The article presents a consensus-based clinical practice guideline for managing high-tone pelvic floor dysfunction (HTFPD), a neuromuscular disorder characterized by non-relaxing pelvic floor muscles, leading to lower urinary tract and defecatory symptoms, sexual dysfunction, and pelvic pain. Despite affecting 80% of women with chronic pelvic pain, there are no widely accepted guidelines for its management. The guideline was developed using the Delphi method, involving 11 experts from various specialties, including urology, urogynecology, minimally invasive gynecology, and pelvic floor physical therapy (PFPT). After three rounds of anonymous surveys, a consensus treatment algorithm was generated, recommending PFPT as the first-line treatment. If PFPT fails to improve symptoms, second-line options include trigger point injections, vaginal muscle relaxants, and cognitive behavioral therapy. Onabotulinumtoxin A injections are suggested as a third-line option, and sacral neuromodulation is recommended as a fourth-line intervention. The largest barrier to care is access to PFPT, and experts recommend at-home pelvic floor relaxation exercises and virtual PFPT visits for those who cannot access in-person therapy. The algorithm aims to provide a structured approach to managing HTPFD, improving patient outcomes and satisfaction.The article presents a consensus-based clinical practice guideline for managing high-tone pelvic floor dysfunction (HTFPD), a neuromuscular disorder characterized by non-relaxing pelvic floor muscles, leading to lower urinary tract and defecatory symptoms, sexual dysfunction, and pelvic pain. Despite affecting 80% of women with chronic pelvic pain, there are no widely accepted guidelines for its management. The guideline was developed using the Delphi method, involving 11 experts from various specialties, including urology, urogynecology, minimally invasive gynecology, and pelvic floor physical therapy (PFPT). After three rounds of anonymous surveys, a consensus treatment algorithm was generated, recommending PFPT as the first-line treatment. If PFPT fails to improve symptoms, second-line options include trigger point injections, vaginal muscle relaxants, and cognitive behavioral therapy. Onabotulinumtoxin A injections are suggested as a third-line option, and sacral neuromodulation is recommended as a fourth-line intervention. The largest barrier to care is access to PFPT, and experts recommend at-home pelvic floor relaxation exercises and virtual PFPT visits for those who cannot access in-person therapy. The algorithm aims to provide a structured approach to managing HTPFD, improving patient outcomes and satisfaction.