafter treatment (P<0.001). The mean sedative drug \nusage in the intervention group was lower than the \ncontrol group, but the difference between the two \ngroups was not significant (P=0.12) (\nTable 2 ). There \nwas also a significant improvement in sexual \nsatisfaction in the botulinum toxin group compared to \nthe placebo group at one month after treatment \n(P=0.001) (\nTable 3 ). The comparison of sexual \nsatisfaction after the intervention between the two \ngroups showed that the scores of the compon ents of \nsatisfaction (P<0.001), dyspareunia (P<0.001), and \norgasm (P=0.001) were significantly higher in the \nbotulinum toxin group than the placebo group. \nHowever, there was no statistically significant \ndifference between the two groups regarding the score \nof libido (P=0.32), psychological stimulation (P=0.09), \nand wetness (P=0.11) (\nTable 4 ). In general, the total \nscore of sexual satisfaction after the intervention \nExcluded (n=14) \n♦ Not meeting inclusion criteria (n=10) \n♦ Declined to participate (n=4) \n♦ Other reasons (n=0) \nLost to follow -up (lack of communication with \npatients) (n=2) \nReview changes in chronic pelvic pain by VAS and \nsexual satisfaction by FSFI at 4 week \nLost to follow -up (patient non-compliance) \n(n=2) \nReview changes in chronic pelvic pain by \nVAS and sexual satisfaction by FSFI at 4 \nweek \n \nAssessed for eligibility (n=50) \nAnalysed (n=16) \n \nAllocated to intervention (n=18) \n♦ Received botulinum injection (n=18) \n \nAllocated to intervention (n=18) \n♦ Received saline injection (n= 18) \n \nAnalysed (n=16) \n \nAllocation \nAnalysis \nFollow-Up \nEnrollment \nRandomized (n=36) \n\nFatemeh Davari Tanha et al. 204 \n      Volume 10, March 2025       Journal of Obstetrics, Gynecology and Cancer Research \nshowed a statistically significant difference between \nthe two groups (P=0.001). No side effects (urinary \nretention, constipation, urinary and fecal incontinence, \nback pain, etc.) caused by botulinum injection were \nreported in this study.  \n \n \nTable 1. Demographic characteristic of the studied population \nDemographic characteristic Group Mean Std. Deviation P-value \nAge \ncontrol 37.38 6.70 \n0.897 \ncase 36.94 5.26 \nBMI \ncontrol 25.34 5.08 \n1.000 \ncase 24.44 4.00 \nChronic pelvic pain \ncontrol 7.13 1.45 \n0.056 \ncase 8.06 1.12 \nDysmenorrhea \ncontrol 2.81 1.04 \n0.051 \ncase 2.25 0.93 \n \n \n \nTable 2. Comparison of pain components in case and control groups \nPain component Group Mean Std. Deviation P-value \nChronic pelvic pain \ncontrol 3.37 0.62 \n0.001 \ncase 2.25 0.93 \nDysmenorrhea \ncontrol 2.81 1.04 \n0.051 \ncase 2.25 0.93 \nDaily need for pain medication \ncontrol 1.18 0.83 \n0.128 \ncase 0.68 0.60 \n \n \n \nTable 3. Comparison of pain components in control group before and after intervention \nCase Group Mean Std. Deviation P-value \nChronic pelvic pain before intervention 8.06 1.12 <0.001 \n Chronic pelvic pain after intervention 2.25 0.93 \nDysmenorrhea before intervention 7.50 1.51 <0.001 \n Dysmenorrhea after intervention 2.25 0.93 \nDaily need for pain medication before intervention 3.88 1.20 \n<0.001 \nDaily need for pain medication after intervention 0.69 0.60 \n \n \n \nTable 4. Comparison of female sexual function index in the two groups of case and control \nFSFI domain Group Mean Std. Deviation P-value \nDesire \ncontrol 4.09 0.39 \n0.323 \ncase 4.28 0.48 \nArousal \ncontrol 4.05 0.31 \n0.094 \ncase 4.22 0.35 \nlubrication \ncontrol 3.90 0.41 \n0.110 \ncase 3.90 0.41 \nOrgasm \ncontrol 4.13 0.38 \n0.003 \ncase 3.70 0.34 \nSatisfaction \ncontrol 4.03 0.47 \n<0.001 \ncase 4.70 0.31 \n\n205 The Effect of Botulinum Toxin in Endometriosis \n      Volume 10, March 2025       Journal of Obstetrics, Gynecology and Cancer Research \nFSFI domain Group Mean Std. Deviation P-value \nPain \ncontrol 3.70 0.18 \n<0.001 \ncase 1.75 0.29 \nTotal score \ncontrol 23.89 1.01 \n0.001 \ncase 23.89 1.01 \n \n4. Discussion \nChronic pelvic pain caused by endometriosis can \nlead to discomfort during menstruation, sexual \nintercourse, and other activities. Sexual satisfaction can \nalso be affected by endometriosis due to pain during \nintercourse and decreased libido (12 -14). Botulin um \ntoxin acts through blocking the release of \nacetylcholine, a neurotransmitter that causes muscle \ncontractions (15) and can help reduce pain and improve \nsexual function. Some studies have shown that \nbotulinum toxin injection can relieve chronic pelvic \npain and women who received botulinum toxin \ninjection reported a 50% reduction in pain compared to \nthose who received a placebo injection (16, 17) . \nTandon, Stratton (16)  investigated the effect of \nbotulinum toxin injection on chronic pelvic pain  in \nwomen with endometriosis. Their case series included \n13 women who received botulinum toxin injections \ninto their pelvic floor muscles. The results showed that \nthe treatment significantly improved muscle spasms \nand pelvic pain  at 4 -8 weeks post -treatment (16). \nStratton et al  (17) also evaluated the efficacy of \nbotulinum toxin injection in 30 women with \nendometriosis-associated chronic pelvic pain. The \nresults showed that the treatment significantly reduced \npain scores one month post-treatment (17). \n A systematic review analyzed data from 5 \nrandomized controlled trials and 12 observational \nstudies that investigated the effect of botulinum toxin \ninjection on chronic pelvic pain. All observational \nstudies found that botulinum toxin injection was \neffective in reducing chronic pelvic pain with the \ngreatest change in visual analog scale from 8.69 at \nbaseline to 3.07 at 24 months post-injection. However, \nonly one of the five randomized controlled trials \nreported improved chronic pelvic pain after the \ntreatment (18). On the other hand, some other studies \ndo not support the use of this treatment method. The \nstudy conducted by Petersen el investigated the effect \nof Injection of 20 I.E. Botox in the vestibule of women \ndiagnosed with vestibulodynia. Botox was not \neffective on reducing pain, improving sexual \nfunctioning, or the quality o f life compared to the \nplacebo group (19). Yaraghi et al  (20) compared the \neffectiveness of functional electrical stimulation of \npelvic floor muscles for treating sexual dysfunction \nwith botulinum treatment. The results found that \nphysiotherapy procedure was more effective than \nbotulinum treatment (20). The present study focused on \nthe use of botulinum toxin injection as a potential \ntreatment option for endometriosis - related chronic \npelvic pain and sexual satisfaction. The women who \nreceived botulinum toxin injections had significantly \nlower levels of pain during intercourse and higher \nlevels of sexual satisfaction compared to those who did \nnot receive the injections.  \nHowever, botuli num toxin has some potential side \neffects, such as urinary retention and constipation (21). \nThese side effects can affect quality of life and may \nneed to be managed with additional treatments. It is \nimportant to note that botulinum toxin injection is not \na cure for endometriosis. It only provides temporary \nrelief from symptoms such as chronic pelvic pain and \npainful intercourse (22) . Women with endometriosis \nshould work closely with their healthcare provider to \ndevelop an individualized treatment plan that addresses \ntheir specific needs.  \nOverall, our study provides valuable insight into the \npotential benefits of botulinum toxin injection for \nendometriosis patients suffering from chronic pelvic \npain and sexual dysfunction. Other treatments such as \nhormonal t herapy or surgery may also be considered \ndepending on individual circumstances. \n \n5. Conclusion \nChronic pelvic pain associated with endometriosis \ncan have a significant impact on a woman's sexual \nhealth and satisfaction. Botulinum toxin injection may \nbe an effective treatment option for reducing pain \nduring intercourse and improving sexual function in \nwomen with endometriosis. However, further research \nis needed to fully understand the long- term effects of \nthis treatment option on sexual health and overall \nquality of life in women with endometriosis. \n \n6. Declarations \nAcknowledgments \nThe authors would like to express their gratitude to \nall participants enrolled in this project. \n \nEthical Considerations \nThe study was approved by the Research Ethics \nCommittee of Tehran University of Medical Sciences, \nTehran, Iran (IR.TUMS.MEDICINE.REC.1400.258). \nThis research was also registered with the code \n(IRCT20091012002576N20) in the Clinical Trial \nRegistration Center of Iran. \n \n\nFatemeh Davari Tanha et al. 206 \n      Volume 10, March 2025       Journal of Obstetrics, Gynecology and Cancer Research \nAuthors' Contributions \nFatemeh Davari Tanha conceived and designed the \nstudy; Mojgn Asadi designed the study and wrote \npaper; Faeze Mirbagheri collected the data; Elham \nFeizabad performed the analysis; Zahra kaveh edited \nthe paper and Kazem Mousavizadeh developed project. \n \nConflict of Interest \nThe authors declare no conflict of interest. \nFund or Financial Support \nThere is no grant support or financial relationship \nassociated with this study.  \n \nConsent to participate \nInformed consent was obtained from all individual \nparticipants included in the study. \n \n \n1. Medvedeva L, Zagorulko O, Shevtsova G. \nBotulinum toxin treatment of neuropathic pain. \nRuss J Pain. 2020;18(2):34-9.  \n[DOI:10.17116/pain20201802134] \n2. Dayal S. Ovarian endometriosis with borderline \nserous tumor-Association or coincidence -A case \nreport and review of literature. Indian J Med \nPaediatr Oncol. 2020;41(03):406-8.  \n[DOI:10.4103/ijmpo.ijmpo_209_18] \n3. Laschke MW, Menger MD. Basic mechanisms of \nvascularization in endometriosis and their clinical \nimplications. Hum Reprod Update. 2018;24(2):  \n207-24. [DOI:10.1093/humupd/dmy001] [PMID] \n4. McKinnon BD, Bertschi D, Bersinger NA, \nMueller MD. Inflammation and nerve fiber \ninteraction in endometriotic pain. Trends \nEndocrinol Metab. 2015;26(1):1-10.  \n[DOI:10.1016/j.tem.2014.10.003] [PMID] \n5. Sampson JA. Peritoneal endometriosis due to \nmenstrual dissemination of endometrial tissue \ninto the peritoneal cavity. Am J Obstet Gynecol. \n1927;14:422-69. [ DOI:10.1016/S0002-\n9378(15)30003-X] \n6. Pluchino N, Wenger J -M, Petignat P, Tal R, \nBolmont M, Taylor HS, et al. Sexual function in \nendometriosis patients and their partners: effect \nof the disease and consequences of treatment. \nHum Reprod Update. 2016;22(6):762-74.  \n[DOI:10.1093/humupd/dmw031] [PMID] \n7. Karp BI, Tandon H, Vigil D, Stratton P. \nMethodological approaches to botulinum toxin \nfor the treatment of chronic pelvic pain, \nvaginismus, and vulvar pain disorders. Int \nUrogynecol J. 2019;30:1071-81.  \n[DOI:10.1007/s00192-018-3831-z] [PMID] \n8. Morrissey D, El -Khawand D, Ginzburg N, \nWehbe S, O'Hare III P, Whitmore K. Botulinum \ntoxin A injections into pelvic floor muscles under \nelectromyographic guidance for women with \nrefractory high-tone pelvic floor dysfunction: a 6-\nmonth prospective pilot study. Urogynecology. \n2015;21(5):277-82. \n[DOI:10.1097/SPV.0000000000000177] [PMID] \n9. Abbott JA, Jarvis SK, Lyons SD, Thomson A, \nVancaille TG. Botulinum toxin type A for chronic \npain and pelvic floor spasm in women: a \nrandomized controlled trial. Obstet Gynecol. \n2006;108(4):915-23. [PMID]  \n[DOI:10.1097/01.AOG.0000237100.29870.cc]  \n10. Naumann M, So Y, Argoff CE, Childers MK, \nDykstra DD, Gron seth GS, et al. Assessment: \nBotulinum neurotoxin in the treatment of \nautonomic disorders and pain (an evidence-based \nreview)[RETIRED] Report of the Therapeutics \nand Technology Assessment Subcommittee of the \nAmerican Academy of Neurology. Neurology. \n2008;70(19):1707-14. [PMID]  \n[DOI:10.1212/01.wnl.0000311390.87642.d8]  \n11. Moradi B, Gity M, Davari Tanha F, Golest ani \nJahromi M, Fayyazi S. Evaluation of the \nDiagnostic Value of TVS (Transvaginal \nsonography) in the Diagnosis of Pelvic \nEndometriosis in Comparison with Laparoscopic \nEvaluation in Patients Referred to the Imaging \nCenter of Imam Khomeini Hospital and Yas \nHospital of Tehran in 2018. J Obstet Gynecol \nCancer Res. 2022;7(4):272-8.  \n[DOI:10.30699/jogcr.7.4.272] \n12. Falcone T, Lebovic DI. Clinical management of \nendometriosis. Obstet Gynecol. 2011;118( 3): \n691-705. \n[DOI:10.1097/AOG.0b013e31822adfd1] \n[PMID] \n13. Bulletti C, Coccia ME, Battistoni S, Borini A. \nEndometriosis and infertility. J Assist Reprod \nGenetic. 2010;27:441-7. [PMID] [PMCID]  \n[DOI:10.1007/s10815-010-9436-1]  \n14. Viganò P, Parazzini F, Somigliana E, Vercellini \nP. Endometriosis: epidemiology and aetiological \nfactors. Best Pract Res Clin Obstet Gynaecol. \n2004;18(2):177-200. \n[DOI:10.1016/j.bpobgyn.2004.01.007] [PMID] \nReferences \n\n207 The Effect of Botulinum Toxin in Endometriosis \n      Volume 10, March 2025       Journal of Obstetrics, Gynecology and Cancer Research \n15. Iversen L. Substance P equals pain substance? \nNature. 1998;392(6674):334-5.  \n[DOI:10.1038/32776] [PMID] \n16. Tandon HK, Stratton P, Sinaii N, Shah J, Karp BI. \nBotulinum toxin for chronic pelvic pain in women \nwith endometriosis: a cohort study of a pain -\nfocused treatment. Reg Anesth Pain Med. 2019;  \n44(9):886-92. [DOI:10.1136/rapm-2019-100529] \n[PMID] [PMCID] \n17. Stratton P, Tandon HK, Phan V, Aredo JV, Sinaii \nN, Shah J, et al. Randomized, placebo -controlled \ntrial of botulinum toxin for endometriosis-related \nchronic pelvic pain. Fertil Steril. 2021;116(3):  \ne52. [DOI:10.1016/j.fertnstert.2021.07.148] \n18. Luo FY, Nasr‐Esfahani M, Jarrell J, Robert M. \nBotulinum toxin injection for chronic pelvic pain: \nA systematic review. Acta Obstet Gynecol Scand. \n2020;99(12):1595-602. \n[DOI:10.1111/aogs.13946] [PMID] \n19. Petersen CD, Giraldi A, Lundvall L, Kristensen \nE. Botulinum toxin type A -a novel treatment for \nprovoked vestibulodynia? Results from a \nrandomized, placebo controlled, double blinded \nstudy. J Sex Med. 2009;6(9):2523- 37. [ PMID] \n[DOI:10.1111/j.1743-6109.2009.01378.x]  \n20. Yaraghi M, Ghazizadeh S, Mohammadi F, \nAshtiani EM, Bakhtiyari M, Mareshi SM, et al. \nComparing the effectiveness of functional \nelectrical stimulation via sexual \ncognitive/behavioral therapy of pelvic floor \nmuscles versus local injection of botulinum toxin \non the sexual functioning of patients with primary \nvaginismus: a randomized clinical trial. Int \nUrogynecol J. 2019;30(11):1821-8.  \n[DOI:10.1007/s00192-018-3836-7] [PMID] \n21. Adelowo A, Hacker M, Shapiro A. Botulinum \ntoxin type A (BOTOX) for refractory myofascial \npelvic pain. Female Pelvic Med Reconstr Surg. \n2013;19:288-92. [PMID] [PMCID]  \n[DOI:10.1097/SPV.0b013e3182989fd8]  \n22. Rubin R. Botulinum Toxin to Treat \nEndometriosis Pain. JAMA. 2019;322(8):716 . \n[DOI:10.1001/jama.2019.12350]. \n \n \nHow to Cite This Article:  \nDavari Tanha, F., Asadi, M., Mirbagheri, F., Feizabad, E., Kaveh, Z., Mousavizadeh, K. The Effect of Botulinum \non Chronic Pelvic Pain and S exual Satisfaction in Women with Endometriosis . J Obs tet Gynecol Cancer Res. \n2025;10(3):201-7. \nDownload citation:                             RIS | EndNote | Mendeley |BibTeX |","source_license":"CC0","license_restricted":false}