Pelvic-perineal pain is an increasingly significant issue in women's health, particularly when it persists over time as it impacts the quality of life of affected women. It is characterized by sensations of pain in the pelvic, perineal, and genital regions, and may be associated with other pelvic floor dysfunctions such as sexual dysfunctions (1).

Pelvic-perineal physiotherapy has been established as an effective intervention in managing postpartum pelvic-perineal pain concerning pelvic floor strength and sexual function (2). Additionally, radiofrequency has emerged as a promising therapeutic technique in this field, showing benefits in collagen reorganization, scar healing, and muscle function. In this context, there is a need to investigate effective therapeutic interventions to alleviate pain and improve the sexual function and quality of life of these women (3).

The hypothesis posited is that the combination of pelvic-perineal physiotherapy with radiofrequency can significantly improve postpartum pelvic-perineal pain, sexual function, and quality of life in postpartum women.

The main objective of the study is to analyze the effects of a multimodal intervention of pelvic-perineal physiotherapy and radiofrequency in women with postpartum pelvic-perineal pain. Furthermore, the secondary aim is to assess the feasibility of such intervention to propose a future randomized clinical trial.

A two-armed parallel-group randomized controlled feasibility study was conducted as a pilot test to assess the feasibility of conducting a larger-scale randomized clinical trial. Fourteen primiparous or multiparous postpartum women with a eutocic or instrumental delivery and experiencing pelvic-perineal pain equal to or greater than 4 cm on the Visual Analog Scale were recruited.

Two pre-intervention and post-intervention assessments were carried out by a Women's Health expert physiotherapist, blinded to the intervention group of the participants. The physiotherapy interventions for both groups were performed by a different physiotherapist specialized in Women's Health.

An initial assessment was conducted before the treatment and another at the end of it. The first assessment included baseline characteristics (anthropometric data, occupational activity, age, etc.) of the participants. The primary variable assessed was pain (Visual Analog Scale) and female sexual function (FSFI questionnaire). Additionally, validated questionnaires were used to measure urinary and bowel symptoms (PFIQ-7), specific quality of life (PFDI-20 questionnaire), and perceived self-efficacy (De Broome Scale). Lastly, the quality of the pelvic floor muscles was evaluated (Modified Oxford Scale) to measure pelvic floor muscle strength.

After obtaining informed consent, the participants were randomly assigned to two intervention groups: the pelvic-perineal physiotherapy control group; and the pelvic-perineal physiotherapy plus radiofrequency intervention group.

Twelve 45-minute sessions were conducted, with a frequency of 2 sessions per week for 6 weeks. Both groups received therapeutic patient education, specific pelvic floor muscle exercises (concentric contraction, eccentric contraction, and relaxation), and conservative and invasive treatment for myofascial pain syndrome. The experimental group received additional extra and intravaginal radiofrequency for 30 minutes per session with capacitive and resistive electrodes to improve the properties of the vulvovaginal tissue.

For statistical analysis, a descriptive analysis was performed using means and standard deviations; and means and medians based on normality assessed by the Shapiro-Wilk test. Categorical variables were expressed as numbers and percentages. Inferential statistics included the t-Student test and the Mann-Whitney U test, as well as differences in means and medians, for analyzing results based on normality or non-normality, respectively.

A total of 14 women took part in the study between March 2023 and January 2024, with no dropouts recorded. The intervention was conducted with all necessary material resources available for the procedure.

The baseline characteristics of the participants are presented in Table 1.

Improvements were observed in pain, sexual function, quality of life, and pelvic floor muscle strength in both treatment groups, with the radiofrequency experimental group showing superior results. However, there were no statistically significant differences between the two treatment groups. 

The outcome variables and differences between groups are shown in Table 2.

The score on the Modified Oxford Scale demonstrated an improvement in muscle contraction capacity in both groups, with most participants being able to perform resistance exercises. There was an improvement in relaxation capacity and awareness of contraction in all participants.

Additionally, a decrease in urinary and bowel symptoms was observed in participants from both groups. Furthermore, good adherence to the treatment was noted in both groups, along with high satisfaction with the intervention.

The results suggest that the combination of pelvic floor physiotherapy and radiofrequency may be effective in treating postpartum pelvic pain, improving various aspects of pelvic health and the quality of life of postpartum women. The adherence and satisfaction with the treatment indicate that this intervention is well tolerated and accepted by the participants.

Based on this pilot study, the feasibility and acceptability of the proposed intervention are good in terms of recruitment capacity, adherence, available material and human resources, and selected variables. It is proposed to conduct a statistical analysis to determine if the type of delivery and the use of instrumentation or not could be confounding factors.

These findings support the importance of multimodal approaches in pain management.

The study provides preliminary evidence on the effectiveness of radiofrequency and pelvic floor physiotherapy in treating postpartum pelvic pain, as the combination of both strategies shows promise in terms of sexual function, quality of life, and muscle strength. 

Additionally, the implementation of a combined pelvic floor physiotherapy and radiofrequency intervention in postpartum women with pelvic pain is feasible. To confirm the results, a randomized clinical trial with a larger sample size is needed.

Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 2010 Jan; 21(1):5-26.
Villa del Pino I, Chillón Martínez R. La adherencia al entrenamiento muscular del suelo pélvico en las mujeres con incontinencia urinaria. Revisión sistemática de la literatura. Fisioterapia 2019;41(4):227-236.
Bretelle F, Fabre C, Golka M, Pauly V, Roth B, Bechaderge V, et al (2020). Capacitive resistive radiofrequency therapy to treat postpartum perineal pain: A randomized study. PLoS ONE15(4):e0231869.