Abbott Jason
School of Women's and Children's Health, University of New South Wales, Barker Street, Randwick, NSW 2031, Australia.
Toxicon. 2009 Oct;54(5):647-53. doi: 10.1016/j.toxicon.2009.01.036. Epub 2009 Mar 3.
Chronic pelvic pain in women is a common symptom with a wide variety of etiologies that demand accurate diagnosis and appropriate treatment if pain reduction is to be effected. Superficial conditions such as provoked vestibulodynia and problems affecting deeper structures such as pelvic floor muscle spasm are difficult to treat and can have significant impacts on quality of life for the sufferer. Apart from daily pain, symptoms such as painful intercourse (dyspareunia), painful bowel motions (dyschesia) and exacerbation of period pain (dysmenorrhea) are commonly reported by patients. For inflammatory conditions, and in areas where muscle spasm is thought to contribute to pain, botulinum toxins (BoNT) are used with considerable success. For gynecological indications, there are limited data, in the form of case reports and small series, to indicate that BoNT used in the vulva may have a benefit for 3-6 months after injection of 20-40U of BOTOX; for women with provoked vestibulodynia. Re-treatment is reported to be successful and side effects are limited. Controlled studies are essential to further explore this indication. For pelvic floor muscle spasm, a greater number of women have been studied and a double blind, randomized controlled study has reported a significant reduction in pelvic floor pressures with significant pain reduction for some types of pelvic pain compared to baseline. There were no differences in pain compared to the control group who had physical therapy as an intervention. Physical therapy could be used as a non-invasive first line treatment, with BoNT injections reserved for those who are refractory to treatment. In summary, BoNT treatment for a variety of gynecological indications seems successful with limited side effects, although there are minimal data, particularly in superficial vulval conditions. To allow recommendation for wider utilization of this treatment, it is essential that more research is performed to add further evidence to our current knowledge.
女性慢性盆腔疼痛是一种常见症状，病因多种多样，若要减轻疼痛，就需要准确诊断并进行适当治疗。一些表浅病症，如激发性前庭疼痛，以及影响更深层结构的问题，如盆底肌肉痉挛，难以治疗，会对患者的生活质量产生重大影响。除了日常疼痛外，患者通常还会报告性交疼痛（性交困难）、排便疼痛（排便困难）和经期疼痛加剧（痛经）等症状。对于炎症性病症，以及在认为肌肉痉挛导致疼痛的部位，肉毒杆菌毒素（BoNT）的使用取得了相当大的成功。对于妇科适应症，以病例报告和小系列研究的形式提供的数据有限，表明在外阴使用BoNT，对于激发性前庭疼痛的女性，注射20 - 40U保妥适后3 - 6个月可能有益；再次治疗据报道是成功的，且副作用有限。对照研究对于进一步探索这一适应症至关重要。对于盆底肌肉痉挛，已有更多女性接受研究，一项双盲随机对照研究报告称，与基线相比，某些类型的盆腔疼痛患者的盆底压力显著降低，疼痛明显减轻。与接受物理治疗作为干预措施的对照组相比，疼痛没有差异。物理治疗可作为非侵入性的一线治疗方法，肉毒杆菌毒素注射则保留给那些治疗无效的患者。总之，肉毒杆菌毒素治疗各种妇科适应症似乎是成功的，副作用有限，尽管数据极少，尤其是在表浅的外阴病症方面。为了能够推荐更广泛地使用这种治疗方法，必须进行更多研究，为我们目前的知识增添更多证据。
