{"paper_id":"0e301a8c-0815-4e0d-b416-48c3034597d0","body_text":"45\nThis is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International  \n(CC BY-NC-SA 4.0). License (http://creativecommons.org/licenses/by-nc-sa/4.0/)\nreview PAPer\nDOI: https://doi.org/10.5114/pm.2026.161669\nMenopause Rev 2026; 25(1): 45-51\nIntroduction\nChronic pelvic pain affects about 26% of the world’s \nfemale population [1]. It is defined as pain originating \nfrom the pelvis, typically lasting more than 6 months \nrelated to conditions such as gynaecological disor -\nders, interstitial cystitis or painful bladder syndrome, \nirritable bowel syndrome, vulvodynia, and pelvic floor \nmuscle tension [2, 3]. Pain could also be linked to the \nstructure of myofascial tissues in the abdominal and \npelvic areas, but the mechanisms are often unclear [4]. \nThe most common debilitating conditions are dysmen-\norrhea, related to menstruation and dyspareunia, relat-\ned vulvodynia, chronic pelvic pain, including low back \npain (LBP) during pregnancy. These pathologies impact \nEffectiveness of transcutaneous electrical nerve stimulation for pelvic pain \nin women: a systematic review\nGianpaolo Ronconi1,2, Rossella Calciano1, Giuseppe Gullo3, Antonella Vitale2, Eliana Rampulla4, Alberto Cutaia2, \nAugusto Fusco5, Elisabetta Lama2, Eleonora Conti3, Valentina Billone3, Paola Emilia Ferrara1\n1Fondazione Policlinico Universitario \" Agostino Gemelli\" IRCCS, Department of Geriatrics, Orthopaedics and Rheumatology, Rome, Italy\n2University Department of Geriatric and Orthopaedic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy\n3AOOR Villa Sofia Cervello, Department of Obstetrics and Gynaecology, University of Palermo, Palermo, Italy\n4Physical and Rehabilitation Medicine, University of Rome Tor Vergata, Rome, Italy\n5 UOSD High-Intensity Neurorehabilitation, Department of Neuroscience, Sensory Organs and Thorax, University Hospital Foundation \n“Agostino Gemelli” IRCCS, Rome, Italy\nAbstract\nChronic pelvic pain (CPP) affects approximately 26% of women and significantly impacts quality of life. \nCommon causes include dysmenorrhea and pelvic floor dysfunction. Transcutaneous electrical nerve stimula-\ntion (TENS) is widely used for pain relief to inhibit pain transmission and stimulate endogenous opioid release. \nThe aim of this study is to evaluate the effectiveness of TENS in the rehabilitation of pelvic pain in women through \nrandomised controlled trials (RCTs). A systematic search was conducted in PubMed and ClinicalTrials.gov data-\nbases using the terms “transcutaneous electrical nerve stimulation”, “pelvic pain”, and “pelvic floor”, selecting \nRCTs published between 2020 and 2025. Inclusion criteria followed the PICO framework, targeting adult women \nwith CPP and TENS as the intervention. Studies involving males, pregnancy, or without full texts were excluded. \nPRISMA guidelines were followed; study quality was assessed using the Cochrane risk of bias tool. Four RCTs met \nthe inclusion criteria; they involved 281 participants. Three studies focused on primary dysmenorrhea (PD) and \none on vestibulodynia. All studies reported a significant reduction in pain following TENS treatment, assessed by \nthe visual analogue scale or numeric rating scale, with some studies also noting reduced analgesic consumption. \nHowever, improvements in secondary outcomes such as sexual function and pelvic floor muscle strength were in-\nconsistent. Transcutaneous electrical nerve stimulation appears to be an effective, safe, and non-invasive modal-\nity for reducing pelvic pain in women, especially in cases of PD and vestibulodynia. Evidence remains limited by \nheterogeneity in study protocols and outcome measures. Further high-quality RCTs are needed for standardized \nprotocols and broader rehabilitative outcomes, including functional and quality-of-life improvements.\nKey words: pelvic floor disorders, pelvic pain, transcutaneous electrical nerve stimulation, rehabilitation, \ndysmenorrhea.\nnot only physical health, but also quality of life, sex-\nual function, mental well-being, and the ability to \nparticipate in daily activities [5, 6]. These conditions \noften overlap with nonpelvic pain disorders (e.g., fibro- \nmyalgia, migraines) and other comorbidities (e.g., \nsleep, mood, cognitive impairment) to contribute to \npain severity and disability [1].