Urogynecological rehabilitation: a multimodal approach

The rehabilitation management of chronic conditions characterised by pelvic pain, such as endometriosis, vulvodynia and vaginismus, requires a comprehensive approach that considers pain, hypertonicity, tissue sensitivity and neuromotor dysfunction. It is possible to personalise treatment and improve clinical outcomes by integrating:

• Ultrasound,
• Electrotherapy and biofeedback,
• Tecartherapy.

Endometriosis, vulvodynia and vaginismus: what they are and why they involve the pelvic floor 

Endometriosis: a chronic inflammatory condition characterised by the presence of endometrial-like tissue outside the uterus. It often causes deep pelvic pain, rigidity and myofascial alterations. The pelvic floor can develop hypertonicity and difficulty in relaxation, contributing to the symptoms.

Vulvodynia: chronic vulvar pain, spontaneous or provoked, not attributable to other conditions. It is associated with nervous hypersensitivity and defensive contraction of the pelvic floor.

Vaginismus: a condition characterised by involuntary contraction of the pelvic muscles that impedes penetration. It is often accompanied by fear of pain, marked hypertonicity and difficulty in perceiving muscle relaxation.

Combined technologies for diagnosis and treatment 

• Ultrasound with GE’s Vscan allows immediate visual assessment of muscle contraction, relaxation and compensation; ideal as external feedback, especially when internal assessment is painful or not tolerated;
• Biostim from Mazet Santé allows antalgic currents to be applied to reduce pain and hypertonicity, while EMG/pressure biofeedback improves muscle perception and control.
• Tecartherapy with T Care Plus acts on deep tissues by increasing microcirculation, reducing tension and improving elasticity. It promotes pain modulation and enhances the effectiveness of manual techniques and active work.

Clinical applications in three urogynecological conditions  

Endometriosis: reduction of hypertonicity and deep pain

• Ultrasound to identify patterns of hypertonicity and poor fascial mobility;
• Tecar therapy to modulate deep pain and tissue stiffness;
• Endorphin currents to reduce sensitivity and facilitate relaxation.

Vulvodynia: management of hypersensitivity and recovery of relaxation

• External ultrasound as the first non-invasive tool;
• Radiofrequency to reduce hypersensitivity and surface tension;
• Relaxation biofeedback to modulate the pain response.

Vaginismus: awareness, desensitisation and reduction of the closing reflex

• Ultrasound as a visual guide to differentiate contraction and release;
• Tecar therapy to reduce muscle defence and increase tolerance;
• electrotherapy to modulate the involuntary closing reflex.

Integrated approach to recovery

The integration of ultrasound, electrotherapy and Tecar therapy is a highly effective approach in the urogynecological rehabilitation of endometriosis, vulvodynia and vaginismus. These technologies allow accurate assessment, significant pain reduction and improved recovery of muscle control, offering more personalised, progressive and well-tolerated therapeutic paths.  

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