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. 2000;1998(2):CD000495.
doi: 10.1002/14651858.CD000495.

Therapeutic ultrasound for postpartum perineal pain and dyspareunia

E J Hay-Smith  1
Affiliations

Therapeutic ultrasound for postpartum perineal pain and dyspareunia

E J Hay-Smith. Cochrane Database Syst Rev. 2000.

Abstract

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 and/or dyspareunia, following childbirth.

Search strategy: The Cochrane Pregnancy and Childbirth Group trials register, Embase, Cinahl (to May 1996), Physiotherapy Index (1985 to May 1996) and World Congress of Physical Therapy 1994 Conference Proceedings.

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 and/or dyspareunia following childbirth.

Data collection and analysis: One reviewer 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 0.37, 95% confidence interval 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 at 10 days (odds ratio 1.64, 95% confidence interval 1.04 to 2.60). However those treated with ultrasound were less likely to have experienced perineal pain at 10 days (odds ratio 0.56, 95% confidence interval 0.34 to 0.92) and three months (odds ratio 0.43, 95% confidence interval 0.22 to 0.84). No other outcome reached significance. Based on one trial, women treated with ultrasound for persistent perineal pain and/or dyspareunia were less likely to report pain with sexual intercourse compared with the placebo group (odds ratio 0.31, 95% confidence interval 0.11 to 0.84). None of the other outcomes measured reached significance.