\nVarious treatments could be used to reduce pain and \nimprove health. These patients often have pelvic floor \nmuscle dysfunction, which can be improved through \nphysiotherapy focused on relaxation techniques and \npelvic floor re-education [7]. \nTranscutaneous electrical nerve stimulation (TENS) \nis a  widely used physical therapy modality for pain \nmanagement and relief. Transcutaneous electrical nerve \nCorresponding author: \nDr. Alberto Cutaia, University Department of Geriatric and Orthopaedic Sciences, Universita Cattolica  \ndel Sacro Cuore, Rome, Italy, e-mail: alberto.cutaia@guest.policlinicogemelli.it\nSubmitted: 05.12.2025\nAccepted: 07.03.2026 \n\nMenopause Review/Przegląd Menopauzalny 25(1) 2026\n46\nstimulation involves the application of low-voltage elec-\ntrical currents through the skin to stimulate peripheral \nnerves. Its analgesic effects are primarily attributed to \nmechanisms such as activation of large-diameter Aβ fi-\nbres, which inhibit pain transmission according to the \ngate control theory, and stimulation of endogenous opi-\noid release, including β-endorphins [9] (Figure 1). \nFurthermore, it is supported by the physiological \nevidence showing inhibition of central nociceptive \nneurons regardless of diagnosis [10, 11]. Transcutane-\nous electrical nerve stimulation devices are typically \ninexpensive and readily available without the need for \na  prescription. Furthermore, they can be safely self- \nadministered. Despite recent research, uncertainty about \nTENS efficacy and effectiveness persists nowadays.  \nAccording to the National Institute for Health and Care \nExcellence Guidelines (2021), the use of TENS is not \nsupported for chronic primary pain, intrapartum care, \nand non-specific LBP [12, 13].\nIt is most frequently used in rehabilitative programs \nregarding musculoskeletal diseases, like osteoarthritis \nand rheumatoid arthritis [14, 15]. \nRecently, TENS has shown promising results in al-\nleviating pelvic pain and improving sexual function, \nparticularly in cases of dysmenorrhea and vulvodynia. \nPrimary dysmenorrhea (PD) is one of the most preva-\nlent causes of pelvic pain in reproductive-age women; \nit is characterized by the association not only with men-\nstrual cramping but also with alterations in pelvic floor \nsensitivity and myofascial trigger points. These features \nsuggest a multifactorial pain aetiology [16, 17]. \nVestibulodynia, instead, is characterized by local-\nized provoked pain at the vulvar vestibule, often ac-\ncompanied by dyspareunia, pelvic floor dysfunction, \nand low sexual quality of life [18]. \nBoth dysmenorrhea and vestibulodynia underline \nthe complex interplay of nociceptive, myofascial, and \ncentral sensitization mechanisms contributing to per -\nsistent pelvic pain in women. Transcutaneous electri-\ncal nerve stimulation could be a non-pharmacological  \nneuromodulation strategy that could improve treat-\nment of these conditions. Previous systematic reviews \nand randomised controlled trials (RCT) report that TENS \nmay modestly reduce pain intensity in PD and chronic \npelvic pain, and specific TENS protocols have demon-\nstrated beneficial effects on burning pain and dyspa-\nreunia in women with provoked vestibulodynia [19, 20].\nIt is important to underline that pelvic pain en-\ncompasses heterogeneous conditions with distinct but \noverlapping mechanisms. This complexity supports the \nneed for multimodal therapies which may address both \nnociceptive and neuromuscular components of pelvic \npain.\nThis review aims to provide an updated synthesis \nof RCTs on the use of TENS for managing pelvic pain \nin women, with a  focus on secondary functional and \nrehabilitative outcomes.