Postpartum perineal pain is the complaint of pain felt between the posterior fourchette and the anus during the postpartum period and up to 12 months after delivery (1). It is more common following perineal trauma (2) and can significantly impact quality of life. Although physiotherapy is recognized as an effective component of multidisciplinary management -using manual techniques combined with other modalities to reduce pain and improve sexual health (3)- evidence regarding the efficacy of monopolar capacitive-resistive radiofrequency (RF) therapy in women with postpartum perineal pain resulting from obstetric trauma remains inconclusive. 
In the context of limited high-quality published evidence, the main objective of this study was to evaluate the therapeutic efficacy of combined abdominal and vulvovaginal RF therapy in women presenting with postpartum pelvic pain between four and 12 months postpartum, due to intrapartum injury.

A double-blinded, randomized, clinical trial following CONSORT guidelines was designed in a tertiary university hospital. It included women attending a specialized perineal clinic who presented postpartum perineal pain that persisted four to 12 months after vaginal delivery involving episiotomy, obstetric anal sphincter injury (identified and repaired during labor), labor dystocia, and/or the delivery of a macrosomic infant. The study was approved by the hospital ethics committee, and all women who accepted participation signed an informed consent form. The study presented two groups, each of which received five 20-minute sessions of RF therapy. The intervention group (ON-RF) received active RF treatment, while the control group (OFF-RF) received sham RF treatment, and both groups were double-blinded. In addition to RF therapy, both groups self-performed daily perineal massage. The primary outcome measure was pain level, ranging from 0 to 10, assessed using the Numeric Rating Scale (NRS) at baseline and after receiving five treatment sessions. A follow-up control was held at six months post-intervention.

A total of 88 women were included, 76 of whom finished the 5 sessions, with a mean age of 35.25 (SD 4.2). 51.15% of the women presented an episiotomy, 37,5% of the women had a levator ani muscle avulsion (LAM), and 15.2% had a lesion of the anal sphincter.
The baseline mean NRS (SD) per group was 7.4 (6.2) and 7.2 (1.5) in the ON-RF and OFF-RF groups, respectively. These values decreased to 2.1 (1.9) (p<0.001) in the ON-RF group and to 5.6 (2.1) in the OFF-RF group (p<0.001). At six months, the mean NRS (SD) was 1.3 (1.9) in the ON-RF group (p=0.118) and 3.3 (2.9) (p=0.002) in the OFF-RF group.

Based on the findings of this randomized clinical trial, active (ON-RF) therapy combined with patient-performed daily perineal massage appears to reduce pain levels more effectively than inactive (OFF-RF) treatment combined with daily perineal massage in women experiencing postpartum perineal pain secondary to an obstetric trauma, between four to 12 months postpartum, and this effect persists for at least six months after treatment.

ON-RF therapy together with self-performed daily perineal massage significantly reduces pain levels in women presenting postpartum perineal pain to a greater extent than OFF-RF together with self-performed daily perineal massage, and its effect persists after six months.

Stergios K Doumouchtsis, Renaud De Tayrac, Joseph Lee, Oliver Daly, Joan Melendez-Munoz, Fiona M Lindo, Angela Cross, Amanda White, Sara Cichowski, Gabriele Falconi, Bernard Haylen. An International Continence Society (ICS)/International Urogynecological Association (IUGA) Joint Report on the Terminology For Assessment And Management of Obstetric Pelvic Floor Disorders. Continence (2022) 100502, https://doi.org/10.1016/j.cont.2022.100502.
Cattani L, De Maeyer L, Verbakel JY, Bosteels J, Deprest J. Predictors for sexual dysfunction in the first year postpartum: A systematic review and meta-analysis. BJOG. 2022 Jun;129(7):1017-1028.
Fernández-Pérez, P., Leirós-Rodríguez, R., Marqués-Sánchez, M., Martínez-Fernández, M., De Carvalho, F., & Maciel, L. (2023). Effectiveness of physical therapy interventions in women with dyspareunia: a systematic review and meta-analysis. BMC Women's Health, 23. https://doi.org/10.1186/s12905-023-02532-8.