Sexual dysfunction is a frequently overlooked and dismissed aspect of quality of life in patients with lower urinary tract disorders, particularly amongst female patients. We aimed to investigate the impact of intravesical botulinum toxin-A (BTX-A) injections on sexual function in women with overactive bladder (OAB), and bladder pain syndrome (BPS) through literature review and subsequent meta-analysis of the studies.

A systematic review was conducted by evaluating publications from PubMed. Studies that reported sexual function outcomes pre- and post-intravesical BTX-A injection were initially reviewed. Studies that investigated effects of intravesical BTX-A on sexual functions of women with OAB, BPS were evaluated in the present study. Among these, publications that used validated sexual function measures (e.g., FSFI, FSDS, SQoL-F) were included in this analysis. Data were pooled using a random-effects model, and standardized mean differences (SMD) with 95% confidence intervals were calculated.

Following literature search and reviews, the total of seven studies (n=230) were included in the present analysis. BTX-A significantly improved sexual function scores in women with OAB and BPS based on FSFI (+0.73 [95% CI: 0.40 to 1.06]) overall, though there was one study that showed no statistically significant change after intravesical BTX-A treatment. Subgroup analysis indicated that greater benefit was seen in women with pelvic pain components than women without pelvic pain components.

We found that BTX-A injections are associated with moderate improvements in female sexual function, particularly in pelvic pain syndromes. The impact is more clearly detected using multidomain tools like FSFI and FSDS. Studies using global quality-of-life tools may underestimate this benefit.

BTX-A may offer therapeutic benefit for sexual dysfunction in women with OAB and pelvic pain syndromes. Sexual function should be routinely assessed amongst patients undergoing intravesical BTX-A treatment. Further investigations are necessary to understand detailed effects of intravesical BTX-A therapy on sexual function of female patients.