Transcutaneous Electric Nerve Stimulation (TENS) for Vulvodynia

By Bryn Zolty, PT

As many as 17% of women may experience pain in the area around the outside of the vagina known as the vulva (1).  Pain in this area can be multifactorial and potentially caused by hormonal changes, inflammatory conditions, musculoskeletal conditions, medications, trauma, nerve pain, cancer, and more. Severity can range from pain with certain activities to constant burning pain. Most women will experience pain with intimacy and intercourse.  

Finding the right care team is important. With such a wide array of potential causes, many women will see several physicians before identifying the cause and starting treatment. One modality that may complement treatment is transcutaneous electric nerve stimulation, or  TENS. This can be placed on areas outside the body, but several studies demonstrate improvement of symptoms when delivered transvaginally.  ​​

F. Murina, V. Bianco, et al, had women trial internal vaginal probes or external electrodes close to the sit bones or over the sacrum. They used the TENS for 20 minutes a session, 2 times a week for 10 weeks. These women demonstrated significant improvement of vulvar pain. 

Murina F, Felice R, Di Francesco S, Oneda S. trialed TENS with vaginal Valium (Diazepam) versus TENS only. This study used TENS for 30 minutes, 3 times weekly for 60 days and found both groups had improvement, but the vaginal valium with the TENS was superior.    

If you think TENS may be a helpful addition to your pelvic pain plan of care, speak with your pelvic PT or practitioner. A pelvic physical therapist can help you figure out the best type of TENS for you and set up one of the protocols used in these studies.   ​

1 Murina F, Bianco V, Radici G, Felice R, Di Martino M, Nicolini U. Transcutaneous electrical nerve stimulation to treat vestibulodynia: a randomised controlled trial. BJOG. 2008 Aug;115(9):1165-70. doi: 10.1111/j.1471-0528.2008.01803.x. PMID: 18715435. 

2 Murina F, Felice R, Di Francesco S, Oneda S. Vaginal diazepam plus transcutaneous electrical nerve stimulation to treat vestibulodynia: A randomized controlled trial. Eur J Obstet Gynecol Reprod Biol. 2018 Sep;228:148-153. doi: 10.1016/j.ejogrb.2018.06.026. Epub 2018 Jun 27. PMID: 29960200.