To evaluate the effect of transcranial direct current electrical stimulation (tDCS) associated with physiotherapy for the pelvic floor in the short and medium term (3 months)  on sexual function, kinesiophobia and quality of life in women with chronic pelvic pain (CPP).

This is a case reports, longitudinal, interventional, quantitative study. Women were recruited through advertising on social media from October 2023 to March 2024. Women aged between 18 and 40 years old who complained of pelvic pain for more than 6 months and who agreed and signed the Free and Informed Consent Form. Pregnant women and women who did not comply with the complete intervention protocol were excluded from the study. The application of tDCS (figure 1) was carried out for 5 consecutive days, for 20 minutes and simultaneously with perineal massage and pelvic floor muscle training (PFMT) with a focus on muscle relaxation.
The assessment instruments used were: Tampa scale for kinesiophobia (TSK), female sexual function index (FSFI), brief pain inventory (BPI) and world health organization quality of life brief version (WHOQOL-BREF). The data were tabulated in the Microsoft Excel 2019 program and analyzed using the Statistical Package for Social Science (SPSS) version 2.3. The numerical variables were presented as means, standard deviations, percentages, and the statistical test used to evaluate the intervention was the Friedman test, considering a p value <0.05.

The data presented here refers to baseline and post-treatment. Our sample will still be re-evaluated 1 and 3 months after the intervention to present the results, following our study objective. Of 7 women recruited, 5 completed the protocol and were included in this study. After the physiotherapy protocol associated with tDCS, we obtained positive results regarding pain, measured by the BPI, and also in quality of life, assessed by the WHOQOL-BREF. There was a post-intervention improvement in pain intensity of 54% (p = 0.043) and in pain interference of 71.80% (p = 0.043). Quality of life improved by 21.2% (p = 0.043). In relation to sexual function, it was noted that there was a higher average in the total score after tDCS when compared to the pre-intervention average, indicating an improvement of 22%, but it was not considered statistically significant (p = 1.0).

In the present study, it was possible to identify that there was a significant improvement in pain intensity and interference, as well as in quality of life after the pelvic floor physiotherapy intervention combined with tDCS (table 1). tDCS applied to the left dorsolateral prefrontal cortex (DLPFC) has been shown to be beneficial in the management of chronic pain, since the stimulated brain region is associated with emotional processing and pain perception, playing an essential role in several cognitive processes (1).
Regarding the function of the pelvic floor, around 50% of women with dysfunctions present an increase in PFM tone. This condition may be related to urinary, evacuation, sexual deficiencies and/or chronic pelvic pain. As a result, an approach was proposed that includes perineal massage, kinesiotherapy, relaxation and proprioception, with the aim of promoting PFM relaxation and pain control, as recommended in the literature for the management of CPP (2).
It was not possible to observe a significant improvement in the FSFI domains after the intervention, which can be explained by the heterogeneity and low number of participants in our sample. A single case study found in the literature, which also performed physiotherapy combined with tDCS, obtained similar results, showing no improvement in sexual function after treatment, but with a significant improvement in pain intensity (3).

tDCS associated with pelvic floor physiotherapy proved to be positive in reducing pain intensity and interference, as well as a significant improvement in the quality of life of women with CPP. However, kinesiophobia and sexual function did not make considerable gains. It is suggested that more randomized clinical trials be carried out, with a larger sample size, in order to demonstrate the effect of tDCS on CPP.

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GADELHA BCCV, MACIEL BGM, SALATA MC, LIMA MSN, OLHER RR, RIBEIRO TG. Transcranial Direct Current Stimulation combined with Physiotherapy in the control of Chronic Pelvic Pain: a case report. Brain Imaging and Stimul. 2023;2:e5322.