Therapeutic ultrasound for postpartum perineal pain and dyspareunia

Too little evidence from trials to show whether women have less pain if they have ultrasound treatment for perineal pain after childbirth.

A woman's perineum (area between the vagina and anus) may bruise, tear or be artificially cut (episiotomy) during childbirth. This may cause perineal pain or pain during sexual intercourse (dyspareunia), sometimes lasting more than a year. Ultrasound treatment involves using a probe to apply sound waves onto the woman's perineal area. The review of trials found too little evidence to show whether women have less perineal pain or dyspareunia if they have ultrasound treatment for pain. There is some evidence from studies that it may be beneficial, but further research is needed.

Authors' conclusions: 

There is not enough evidence to evaluate the use of ultrasound in treating perineal pain or dyspareunia, or both, following childbirth.

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Background: 

Proponents of therapeutic ultrasound suggest it can decrease pain by resolution of inflammation processes and reducing the pressure on pain sensitive structures by haematoma and oedema.

Objectives: 

The objective of this review was to assess the effects of therapeutic ultrasound for treating acute perineal pain, persistent perineal pain or dyspareunia, or both, following childbirth.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2008).

Selection criteria: 

Randomised and quasi-randomised trials comparing active therapeutic ultrasound with no treatment, placebo ultrasound, or any other 'standard' or active treatment for women with acute or persistent perineal pain or dyspareunia, or both, following childbirth.

Data collection and analysis: 

One review author assessed trial quality and extracted data.

Main results: 

Four trials involving 659 women were included. The trials were of variable quality.

Based on two placebo controlled trials, women treated with active ultrasound for acute perineal pain were more likely to report improvement in pain with treatment (odds ratio (OR) 0.37, 95% confidence interval (CI) 0.19 to 0.69). No other outcome reached significance. In one trial comparing pulsed electromagnetic energy with ultrasound for acute perineal pain, women treated with ultrasound were more likely to have bruising post-treatment (OR 1.64, 95% CI 1.04 to 2.60). However, those treated with ultrasound were less likely to have experienced perineal pain within the last 24 hours at 10 days (OR 0.56, 95% CI 0.34 to 0.92) and pain within the last week at three months (OR 0.43, 95% CI 0.22 to 0.84). No other outcome reached significance. Based on one trial, women treated with ultrasound for persistent perineal pain or dyspareunia, or both, were less likely to report pain with sexual intercourse compared with the placebo group (OR 0.31, 95% CI 0.11 to 0.84). None of the other outcomes measured reached significance.

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