\nMaterial and methods\nA bibliographic search was performed using the \nPubMed and ClinicalTrials.gov databases. The  search \nstrategy combined Medical Subject Headings (MeSH) \nterms and free-text keywords. The  following search \nstring was used: ((“Transcutaneous Electric Nerve Stim-\nulation”[Mesh] OR TENS OR “electrical nerve stimula-\ntion” OR “transcutaneous electrical stimulation”) AND \n((“Dysmenorrhea”[Mesh] OR “primary dysmenorrhea” \nOR “menstrual pain”) OR (“Vulvodynia”[Mesh] OR “vul-\nvar pain” OR “vestibulodynia” OR “vulvar vestibulitis”))) \nAND (“Randomized Controlled Trial”[Publication Type] \nOR randomized[Title/Abstract] OR sham[Title/Abstract] \nOR placebo[Title/Abstract]). \nFilters were applied to restrict the results to stud-\nies involving humans, female participants, and articles \npublished in English. We selected papers from January \n2020 to December 2025. Additional filters included arti-\ncle type (RCT) and age categories (adolescent and adult \npopulations). The reference lists of the included studies \nwere manually screened to identify any additional rele-\nvant publications.\nIn accordance with the PICO model [21], we consid-\nered eligible RCTs satisfying the following criteria:\nP  (population): adult women (aged > 18 years) diag-\nnosed with pelvic pain. Male participants, animal \nmodels, individuals with dermatological conditions \naffecting the pelvic area, pregnant women were ex-\ncluded,\nI (intervention): TENS,\nC  (comparison or control(s): no specific comparators \nwere considered in this review,\nO (outcome): pain reduction.\nAll articles underwent independent evaluation by \ntwo reviewers (RC and PEF). Disagreements between the  \ntwo independent reviewers were resolved through dis-\ncussion and mutual consensus. In cases of divergent \nopinions, final decisions were made based on the over-\nall methodological consistency of the review. No con-\nflicts of interest were reported by any of the reviewers. \nFigure 1. Gate control [8]\n\nMenopause Review/Przegląd Menopauzalny 25(1) 2026\n47\nEvidence acquisition registration \nWe used the PRISMA reporting guidelines when writ-\ning this report [22]. This review was prospectively reg-\nistered in the PROSPERO database before commencing \nthe literature search and it is available at https://www.\ncrd.york.ac.uk/prospero; ID number 1151312. The meth-\nodological quality of the included studies was assessed \nusing the Cochrane risk of bias tool through the RevMan \nsoftware (https://revman.cochrane.org/info). This soft-\nware provided the evaluation of seven key domains: \nrandom sequence generation, allocation concealment, \nblinding of participants and personnel, blinding of out-\ncome assessment, incomplete outcome data, selective \nreporting, and other potential sources of bias. Each do-\nmain was judged as having a low, unclear, or high risk of \nbias, and results were visually summarized using a colour- \ncoded system: green for low risk, yellow for unclear risk, \nand red for high risk (Figure 2). \nResults\nThe included RCTs, published between 2021 and \n2024, involved a  total of 281 participants (154 in the \nintervention groups and 127 in the control groups). All \nstudies enrolled female populations, with mean ages \nranging from 17 to 31 years. The most frequently investi-\ngated condition was PD, addressed in three trials [23–25],  \nwhile only one study focused on vestibulodynia [20].  \nAlthough all studies used TENS as the main intervention, \nsubstantial heterogeneity was observed in terms of de-\nvices, stimulation parameters, administration modalities, \nand treatment duration. Murina et al. [20] adopted an in-\ntravaginal, self-administered home-based protocol com-\nbining high- and low-frequency stimulation for 30 min-\nutes, three times per week, over a 120-et al. day period. \nIn contrast, the PD trials exclusively employed trans-\ncutaneous approaches: Guy et  al. [23] used adhesive \npatches with variable frequencies (60–100 Hz), McLagan \net al. [24] applied a commercial wearable device delivering \nstimulation (50–100 Hz), and Manisha and Anuradha [25]  \nadministered high-frequency stimulation (100  Hz) for \n20 minutes on the first day of menstruation. All included \nstudies reported a significant reduction in pain in study \ngroups. Murina et al. [20] observed significant improve-\nments in burning pain and dyspareunia, but no statisti-\ncally significant changes in secondary outcomes (female \nsexual functioning index – FSFI, vulvar pain functional \nquestionnaire, pelvic floor muscle strength), suggesting \na predominantly analgesic effect of moderate clinical rel-\nevance. In the PD trials, Guy et al. [23] reported a mean \npain reduction of 53%, associated with a rapid onset of \naction