Is Physical Therapy the Answer for Chronic Pelvic Pain? Understanding the Latest Study Results

Have you been suffering with chronic pelvic pain? Chronic pelvic pain may be diagnosed as vulvodynia, vestibulodynia, dyspareunia (painful sex), and interstitial cystitis/bladder pain syndrome. Chronic pelvic pain can be present in up to 25% of women who get prescribed medications which minimally help and come with side effects. Many try a variety of treatments but still don’t feel like they’ve gotten a handle on their pain. The World Health Organization describes it as a neglected condition. Persistent pelvic pain causes a significant socioeconomic burden due to it limiting one’s ability to work and socialize. This impacts emotional suffering as well, leading to a decrease in quality of life. 

I have had the privilege to help many women manage their pelvic pain and resume activities they felt were out of their reach - I knew I could help them on their journey… and now a new study shows that Physical Therapy is effective treatment for chronic pelvic pain/persistent pain! We’ve got the proof!

This systematic review was done of over 5000 randomized control studies (the gold standard for research) assessing four different types of non pharmacological therapies to address chronic pelvic pain. The types of therapies that were studied were: 

• Physical Therapy ("multimodal" or consisting of a combination of): 

  • Exercise

  • Pelvic floor therapy

  • Pain education

  • Manual therapy

  • Self management skills

  • Behavior and lifestyle modifications

  • Psychologically informed elements like coping skills, graded exposure/desensitization.

• Psychological approaches

  • cognitive behavioral therapy

  • mindfulness

• Acupuncture

  • traditional acupuncture

  • electro-acupuncture

• Other tissue based therapies by themselves

  • Electrotherapy

  • stretching

In addition to assessing the four treatment approaches, the studies that were chosen to be reviewed included subjects with vulvodynia, vestibulodynia, dyspareunia (painful sex), interstitial cystitis/bladder pain syndrome without underlying pathology (like cancer or infection) and excluded (generalized) pelvic girdle pain, endometriosis related diagnoses, genitourinary syndrome of menopause and Hunner-type cystitis. 

The general conclusion was that multimodal physical therapy resulted in a decrease in pain compared to non conservative treatments, while predominantly psychological approaches did little to help decrease pain. 

Considering that persistent pelvic pain not only impacts physical pain, this study also broke down the effects of these treatments on other aspects of life. It looked at it’s impact on pain, sexual function, general physical function as well as bladder/bowel function, psychological function, health related quality of life, pelvic symptoms severity/bother, pelvic floor muscle function, and perceived improvement.

In regards to pain, physical therapy showed lower pain intensities compared other treatments, including non conservative treatments like surgery and medicine. Psychological and acupuncture treatments by themselves showed no important effect on pain. While “other tissue based monotherapies” (electrical stimulation, massage, stretching, myofascial techniques, pelvic floor muscle biofeedback, lifestyle modifications) had varied outcomes, they generally showed little to no benefit on their own.

In regards to sexual function, physical therapy showed superior results, however also fewer attempts at intercourse. This study viewed this as a possible flexibility towards sexual activities that worked for the individual. Psychological treatments showed better results compared to those who had no treatment. There were only a total of two acupuncture studies that assessed sexual function. One noted improvement, but may have been attributed to a lower pain level, while the other study used acupuncture with lidocaine - but it was better than “sham acupuncture with lidocaine (nontraditional acupuncture). Again, the monotherapies were varied, electrotherapies and biofeedback showed no difference in sexual function, while manual vaginal therapies benefitted sexual function compared to vaginal injections of steroids and/or pain medications. 

General conclusions show that multimodal PT showed significant lowering of pain post treatment and moderately for intermediate term (3-9 months). Multimodal PT also showed significant improvement in sexual function, physical function (bladder/bowel function, general physical function), psychological function, health related quality of life, pelvic symptoms severity, pelvic floor muscle function, perceived improvement. 

If you're struggling with persistent pelvic pain or any of these diagnoses, call our offices to see how physical therapy can be tailored to your specific needs!

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Reference:

Małgorzata Starzec-Proserpio, Helena Frawley, Kari Bø, Mélanie Morin,Effectiveness of nonpharmacological conservative therapies for chronic pelvic pain in women: a systematic review and meta-analysis,American Journal of Obstetrics and Gynecology,Volume 232, Issue 1,2025,Pages 42-71,

ISSN 0002-9378