![]() ![]() The gate theory is one proposed mechanism of action. TENS works by altering the ability to perceive pain signals. There are several theories to explain the mechanism of action of electrical stimulation. The intensity, also known as the power, of the unit can be set to a sensory or motor threshold with any frequency (2). High frequency is considered as > 50 Hz whereas low frequency is < 10 Hz. Electrical stimulation has three different programmable settings including the frequency, intensity and pulse duration. It is delivered through peripheral nerve stimulation, a TENS unit, or sacral neuromodulation using an implantable device. After treatment, all 12 women were able to have vaginal intercourse (13).Įlectrical stimulation is used extensively for the treatment of various pain disorders. ![]() A smaller study of 12 women used electrical stimulation biofeedback and gradual desensitization in the treatment of vaginismus. In this protocol, the TENS unit was set to 100 Hz with 100ms pulse width for the first 8 hours of the menstrual cycle and then repeated for another menstrual cycle (9). Another study used a TENS unit to treat primary dysmenorrhea. Pain scores, dyspareunia and overall sexual functioning were significantly improved in the active arm compared to placebo (8). These sessions were completed on a twice per week basis for 10 weeks. In this study, they used a TENS unit to treat vestibulodynia using a protocol of 15 min of 10 Hz followed by 15 minutes of 50 Hz. ![]() conducted a randomized controlled trial comparing use of a vaginal probe delivering electrical stimulation to a sham device. ES delivered specifically through a transcutaneous electrical nerve stimulator (TENS) unit results in notable benefit in pain and dyspareunia (8,12,21-23). Electrical stimulation (ES) to the pelvic floor is an effective treatment in vaginismus, vulvar vestibulitis, urinary urgency, and levator ani hypertonus (11-15). performed a retrospective chart review and discovered that physical therapy, particularly internal manual techniques, is a successful technique in treating patients with vaginismus (5). Pelvic floor rehabilitation addresses the pelvic floor dysfunction and may include manual therapy, transvaginal biofeedback and electrical stimulation. Pelvic floor physical therapy is an effective treatment. A comprehensive and integrative approach is ideal and may include physical therapy, medications, or cognitive behavioral therapy. Persistent pain despite aggressive treatment of organic etiologies may imply a psychogenic overlay. Each patient's experience of pain is unique and may be any combination of visceral, neuropathic, or even somatic in etiology. Treatment of chronic pelvic is challenging due to a poor understanding of pain processing and physiology. Previous estimates indicate that 88% of sexually active chronic pelvic pain patients report pain during or after intercourse (1). However, its impact extends beyond sexual functioning as it can affect a woman's reproductive health and overall sense of well-being. It may lead to decreased arousal, loss of libido, and anorgasmia. ![]() Understandably, women with dyspareunia often suffer a decline in sexual functioning. (1) Dyspareunia is defined as recurrent or persistent pain associated with sexual intercourse and affects approximately 8-21% of women in the United States (19, 20). The economic burden can be substantial, with previous estimates of 2.8 billion dollars per year. In a study conducted by Mathias et al., one in seven women experience chronic pelvic pain. Furthermore, it can be associated with major insomnia, psychosexual trauma, and mood disorders resulting in challenging cases characterized by pain that is refractory to standard treatment modalities. Many organ systems may be involved including musculoskeletal, neurologic, genitourinary, psychiatric or gastrointestinal systems. Why Should I Register and Submit Results?Ĭhronic pelvic pain (CPP) is a complex and devastating diagnosis, encompassing multiple different conditions. ![]()
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