Non-ablative radiofrequency (NARF) is a beneficial treatment for muscle disorders (1) and vaginal dilator is a beneficial approache in women with genito-pelvic pain/penetration disorder (GPPPD) (2), but there is a lack of studies on their combination to treat GPPPD. The goal was to describe clinical outcomes related to pain during penetration, sexual function, sexual quality of life (QoL), and perception of stress with the combined therapy of NARF and vaginal dilator in women with GPPPD

The participants were recruited by active search. Data collection took place between March 2024 and August 2025. Women aged 18 to 45 years with complaints of GPPPD who had been in a stable relationship for at least 6 months were included. Exclusion criteria were chronic degenerative disease, cognitive deficit, genital agenesis, history of genital cancer/radiotherapy, use of pelvic or lumbosacral prosthesis, cardiac pacemaker, pregnancy, endometriosis, genital and/or systemic infection, simultaneous treatment for GPPPD, and sexual complaints of the partner. In the initial evaluation, an admission form was applied, followed by a physical examination. The outcomes observed were: pain during penetration by the Visual Numerical Scale (VNS); Female Sexual Function Index (FSFI); Sexual Quality of Life Questionnaire–Female (SQoL-F); Perception Stress Scale – 10 (PPS-10) and satisfaction with the Likert Scale. The reassessment took place one week after. The intervention consisted of 8 weekly sessions of NARF (36°C-38°C), applied to the perineal body and transverse muscles (2’ on each side), followed by insertion of a vaginal dilator maintained for 15’. The participants were instructed to use the dilator at home. The statistical analysis was descriptive.

The sample consisted of 6 women aged between 21 and 37 years (26.7±5.7), and the relationship time was 2.5 years (2.0–4.5). Primary (5/6) and superficial (5/6) GPPPD predominated. On physical examination, most of them presented pain on palpation and hyperactive muscle; half had muscle contractures; vaginal examination wasn’t performed in one patient due to intense pain. Before the intervention, the majority (5/6) had sexual dysfunction according to the FSFI. After the intervention, all of them increased their total FSFI score and two reached values above the cut-off point (Table 1). Regarding VNS, before treatment four participants reported severe pain (9–10) and two moderate pain (4–6). After the intervention, five reduced pain to mild levels (0–3), while one maintained the score; one participant had no pain. In the SQoL-F, four participants increased their score, and one showed a reduction of five points. In the PSS-10, the results were heterogeneous: reduced from 3 points to 6 points and increased from 3 points to 12 points (Table 2).

The findings suggest a reduction in pain and an improvement in sexual function. These results appear to be related to the thermal and analgesic effects that promote muscle relaxation, and interruption of the fear–tension–pain cycle provided by the combined therapy. A trend toward improvement in sexual QoL was observed, while the perception of stress varied among participants. Stress is multifactorial and influenced by various aspects, which may explain the observed variability. Given the descriptive study design, the small sample size, the absence of a control group, and the lack of follow-up, the results should be interpreted with caution.

Combined therapy suggests a reduction in pain during penetration, improvement in sexual function and sexual QoL with the treatment. The findings on stress perception were heterogeneous. Randomised controlled trials, with larger sample sizes and longitudinal follow-up, are needed to confirm these results.

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Dias-Amaral A, Marques-Pinto A. Female genito-pelvic pain/penetration disorder: review of related factors and overall approach. Rev Bras Ginecol Obstet. 2018;40(12):787–93.