Botulinum toxin has been used for therapeutic purposes for the last three decades. Among other indications approved by the Food and Drug Administration, it has recently been approved for treatment of urinary incontinence associated with neurogenic detrusor overactivity. However, botulinum toxin has also been used off-label for a multitude of other urologic and gynecologic conditions. This article reviews the most current data regarding its efficacy and safety in urogynecology.