Things Fall Apart

The Obstetrician & Gynaecologist

10.1576/toag.10.2.075.27394 www.rcog.org.uk/togonline

2008;10:75–79

Review

Review Nonurological uses of botulinum toxin in gynaecology
Authors Akila Anbazhagan / Ralph Roberts

Key content:
• Botulinum toxin is a powerful neurotoxin which causes temporary flaccid muscle paralysis. • A number of potential gynaecological applications have been described in addition to the well-established uses in urogynaecology.

Learning objectives:
• To understand how botulinum toxin works. • To learn about the preparations available and their contraindications and side-effects. • To be aware of the potential uses of botulinum toxin in the treatment of vaginismus and other gynaecological pain syndromes.

Ethical issues:
• Many of the uses described are still essentially experimental, although largely accepted into mainstream practice: does this need to be acknowledged when counselling women?
Keywords botulinum toxin / chronic pelvic pain / vaginismus / vulvar vestibulitis / vulvodynia
Please cite this article as: Anbazhagan A, Roberts R. Nonurological uses of botulinum toxin in gynaecology. The Obstetrician & Gynaecologist 2008;10:75–79.

Author details
Akila Anbazhagan MRCOG Specialist Registrar Department of Obstetrics and Gynaecology, Royal Jubilee Maternity Hospital, Grosvenor Road, Belfast BT12 6BJ, UK Ralph Roberts MD FRCP MRCOG Consultant Obstetrician and Gynaecologist Department of Obstetrics and Gynaecology, Ulster Hospital, Dundonald BT16 1RH, UK Email: [e-mail] (corresponding author)

© 2008 Royal College of Obstetricians and Gynaecologists

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Review

2008;10:75–79

The Obstetrician & Gynaecologist

Introduction
Botulinum toxin is a neurotoxin produced by the Gram-positive, rod-shaped, anaerobic bacterium, Clostridium botulinum. It is known to cause botulism, a type of food poisoning that results in flaccid muscle paralysis and death. It was first isolated in 1897 by the

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