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Endometriosis-associated pain syndrome is a chronic inflammatory disease. The presence of endometriotic lesions leads to painful symptoms such as secondary dysmenorrhea, profound dyspareunia and abdominal and pelvic pain (Haas et al., 2012)
TENS may be an option to consider for pain relief associated with endometriosis. One study showed that the use of TENS for self-management of pain in combination with hormone therapy improved pain, deep dyspareunia, quality of life and sexual function in women with severe endometriosis (Mira et al., 2020).
Vaginal or Cesarean delivery can result in scarring.
Unfortunately, the pain associated with the scar can persist over time and become chronic. 15% of women experience scar pain between 3 and 6 months postpartum and 11% still have pain more than 12 months postpartum (Weibel et al., 2016).
Various strategies using TENS can decrease the pain associated with perineal and Cesarean scars.
Primary dysmenorrhea is defined as lower abdominal pain associated with menstruation in women. It can be accompanied by various symptoms such as nausea, vomiting, fatigue, headaches and dizziness.
This pain is the most common gynecological problem affecting about 50% of menstruating women. For some women, the pain can be severe enough to interfere with their day-to-day activities.
TENS can help women with primary dysmenorrhea in their daily lives by reducing the associated pain.
Several studies have demonstrated its benefits. Improvements in pain, ibuprofen use and quality of life have been observed (Manisha and Anuradha, 2021; Arik et al., 2022; Lauretti et al., 2015; Bai et al., 2017).
Deep dyspareunia is defined as pain during deep penetration (Steege & Zolnoun, 2009). It is only felt during penetration. It may be worse after ovulation or during the premenstrual period.
TENS can be an interesting method to combine with pelvic-perineal physiotherapy for patients suffering from deep dyspareunia. One study showed that using TENS in addition to physical therapy exercises significantly reduced pain and improved sexual function in patients with deep dyspareunia (Dionisi & Senatori, 2011).
Pudendal neuralgia is chronic, disabling neuropathic pain in the pudendal nerve area (Ploteau et al., 2015). The pain can manifest itself in different ways such as burning, electric shock or pressure sensation. It is predominant during the day and while sitting, forcing people to stand up. Several factors can trigger this type of neuralgia such as vaginal delivery, chronic constipation, trauma to the buttocks or back, excessive cycling and pelvic surgery.
TENS is a way to provide pain relief for people with pudendal neuralgia (Eid et al., 2021).
Painful bladder syndrome, also known as interstitial cystitis, is a condition of the urinary system that manifests itself as chronic pain or discomfort in the bladder and surrounding pelvic area. This pain is accompanied by at least one other urinary symptom such as urgency or frequency of urination.
Stimulation of the posterior tibial nerve with TENS is well documented. Patients have reported a decrease in signs and symptoms associated with interstitial cystitis using this procedure.
Vaginismus is defined as recurrent and persistent muscle spasms of the outer third of the vagina that interfere with vaginal penetration.
TENS or neuromuscular stimulation can be used following a physiotherapy evaluation.
Vestibulodynia is a subcategory of vulvodynia. The pain is specifically located in the vulvar vestibule, meaning the area around the vaginal entrance (Goldstein et al., 2016).
It is often described as a burning sensation when there is pressure applied directly to the vulvar vestibule, during penetration with a tampon, during sexual intercourse or during a gynecological examination.
TENS helps to reduce pain signals. Studies have actually shown that TENS could significantly improve pain and sexual function in women with vulvodynia and vestibulodynia (Morin, 2017; Murina et al., 2008; Murina et al., 2013; Murina et al., 2018).
Vulvodynia is one of the most common reasons for consultations in gynecology. It is defined as pain in the vulva that has persisted for more than 3 months, without any visible lesion or identifiable cause (Goldstein et al., 2016). This pain has a significant impact on the woman’s quality of life.
TENS can reduce pain signals. In fact, studies have shown that TENS significantly improves pain and sexual function in women with vulvodynia (Morin, 2017; Murina et al., 2008; Murina et al., 2013; Murina et al., 2018).
The pain associated with contractions and childbirth is considered one of the most intense experiences in a woman’s life. The well-being of the fetus and the progress of labour can be affected by poor pain management (Thuvarakan et al., 2020).
The use of TENS from 37 weeks onwards is a safe, non-pharmacological way to treat pain associated with childbirth. It is also a complementary alternative to various conventional pain management methods.
TENS decreases the transmission of pain by using endogenous mechanisms.
It is therefore a safe and natural analgesic method for both mother and baby (Daniel et al., 2020).
In addition, it provides a sense of control to the woman during contractions (Dowsell et al., 2019).
Women who have tried it have enjoyed their experience and are willing to use it again (Doswell et al., 2009).