and a  marked decrease in analgesic consump-\ntion, indicating a large and clinically meaningful effect. \nSimilarly, McLagan et al. [24] demonstrated a significant \nreduction in pain across all cycles and a  lower use of \nnon-steroidal anti-inflammatory drugs (NSAID), suggest-\ning at least a moderate treatment effect. Manisha and \nAnuradha [25] found significant intra- and intergroup dif-\nferences for all assessed outcomes, consistent with a ro-\nbust analgesic response. Only two studies documented \na significant reduction in analgesic consumption [23, 24], \nwhereas Murina et al. [20] did not observe significant im-\nprovements in sexual function or muscle performance. \nThe methodological quality of the included studies \nwas assessed using the Cochrane risk of bias tool avail-\nable through the RevMan software (https://revman.co-\nchrane.org/info) (Figure 3).\nThe risk of bias assessment revealed substantial \nconcerns in several domains, particularly regarding de-\ntection bias, incomplete outcome data, and selective \nreporting. Only one study [20] was judged to be at low \nrisk of detection bias, while two [24, 25] were rated as \nhigh risk. Small sample sizes, heterogeneous follow-up \ndurations (ranging from immediate post-treatment as-\nsessments to 120 days), and non-standardized proto-\ncols further reduce the robustness of the findings.\nConsequently, although the available evidence sug-\ngests a potentially clinically meaningful benefit of TENS \nin the management of pelvic pain, the heterogeneity \nof protocols, the lack of standardized effect size report-\ning, and the overall methodological limitations prevent \ndefinitive conclusions. Larger, well-designed RCTs with \nstandardized protocols and complete outcome report-\ning are required to enable a  precise quantification \nof treatment effects and to improve the comparability \nof future findings (Table 1).\nFigure 2. Study selection process for transcutaneous electri-\ncal nerve stimulation in pelvic pain assessed through PRISMA \n2020 statement\nIdentificationScreeningIncluded\nRecords identified \nfrom: PubMed \nand ClinicalTrials.gov \ndatabases  \n(n = 379)\nRecords excluded \n(n = 354)\nRecords screened\n(n = 16 + 9)\nReports assessed  \nfor eligibility\n(n = 6)\nReports excluded: male \nparticipants, animal models, \nsubjects with dermatological \nconditions affecting the \npelvic area, abstract/full text \nnot accessible, pregnancy, \npublished between 2020 \nand 2025\nStudies included  \nin review (n = 4)\nIdentification of studies via databases and registers\n\nMenopause Review/Przegląd Menopauzalny 25(1) 2026\n48\nDiscussion\nThe present review provides an updated synthesis \nof RCTs published in 2020–2025 on the use of TENS for \nthe management of pelvic pain in women. The review \nfocuses on secondary functional and rehabilitative out-\ncomes in addition to pain reduction, in comparison with \nprevious systematic reviews, including the recent one \nby Han et al. [26].\nThe collective evidence from these four studies sug-\ngests potential efficacy of TENS in reducing pelvic pain \nin women, particularly in conditions such as PD and \nvestibulodynia, with benefits primarily observed in an-\nalgesic outcomes, as pain intensity was the main end-\npoint assessed across all included trials.\nThese findings are consistent with those reported in \nprevious systematic reviews. For instance, the analysis \nconducted by Igwea et al. [27], published in 2016, dem-\nonstrated significant reductions in dysmenorrheic pain \nfollowing TENS application. Similarly, Proctor et al. [28] \nreported that high-frequency TENS was superior to \nboth placebo and low-frequency TENS in alleviating \npain in women with primary dysmenorrhea.\nThe analgesic efficacy of TENS is further supported \nby the findings of Fernández-Pérez et  al. [29], whose \nsystematic review, focusing on women with dyspareu-\nnia, reported similar outcomes. However, it should be \nnoted that the studies included in their analysis pre-\ndate the present review period and exhibit substantial \nmethodological heterogeneity. \nFurthermore, there is evidence to suggest that the \nuse of TENS has been associated with a  decreased \nuse of medications, particularly NSAID, as shown by \nMcLagan et al. [24]. However, a comprehensive system-\natic review by Johnson et al. [30], which encompassed \n381 studies across a wide range of clinical conditions, \nreported only low-certainty evidence that lends support \nto the conclusion that TENS is superior to pharmaco-\nlogical analgesia.