(055) Adjuvant Low Intensity Shockwave Therapy for the Treatment of Postpartum Injury and Dyspareunia

Abstract Introduction Low-intensity extracorporeal shock wave therapy (LiSWT) is a non-invasive medical treatment that has been used successfully to treat chronic perineal pain, pelvic pain, and hypertrophic scar tissue and is a Grade A Recommendation for the treatment of male chronic pelvic pain (American Urologic Association, 2025). However, there is no research on the efficacy of LiSWT in a postpartum population with injuries related to childbirth. Given the profound impacts on pathological scar tissue, muscle repair, and nerve regeneration, LiSWT may be helpful for postpartum populations to recover from injuries and related chronic pain. Objective We report a unique case of female chronic perineal, pelvic pain and sacroiliac (SI) joint instability following birth trauma that was treated with a multimodal approach, and included LiSWT. Methods A 60-year old post-menopausal woman presented with persistent episiotomy scar pain, pelvic pain, blunted orgasm, hip pain, and dyspareunia after two vaginal deliveries 27 and 25 years ago. She had undergone pelvic floor physical therapy (PFPT), utilized strength training, gyrotonic exercises, and swimming to treat her symptoms prior to her presentation. After 10 cycles of LiSWT over the course of six months, she completed a modified Patients Global Impression of Improvement (PGI-I) for Incontinence Survey (PGI-I). Based on the PGI-I and subjective interview, the patient reported she was very much improved. LiSWT was applied to the patient’s labia majora, perineum, SI joint, lumbar spine, and psoas muscles. A total of 6000 shocks at 0.12 mJ/mm2 were administered at each session. In addition to LiSWT, the patient also received pelvic floor abobotulinumtoxinA (Dysport) injections, and continued her prior regimen of PFPT and exercise. Results The patient experienced pelvic floor dysfunction and pain over her episiotomy scar for over 20 years; utilizing a combination of non-invasive and invasive therapies, such as PFPT, LiSWT, and Dysport injections, the patient reported subjective improvement for the first time in years. This is the first known case in the literature that reports treatment of episiotomy scar tissue pain using LiSWT. Conclusions LiSWT may be considered as an adjuvant therapy for postpartum patients with pelvic floor dysfunction following scarring from perineal tears, episiotomies, or other childbirth-related injuries. Childbirth-related perineal trauma affects approximately 80% of women after vaginal birth, making this population essential to study given the profound impact such injuries can have on physical, sexual, and psychological well-being (Cruz de Amorim A 2025). As LiSWT has already been widely reported in the literature as a safe, non-invasive, and potentially restorative therapy to promote wound healing, pain management, and sexual health, it is imperative to continue to study its applications in the postpartum population. Disclosure No.