LiSWT may offer a noninvasive option for postpartum pelvic pain, with potential benefits across both chronic and earlier-stage scar-related dysfunction.
Low-intensity extracorporeal shock wave therapy (LiSWT) has already been introduced as a potential second-line option for chronic postpartum pelvic pain following failed conservative management. In a recently reported case, a 60-year-old woman with more than 20 years of episiotomy-related pain experienced meaningful improvement after a multimodal regimen that included LiSWT, pelvic floor physical therapy, and abobotulinumtoxinA injections. Building on those findings, new insights focus on when this therapy may be most effective, how clinicians should identify candidates, and how to counsel patients.1
Sarina Hanfling, research coordinator for Rachel Rubin MD PLLC and a medical student at the University of Maryland School of Medicine, who presented the case, emphasized that although the reported patient had decades-long symptoms, earlier intervention may offer greater benefit.
“This case demonstrates benefit after even 25 years,” she said. “So we think that earlier intervention could prevent that long-term dysfunction and definitely needs to be investigated.”
Mechanistically, LiSWT may be particularly relevant during the early postpartum period when scar formation is evolving.
“The shock waves’ proposed mechanisms are angiogenesis, neurogenesis, and reducing fibrotic tissue markers,” Hanfling said. “So it could be really valuable… in that subacute maybe 6-month postpartum period when pathological scar formation is occurring but not yet fully established.” She noted that earlier use could potentially prevent chronic pain patterns, though evidence remains limited.
For practicing OB/GYNs, identifying appropriate candidates is a key consideration. Hanfling highlighted several clinical features that may warrant referral beyond continued conservative care.
“The key clinical features would be localized scar tenderness and dyspareunia that is specifically related to the scarring,” she said, particularly when symptoms interfere with daily activities and quality of life.
She outlined four practical triggers for escalation: “Persistent and distressing pelvic pain beyond 12 weeks postpartum… symptomatic episiotomy or laceration causing dyspareunia… failed response to pelvic floor physical therapy… and patients who may need escalation to injections but are declining that.” In these scenarios, LiSWT may serve as an intermediate option before more invasive interventions.
Safety remains a central concern when introducing energy-based therapies to sensitive genital tissues. Hanfling noted that existing data—primarily from male chronic pelvic pain—are reassuring.
“Shock wave… has an excellent safety profile in pelvic and perineal tissues,” she said. “If it’s been safe and effective for penile tissue with no side effects, no need for anesthesia, there’s limited reason to believe it would impact female genitourinary tissues.”
However, patient counseling should address expectations and limitations.
“Patients can experience mild discomfort during the therapy,” she said, and treatment typically requires “anywhere from 4 to 12 sessions over several weeks,” with improvements that “can be slow and take some time.” She also emphasized transparency around the evidence gap: “We have this robust evidence base in male chronic pelvic pain, but the data just is limited in our postpartum population.”
In the reported case, outcomes extended beyond pain reduction alone.
“The pain was really just holding her back from experiencing her full quality of life,” Hanfling said, noting impacts on physical activity, sexual function, and emotional well-being. While symptoms did not fully resolve, “it did improve her quality of life—and that’s what we’re looking at.”
As interest in LiSWT grows, further research will be needed to define optimal timing, patient selection, and long-term outcomes in postpartum populations.
Reference:
1. Hanfling S, Macrae K; Twyford A; Wardrop F; Rubin R. Adjuvant low intensity shockwave therapy for the treatment of postpartum injury and dyspareunia. Presented at: International Society for the Study of Women’s Sexual Health Annual Meeting 2026. February 12-15, 2026. Long Beach, California. Abstract 055