\nIn contrast to the relatively consistent evidence \nsupporting the analgesic effects of TENS, findings re-\nlated to functional and rehabilitative outcomes remain \nlimited and less conclusive. Outcomes, such as sexual \nfunction, pelvic muscle strength, and overall functional \nperformance were assessed in only a  small number \nof  studies and were not consistently included as pri-\nmary endpoints, thereby limiting the strength of the \nconclusion that can be drawn regarding the rehabilita-\ntive effects of TENS.\nWhile evidence from other clinical populations sug-\ngests potential benefits of TENS on quality of life and \nfunctional capacity, such findings cannot be directly  \nextrapolated to women with pelvic pain and should be \ninterpreted with caution.\nFor instance, Katirci Kirmaci et al. [31] examined the \nimpact of different electrical stimulation modalities on \npain, functional capacity, and quality of life in patients \nwith multiple sclerosis, employing the multiple sclerosis \nFigure 3. Evaluation of risk of bias through Cochrane RevMen risk of bias tool \nRandom sequence generator (selection bias)\nAllocation concealment (selection bias)\nBlinding of participants and personnel (personal bias): all outcomes\nBlinding of outcome assessment (detection bias): all outcomes\nIncomplete outcome data (attrition bias): all outcomes\nSelective reporting (reporting bias) \nOther bias \nGuy et al.\nManisha et al.\nMcLagan et al.\nMurina et al.\n Low risk of bias    Unclear risk of bias    High risk of bias\nRandom sequence generator (selection bias)\nAllocation concealment (selection bias)\nBlinding of participants and personnel (personal bias): all outcomes\nBlinding of outcome assessment (detection bias): all outcomes\nIncomplete outcome data (attrition bias): all outcomes\nSelective reporting (reporting bias) \nOther bias \n0% 25% 50% 75% 100%\n\nMenopause Review/Przegląd Menopauzalny 25(1) 2026\n49\nTable 1. Characteristics of the study\nAuthor [year] Study \ndesign\nPathology Study group Control group 1 Outcome measure Follow-up Results\nMurina et al.\n[20]\nRCT VBD TENS (EVA; Sirval)\nVaginal probe (Periprobe VAG2ST; Sirval)\nself-administered domiciliary protocol\n15 min of 100 Hz frequency, a pulse width of 50 μs, \nand time on : off 20 : 10 s\n(first program) followed by 15 min of 5 Hz frequency, \na pulse width of 100 μs, and time on : off 20 : 10 s \n(second program)\n3/week\nNo. of patients = 40 → 39F\nMean age 27.0\nTENS\n15 min of 60 Hz frequency, \na pulse width of 50 μs, \nand time on : off 20 : 10 s  \n(first program) followed  \nby 15 min of 5 Hz frequency, \na pulse width of 200 μs, and \ntime on : off 20 : 10 s (second \nprogram)\n3/week\nNo. of patients = 40 → 39F\nMean age 27.7\nVAS (burning/pain \n+ dyspareunia score);\nV-Q\nFSFI\nPFM activity at rest\nPFM peak activity\nPFM strength\nT0: baseline\nT1: day 60\nT2: day 120\nAt T2 in the study group, \nimprovement: burning/\npain (p = 0.003) and \ndyspareunia (p = 0.01)  \nVAS scores\nImprovement not \nstatistically significant: \nFSFI, V-Q, and muscle-\nstrength measures \nGuy et al. \n[23]\nRCT PD TENS (menstrual cycle 1) → Sham (menstrual cycle 2)\n(Patch d’électrothérapie URGO)\nProgram 1: continuous high frequency (100 Hz) \nProgram 2: different frequencies  \n(60 Hz, 80 Hz and 100 Hz) in continuous \nand discontinuous mode\n15 intensity levels\n30 min treatment\nmax 6 times/day\nNo. of patients = 20 → 19F\nMean age 29.2 ±6.1\nSham (menstrual cycle 1)  \nTENS (menstrual cycle 2)\nNo. of patients = 20 → 18F\nMean age 29.7 ±7.1\nVAS\nSpeed of action\nPersistence  \nof the effect\nTherapeutic savings\nSatisfaction\nT0: baseline\nT1: + 5 days after \nthe end of menses \nof cycle 1\nT2: + 5 days after \nthe end of menses \nof cycle 2 \nIn favour of TENS:\n•  significant decrease \nin the pain of 53%  \n(p < 0.0001), \n•  rapid relief, less than \n20 minutes in 74%,\n•  difference in analgesic \nconsumption of –93%  \n(p < 0.01)\nMcLagan et al.