Non-ablative radiofrequency (NARF) is a non-invasive treatment option that reduces muscle tension through heating generated by the interaction between electromagnetic energy and tissue [1]. It has shown promise In the treatment of women with Genito-pelvic Pain/Penetration Disorder (GPPPD) [2]. The aim of this study was to evaluate the safety and feasibility  of NARF in women with GPPPD.

This is a descriptive feasibility and safety study with 18 to 45 year-old with complaints of GPPPD. Participants with chronic degenerative diseases, cognitive deficit, genital radiotherapy history, use of pelvic or lumbosacral prostheses, cardiac pacemakers, pregnancy and infections were excluded. Sociodemographic data were collected. Questionnaires such as the Sexual Quality of Life Scale - Female (SQoL-F) and Perceived Stress Scale - 10 (PSS-10) were used. One physical perineal evaluation, and eight sessions of NARF were performed, once a week, with a 2-minute application on the transverse perineal muscles and perineal body with 36°C to 38°C temperatures. Treatment included vaginal dilators for 15 minutes in the session, and daily at home. Pain intensity assessed using a Verbal Numeric Scale (VNS) ranging 0 to 10 pain, while treatment satisfaction was rated on a 5-point scale (1= very dissatisfied; 5=very satisfied). Absences from sessions and possible adverse reactions to treatment were recorded. The treatment reassessment was performed after the last in-office session.

This study included four nulliparous women with a mean age of 28.5±7.1 years, with no gynecological surgeries. 50% of participants reported a family income of 2-3 times the minimum wage. 75% of the women missed at least one session. 75% of the participants reported improvement in their SQoL-F final score, suggesting a positive sexual life quality impact, while 25% remained unchanged. Further information on the sample is provided in Table 1.

NARF induces heating generation, promoting tissue remodeling. However, improper application may pose risks [1]. In this study, 1 patient (25%) experienced a slight bleeding after vaginal examination and withdrawal of the vaginal dilator, without introitus injury, and reported initial menstruation, excluding a direct NARF adverse effect. NARF heating improves the flexibility of connective tissue and reduces muscle tone and pain perception [3]. VNS assessment indicated that three participants (75%) reported improvements of  70%, 80% and 90% in penetration pain, while one (25%) reported no change. The total PSS-10 score is obtained by adding up the answers to 10 items, ranging from 0 to 40, where higher scores indicate lower perceived stress. Two patients (50%) showed a reduction in their PSS-10 score, with individual variations: P1 (-5; 15%), P2 (-4; 20%), P3 (-6; 19%) and P4 (-12; 133%). Due to the complexity of stress perception, these results may reflect either an adaptation to the intervention or an increased awareness of discomfort.
The SQoL-F is an instrument for assessing the impact of female sexual dysfunction on sexual life quality, with scores ranging from 18 to 108. Higher scores indicate better sexual life quality. Three participants (75%) showed improvement in their scores. These findings suggest an association between pain reduction, therapeutic support and improved body self-awareness. Regular treatment attendance favors pain results improvement. All participants had moderate attendance, even in the face of routine difficulties in urban mobility, 75% having low income and personal limitations regarding intimate treatment.

Preliminary findings from this study suggest that NARF is a feasible and safe therapeutic option  for women with GPPPD.

Adson A, Lins AF, Santos DM, Leal MRD. Radiofrequência não ablativa no tratamento das disfunções do assoalho pélvico: uma revisão narrativa da literatura. Ciênc Saúde. 2023 Ago;27(125):1-9. doi: 10.5281/zenodo.8333259.
Araújo T, Scalco SC. Transtornos de dor gênito pélvica/penetração: uma experiência de abordagem interdisciplinar em serviço público. Rev. Bras. Sex. Humana. 2019 Jun;30(1). doi: 10.35919/rbsh.v30i1.72
Bretelle F, Fabre C, Golka M, Pauly V, Roth B, Bechadergue V, et al. (2020) Capacitiveresistive radiofrequency therapy to treat postpartum perineal pain: A randomized study. PLoS ONE 15(4): e0231869. https://doi.org/ 10.1371/journal.pone.0231869.