A Trial of Pelvic Floor Chemodenervation in Patients Undergoing Physical Therapy for High Tone Pelvic Floor Dysfunction

Inclusion Criteria: * Age 18 years or older * \>6 month history of pelvic pain or dyspareunia with high tone pelvic floor dysfunction on exam (pain with palpation of superficial transverse perineii, bulbocavernosus insertion to perineal/central tendon and/or levator ani complex/iliococcygeus) * Women with male sexual partners * History of undergoing pelvic floor physical therapy with internal manipulation including trigger point release as directed, with inability to meet goals of therapy despite appropriate pelvic floor physical therapy approach * Able to read, write, and comprehend English sufficiently to offer informed consent Exclusion Criteria: * Presence of intact hymen, preventing internal manipulation during pelvic floor physical therapy * Pregnancy at the time of injection * Breast feeding at the time of injection * History of Myasthenia Gravis, Amyotrophic Lateral Sclerosis, Lambert-Eaton syndrome, allergy to Botulinum toxin A, or other contraindication to Botulinum toxin A injection * History of documented skin disorder of the vulva other than vaginal atrophy or lichen planus * Prior pelvic radiation * Stage II-IV pelvic organ prolapse * Has had a pelvic floor Botulinum toxin A injection within the last 12 weeks * Unable to provide informed consent