\n[24]\nRCT PD TENS\n(Therabody PowerDot®) \nUno (single unit)/duo (dual unit)/control (NSAID) \nin randomised order\nContinuous HF (50–100 Hz) with a phase duration \nof 100 μs from 30 to 90 min treatment\nNo. of patients = 34 → 26F\nMean age 24.6 ±3.4\nNRS T0: pre use\nT1: post use\nSignificant reduction \nin pain during the Control \n(–3.52 ±1.9), Uno (–2.10 \n±1.6), and Duo (–2.19 ±1.7) \ncycles (p < 0.001)\nDifference in the doses \nof NSAID during the Control \ncycle (3.5 ±2.6), compared \nwith that of Uno (1.5 ±3.0), \nor Duo (1.1 ±2.6) (p = 0.004)\nManisha et al.\n[25]\nRCT PD TENS (Stim Tec4) root level L3–L5\nFrequency 100 Hz, pulse duration 80 μs, intensity  \nup to the tolerated level\n20 min on the first day of menstruation\nNo. of patients = 70F\nMean age 17.21 ±1.178\nNo. of patients = 70F\nMean age 17.50 ±1.327\nNRS pain  \n(lower abdomen\nReferred lower back \nReferred bilateral \nthigh)\nSystolic blood \npressure\nT0: pre use\nT1: post use\nSignificant difference \nin intragroup and \nintergroup comparison \nof all the outcome variables \nFSFI – female sexual functioning index, HF – high frequency, NRS – numeric rating scale, NSAID – non-steroidal anti-inflammatory drugs, PD – primary dysmenorrhea, PFM – pelvic floor muscle, RCT – randomised controlled trial, \nTENS – transcutaneous electrical nerve stimulation, VAS – visual analogue scale, VBD – vestibulodynia, V-Q – vulvar pain functional questionnaire\n\nMenopause Review/Przegląd Menopauzalny 25(1) 2026\n50\ninternational quality of life scale. While both interferen-\ntial current therapy and TENS demonstrated significant \nimprovements in pain and functional capacity, TENS \nwas found to be more efficacious in enhancing quality \nof life. The findings are derived from a non-pelvic pain \npopulation and therefore provide only indirect support \nfor potential functional benefits of TENS in pelvic pain \nconditions.\nWith regard to the specific issue of pelvic pain, Mira \net  al. [32] provided relevant evidence by comparing \nhormonal therapy and TENS in patients with endome-\ntriosis. Their results demonstrated significant improve-\nments in sexual function, particularly in the lubrication \nand pain domains of the FSFI, in the group receiving \nTENS. However, these findings are limited to a specific \nclinical population and treatment context, and there-\nfore offer supportive but not generalizable evidence \nregarding the potential functional benefits of TENS in \nwomen with pelvic pain.\nDespite the paucity of research investigating the \ncost-benefit profile of TENS in the context of pelvic pain \nand pelvic floor dysfunctions, it may represent a poten-\ntially cost-effective option. This is attributable to its non-\ninvasive nature, low risk profile, and ease of adminis-\ntration. Supporting evidence from other clinical areas, \nsuch as the review by Woods et al. [33], which compared \nthe cost-effectiveness of various non-pharmacological \ntreatments for knee osteoarthritis, indicated that TENS \nrepresents a cost-efficient therapeutic option when all \navailable trials are taken into consideration.\nThe findings of the present review can be inter -\npreted in terms of their clinical implications. It is sug-\ngested that TENS may be considered as an adjunctive, \nnon-pharmacological option for the management of \npelvic pain in women, primarily due to its analgesic  \neffects, particularly in the specific clinical conditions \nfor which evidence is currently available. Additionally, \nTENS may have the potential to reduce reliance on \npharmacological treatments; however, this effect has \nbeen directly assessed in only a limited number of stud-\nies and should therefore be interpreted with caution. \nWhile preliminary evidence suggests the possibility of \nbenefits on secondary outcomes, including sexual func-\ntion and functional performance, the current evidence \nsupporting these rehabilitative effects remains limited \nand insufficient to draw firm conclusions.\nConsequently, TENS should be regarded primarily \nas a symptomatic intervention rather than a compre-\nhensive rehabilitative approach for addressing broader \nfunctional impairments.