**8. Conclusions**

It is challenging to treat female CPPS patients because of the uncertainty of this disorder. There is currently no definite animal model for CPPS, although the chemical-induced cystitis rat model has been used to investigate the treatment strategy for this disease. Combination management, including physical therapy, biofeedback, behavioral modifications, and medicines may improve CPPS in women. Current literature suggests BoNT-A injection provides promising results in relieving symptoms of pelvic floor pain and muscle spasms in female patients. Intravesical injection of BoNT-A plus hydrodistension also helps to improve symptoms in refractory IC/BPS patients. BoNT-A injection appeared to have long-term beneficial effects for sexual activity in patients with sexual pain syndrome. It is safe for BoNT-A injection with limited adverse effects. However, more double-blind, randomized, controlled clinical studies and well-designed animal studies are needed to support the beneficial efficacy of BoNT-A injection in female patients with CPPS.

**Author Contributions:** C.-L.C. and E.M. wrote the paper; E.M. supervised and revised the paper. All authors have read and agreed to the published version of the manuscript.

**Funding:** This work was supported by Tri-Service General Hospital (grant No. TSGH-D-109067) to En Meng.

**Conflicts of Interest:** The authors declare no conflict of interest.