When pushing a baby, the pelvi-perineal area may experience trauma such as stretching, episiotomy and 1st to 4th degree tears. The pain associated with these traumas can be uncomfortable for patients.
Postpartum pain management is not simple: adverse effects for the mother, such as nausea/vomiting, constipation, sedation and interference with lactation, should be avoided, as should transmitting these effects to the child through the breast milk.
TENS can be used to reduce pain signals in the vulvar and perineal area (Pitangui et al., 2012).
Cesarean section is a surgical procedure that causes postoperative pain. Patients may also experience persistent scar-related pain for up to 12 months after delivery (Weiber et al., 2016).
It is important to effectively manage this pain while considering the possible adverse effects to the mother, breastfeeding and the baby.
TENS can decrease scar and uterine pain.
In one study, postoperative pain associated with Cesarean section was significantly reduced with the use of TENS, and opioid use decreased by 20% among these women (Kayman-Kose et al., 2014).
Postpartum musculoskeletal pain is common. In fact, 35% of women are reported to have lower back pain 1 month postpartum (Li et al., 2018).
In addition, other pain can occur in the daily routine associated with poor ergonomics during infant care:
- due to prolonged positioning for breastfeeding and bottle feeding
- due to prolonged positioning and tasks with a babe in arms
TENS can be an analgesic method for reducing pain locally depending on the positioning of the electrodes. It can be used during tasks or during a rest period.
TENS can also be used to manage pain without side effects or affecting breastfeeding and infants.
Childbirth can bring many sudden changes to a woman’s physiology.
The pelvic region can undergo many traumas such as stretching of the fascia, the vaginal wall, the vulva and the perineum. These structures can take some time to return to their normal state, and this can lead to some discomfort such as stress incontinence.
Fortunately, more and more women are turning to pelvic perineal rehabilitation in physiotherapy. However, some women may have difficulty performing their exercises properly at home.
Neuromuscular stimulation (NMES) can therefore be a tool to help a woman better understand how to properly contract the pelvic floor and optimize the rehabilitation exercises prescribed by the physiotherapy professional.
After birth, the contractions of childbirth will give way to afterpains. These uterine contractions shrink the uterus and help prevent significant blood loss. They are similar to menstrual cramps and are strongest during breastfeeding (De Sousa et al., 2014).
These pains are a common complaint that can also compromise breastfeeding and its effectiveness (Woods et al., 2014).
Natural methods of pain relief have been the subject of several research studies for breastfeeding women. TENS may be an effective tool to manage this type of pain (De Sousa et al., 2014).
The pelvic floor muscles provide essential functions to the quality of life of a person: intimate relations, continence and support.
Weakness of the pelvic floor muscles can lead to several inconveniences such as pelvic organ prolapse, incontinence and pain. Pelvic floor rehabilitation is often recommended for these conditions. This rehabilitation must be adapted to each person according to their specific issues.
The EVA can be used as a complementary tool with pelvic floor rehabilitation and home exercises. It helps gain a good understanding of contraction and relaxation, helps with contraction and can be adjusted along with the progress of the exercises prescribed by the healthcare professional.
Stress urinary incontinence is defined by involuntary urine leaks during physical exertion such as walking, running, coughing or sneezing.
Several factors may be responsible for the associated urine leakage, most notably pelvic floor muscle dysfunction.
Pelvic health rehabilitation and pelvic floor exercises are the first line of treatment for this type of condition. Although Kegel exercises are known to be effective, they aren’t a miracle cure. In fact, to be effective, the person must do them properly and they must be adapted to her condition.
Muscle neurostimulation is helpful in pelvic health rehabilitation and home exercises. It makes understanding contraction easier, facilitates contraction and can be adjusted as the exercises progress.
Mixed urinary incontinence occurs when symptoms associated with stress incontinence and urge incontinence are both present.
Your healthcare professional can determine the treatment(s) needed with the EVA based on your signs and symptoms.
Urge incontinence describes an involuntary urine leak accompanied by an urgent need to urinate.
This type of incontinence represents 35% of cases of urinary incontinence. It affects women of all ages and is more prevalent with age and menopause.
A procedure called the posterior tibial nerve stimulation has been the focus of several studies: TENS is used to stimulate the nerve, which belongs to the same region as the nerve responsible for the sphincters and bladder.
Pelvic organ prolapse is a spectrum associated with pelvic floor dysfunction. It occurs when the ligaments and the muscles of the pelvic floor no longer support the pelvic organs (bladder, uterus, rectum) resulting in a drop from their normal position. It commonly occurs in women after pregnancy or surgery (Barber, 2016).
Based upon the stage of the prolapse and recommendations from your healthcare provider, neuromuscular stimulation may be recommended as a complementary resource to pelvic health rehabilitation and home exercises.
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