Shock wave therapy described for chronic perineal and pelvic pain in case report

A case report describing the use of low-intensity extracorporeal shock wave therapy in a patient with more than 2 decades of episiotomy scar pain and pelvic floor dysfunction suggests the treatment may have a role in managing chronic postpartum perineal injury—and raises broader questions about how this modality could be integrated into existing care algorithms.

"In this case report, we examine the impact of shock wave therapy on a patient who had 20-plus years of residual episiotomy scar pain and hip dysfunction, sacroiliac joint pain, and overall dyspareunia after 2 vaginal deliveries," said Sarina Hanfling, research coordinator for Rachel Rubin MD PLLC and a medical student at the University of Maryland School of Medicine. "She had been doing physical therapy and strength training but came to our office after experiencing dyspareunia and pain on just a daily basis." The report was presented at the International Society for the Study of Women’s Sexual Health Annual Meeting 2026 in Long Beach, California.

The patient, a 60-year-old postmenopausal woman, received 10 sessions of low-intensity extracorporeal shock wave therapy (LiSWT) over 6 months. Treatment targeted the labia majora, perineum, sacroiliac joint, lumbar spine, and psoas muscles, delivering 6000 shocks at 0.12 mJ/mm² per session. In parallel, she continued pelvic floor physical therapy and received 3 pelvic floor abobotulinumtoxinA (Dysport) injections.

Using a modified Patient Global Impression of Improvement survey, the patient reported being "very much improved"—the first subjective improvement she had experienced in years.

"After each appointment, we interviewed the patient, and she ended up reporting a vast improvement in her chronic pain and tension. Her quality of life was just improved tremendously,” Hanfling said.

Hanfling acknowledged the multimodal nature of the treatment.

"She received more than just shock wave—she also got the pelvic floor therapy," she said. "We do have some evidence to suggest that the shock wave was part of her reduction in pain."

The authors believe this represents the first published case of LiSWT applied specifically to episiotomy scar tissue pain. The finding is clinically timely: Childbirth-related perineal trauma affects approximately 80% of women following vaginal birth, yet postpartum populations have been largely excluded from LiSWT research to date.

Regarding where LiSWT fits within treatment algorithms, Hanfling pointed to recent guideline updates as context.

"Last year, the American Urological Association released their expert guidelines on treating male chronic pelvic pain and chronic prostatitis, and they found that treatment with shockwave was a Grade A recommendation," she noted. "If we can be certain about it working in male chronic pain, I think it's worthwhile examining in our female population."

She envisions LiSWT as a second-line option following failed conservative management.

"Shock wave would most appropriately fit in as a second-line therapy after failed conservative management, particularly pelvic floor physical therapy," Hanfling said. American College of Gynecology guidelines currently recommend NSAIDs or acetaminophen, then topical agents, then physical therapy for postpartum pain. LiSWT could logically follow 8 to 12 weeks of failed physical therapy—before escalating to injections or surgical revision.

"It's safe, it's non-invasive—it could be a really good option before escalating to procedural interventions," Hanfling said.

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