Reviewer's conclusions: There is not enough evidence to evaluate the use of ultrasound in treating perineal pain and/or dyspareunia following childbirth.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Ultrasound versus placebo for acute perineal pain, Outcome 1 No improvement (self‐report) post‐treatment.
1.2
1.2. Analysis
Comparison 1 Ultrasound versus placebo for acute perineal pain, Outcome 2 Pain post‐treatment.
1.3
1.3. Analysis
Comparison 1 Ultrasound versus placebo for acute perineal pain, Outcome 3 Change in pain score post‐treatment.
1.4
1.4. Analysis
Comparison 1 Ultrasound versus placebo for acute perineal pain, Outcome 4 Pain within last 24 hours at 10 days.
1.5
1.5. Analysis
Comparison 1 Ultrasound versus placebo for acute perineal pain, Outcome 5 Pain within last week at 3 months.
1.6
1.6. Analysis
Comparison 1 Ultrasound versus placebo for acute perineal pain, Outcome 6 Bruising post‐treatment.
1.7
1.7. Analysis
Comparison 1 Ultrasound versus placebo for acute perineal pain, Outcome 7 Change in bruise size post‐treatment.
1.8
1.8. Analysis
Comparison 1 Ultrasound versus placebo for acute perineal pain, Outcome 8 Bruising at 10 days.
1.9
1.9. Analysis
Comparison 1 Ultrasound versus placebo for acute perineal pain, Outcome 9 Oedema post‐treatment.
1.10
1.10. Analysis
Comparison 1 Ultrasound versus placebo for acute perineal pain, Outcome 10 Oedema at 10 days.
1.11
1.11. Analysis
Comparison 1 Ultrasound versus placebo for acute perineal pain, Outcome 11 Haemorrhoids post‐treatment.
1.12
1.12. Analysis
Comparison 1 Ultrasound versus placebo for acute perineal pain, Outcome 12 Change in haemorrhoid size post‐treatment.
1.13
1.13. Analysis
Comparison 1 Ultrasound versus placebo for acute perineal pain, Outcome 13 Haemorrhoids at 10 days.
1.14
1.14. Analysis
Comparison 1 Ultrasound versus placebo for acute perineal pain, Outcome 14 Oral analgesia within 24 hours at 10 days.
1.15
1.15. Analysis
Comparison 1 Ultrasound versus placebo for acute perineal pain, Outcome 15 Wound breakdown at 10 days.
1.16
1.16. Analysis
Comparison 1 Ultrasound versus placebo for acute perineal pain, Outcome 16 Dyspareunia at 3 months.
1.17
1.17. Analysis
Comparison 1 Ultrasound versus placebo for acute perineal pain, Outcome 17 No resumption of sexual intercourse at 3 months.
2.1
2.1. Analysis
Comparison 2 Ultrasound versus pulsed electromagnetic energy (PEME) for acute perineal pain, Outcome 1 No improvement (self‐report) post‐treatment.
2.2
2.2. Analysis
Comparison 2 Ultrasound versus pulsed electromagnetic energy (PEME) for acute perineal pain, Outcome 2 Pain post‐treatment.
2.3
2.3. Analysis
Comparison 2 Ultrasound versus pulsed electromagnetic energy (PEME) for acute perineal pain, Outcome 3 Change in pain score post‐treatment.
2.4
2.4. Analysis
Comparison 2 Ultrasound versus pulsed electromagnetic energy (PEME) for acute perineal pain, Outcome 4 Pain within last 24 hours at 10 days.
2.5
2.5. Analysis
Comparison 2 Ultrasound versus pulsed electromagnetic energy (PEME) for acute perineal pain, Outcome 5 Pain within last week at 3 months.
2.6
2.6. Analysis
Comparison 2 Ultrasound versus pulsed electromagnetic energy (PEME) for acute perineal pain, Outcome 6 Bruising post‐treatment.
2.7
2.7. Analysis
Comparison 2 Ultrasound versus pulsed electromagnetic energy (PEME) for acute perineal pain, Outcome 7 Change in bruise size post‐treatment.
2.8
2.8. Analysis
Comparison 2 Ultrasound versus pulsed electromagnetic energy (PEME) for acute perineal pain, Outcome 8 Bruising at 10 days.
2.9
2.9. Analysis
Comparison 2 Ultrasound versus pulsed electromagnetic energy (PEME) for acute perineal pain, Outcome 9 Oedema post‐treatment.
2.10
2.10. Analysis
Comparison 2 Ultrasound versus pulsed electromagnetic energy (PEME) for acute perineal pain, Outcome 10 Oedema at 10 days.
2.11
2.11. Analysis
Comparison 2 Ultrasound versus pulsed electromagnetic energy (PEME) for acute perineal pain, Outcome 11 Haemorrhoids post‐treatment.
2.12
2.12. Analysis
Comparison 2 Ultrasound versus pulsed electromagnetic energy (PEME) for acute perineal pain, Outcome 12 Change in haemorrhoid size post‐treatment.
2.13
2.13. Analysis
Comparison 2 Ultrasound versus pulsed electromagnetic energy (PEME) for acute perineal pain, Outcome 13 Haemorrhoids at 10 days.
2.14
2.14. Analysis
Comparison 2 Ultrasound versus pulsed electromagnetic energy (PEME) for acute perineal pain, Outcome 14 Oral analgesia post‐treatment.
2.15
2.15. Analysis
Comparison 2 Ultrasound versus pulsed electromagnetic energy (PEME) for acute perineal pain, Outcome 15 Oral analgesia within 24 hours at 10 days.
2.16
2.16. Analysis
Comparison 2 Ultrasound versus pulsed electromagnetic energy (PEME) for acute perineal pain, Outcome 16 Wound breakdown at 10 days.
2.17
2.17. Analysis
Comparison 2 Ultrasound versus pulsed electromagnetic energy (PEME) for acute perineal pain, Outcome 17 No resumption of sexual intercourse at 3 months.
2.18
2.18. Analysis
Comparison 2 Ultrasound versus pulsed electromagnetic energy (PEME) for acute perineal pain, Outcome 18 Dyspareunia at 3 months.
3.1
3.1. Analysis
Comparison 3 Ultrasound versus placebo for persistent perineal pain or dyspareunia, or both, Outcome 1 Continuing perineal pain.
3.2
3.2. Analysis
Comparison 3 Ultrasound versus placebo for persistent perineal pain or dyspareunia, or both, Outcome 2 Discomfort with standing.
3.3
3.3. Analysis
Comparison 3 Ultrasound versus placebo for persistent perineal pain or dyspareunia, or both, Outcome 3 Discomfort wearing jeans.
3.4
3.4. Analysis
Comparison 3 Ultrasound versus placebo for persistent perineal pain or dyspareunia, or both, Outcome 4 Unable to use tampons.
3.5
3.5. Analysis
Comparison 3 Ultrasound versus placebo for persistent perineal pain or dyspareunia, or both, Outcome 5 Pain with vaginal penetration.
3.6
3.6. Analysis
Comparison 3 Ultrasound versus placebo for persistent perineal pain or dyspareunia, or both, Outcome 6 Pain with sexual intercourse (dyspareunia).
3.7
3.7. Analysis
Comparison 3 Ultrasound versus placebo for persistent perineal pain or dyspareunia, or both, Outcome 7 Pain after sexual intercourse.
3.8
3.8. Analysis
Comparison 3 Ultrasound versus placebo for persistent perineal pain or dyspareunia, or both, Outcome 8 Pain day after sexual intercourse.
3.9
3.9. Analysis
Comparison 3 Ultrasound versus placebo for persistent perineal pain or dyspareunia, or both, Outcome 9 Bleeding after sexual intercourse.
3.10
3.10. Analysis
Comparison 3 Ultrasound versus placebo for persistent perineal pain or dyspareunia, or both, Outcome 10 Sexual intercourse not attempted or not achieved.
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References

References to studies included in this review

Bewley 1985 {unpublished data only}
    1. Bewley EL. A trial to test the effectiveness of Megapulse, as opposed to Ultrasound, in the treatment of perineums in post delivery women. Data on file.
Creates 1987 {published data only}
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Everett 1992 {published data only}
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Grant 1989 {published data only}
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References to studies excluded from this review

Foulkes 1980 {published data only}
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McClaren 1984 {published data only}
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References to other published versions of this review

Hay‐Smith 1995
    1. Hay‐Smith J. Ultrasound treatment of perineal pain. [revised 27 January 1994]. In: Enkin MW, Keirse MJNC, Renfrew MJ, Neilson JP, Crowther C (eds.) Pregnancy and Childbirth Module. In: The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM]. The Cochrane Collaboration; Issue 2, Oxford: Update Software; 1995.

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