\nThis review has limitations that should be acknowl-\nedged when interpreting the findings. Firstly, the num-\nber of eligible studies included is limited, which restricts \nthe overall strength and generalizability of the evidence. \nSubstantial heterogeneity was observed among the \nstudies in terms of TENS application protocols, includ-\ning electrode placement, stimulation parameters and  \nfollow-up periods. This variability complicated direct com-\nparison of results and limited the possibility of defining \nstandardized treatment parameters for clinical practice. \nThe control conditions differed across studies, rang-\ning from sham stimulation to alternative TENS settings \nor no treatment. Such methodological differences have \nthe potential to introduce bias in the interpretation of \ncomparative outcomes and may influence effect sizes. \nWhile pain reduction was consistently assessed as \nthe primary outcome, secondary outcomes such as sex-\nual function, pelvic floor muscle strength, and overall \nfunctional performance have been less frequently and \nless rigorously investigated. The limited attention paid \nto these parameters prevents a comprehensive evalua-\ntion of TENS as a rehabilitative tool beyond its analgesic \neffects. \nThe duration of the follow-up periods was generally \nlimited, with only one study extending to 120 days. This \nlimits the understanding of the long-term efficacy and \nsustainability of TENS-induced improvements, as well \nas its potential role in chronic pain management and \nrelapse prevention. \nAdditionally, the studies reviewed did not system-\natically evaluate cost-effectiveness, patient adherence, \nor satisfaction, factors that are crucial for translating \nclinical efficacy into practical implementation. \nFinally, publication bias cannot be excluded. Stud-\nies reporting positive outcomes are more likely to be \npublished, which may overestimate the apparent  \neffectiveness of TENS in the treatment of pelvic pain. In \naddition, potential conflicts of interest in the included \nstudies may further influence the reported outcomes \nand should be taken into consideration when interpret-\ning the findings.\nIt is therefore evident that future research should \naddress the aforementioned limitations through more \nsystematic and methodologically robust investigations. \nThere is a need for large-scale, multicentre RCTs with \nharmonization of the parameters used, in order to fa-\ncilitate the development of clinical guidelines. More-\nover, future studies should adopt a  multidimensional \napproach, assessing not only pain intensity but also \nfunctional outcomes and overall quality of life. Finally, \nlong-term follow-up assessments are essential to eval-\nuate the sustainability of the beneficial effects of TENS.\nConclusions\nThe present review indicates that TENS may be ef-\nfective in reducing pelvic pain in women, particularly in \nconditions such as dysmenorrhea and vestibulodynia, \nwith consistent evidence for analgesic effects. Evidence \nregarding secondary functional and rehabilitative out-\ncomes, including sexual function and pelvic muscle per-\nformance, remains limited and inconclusive.\n\nMenopause Review/Przegląd Menopauzalny 25(1) 2026\n51\nTranscutaneous electrical nerve stimulation may \nbe considered as an adjunctive, non-pharmacological \noption for pain management, potentially reducing re-\nliance on medications. However, given the small num-\nber of studies, heterogeneity of protocols and limited \nlong-term follow-up, it should be regarded primarily as \na symptomatic intervention rather than a comprehen-\nsive rehabilitative approach.\nFuture research should focus on large-scale, multi-\ncentre RCTs with standardized protocols, multidimen-\nsional outcome assessment, and long-term follow-up to \nclarify both analgesic and functional benefits and guide \nclinical practice. \nDisclosures\n1. Institutional review board statement: Not applicable. \n2. Assistance with the article: None. \n3. Financial support and sponsorship: None. \n4. Conflicts of interest: None.\nReferences\n1. Lamvu G, Carrillo J, Ouyang C, Rapkin A. Chronic pelvic pain in women: \na review. JAMA 2021; 325: 2381-2391. \n2. Latthe P , Latthe M, Say L, Gülmezoglu M, Khan KS. WHO systematic \nreview of prevalence of chronic pelvic pain: a  neglected reproductive \nhealth morbidity. BMC Public Health 2006; 6: 177. \n3. 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