Biofeedback or TENS—do they help pelvic pain?

Chronic pelvic pain affects many women and can stem from various causes including endometriosis, pelvic floor dysfunction, vulvodynia, bladder pain syndrome, or scar tissue from surgery or childbirth. The pain may feel like a constant ache, sharp stabbing, burning, or deep pressure. It often leads to muscle guarding—where the pelvic floor muscles tighten protectively—which then perpetuates the pain cycle.

Biofeedback and TENS are both conservative, evidence-based interventions that target different aspects of this pain cycle. They are typically used alongside pelvic physiotherapy, psychological support, and medical treatments rather than as standalone cures. Understanding how each works helps you make an informed choice about which might suit your symptoms best.

What is Biofeedback and How Does It Work?

Biofeedback is a therapeutic technique that teaches you to gain conscious control over involuntary muscle activity. In pelvic pain, the pelvic floor muscles often become chronically tense or spasm without you realising it. A small sensor (usually a vaginal or anal probe) measures muscle tension and displays it on a screen as a graph, colour, or sound.

• Visual Learning: You see in real-time when your muscles are contracting or relaxing, helping you identify patterns of tension you were previously unaware of.
• Re-training: With guidance from a pelvic physiotherapist, you learn specific relaxation and breathing techniques to “down-regulate” overactive muscles.
• Brain-Body Connection: Over time, this retrains your nervous system to reduce the automatic guarding response that fuels chronic pain.

Biofeedback is particularly helpful for conditions like vaginismus, levator ani syndrome, and pain related to pelvic floor hypertonia (high muscle tone).

What is TENS and How Does It Work?

TENS therapy involves placing small electrode pads on the skin near the area of pain. These deliver mild electrical pulses that stimulate sensory nerves. The proposed mechanisms include:

• Gate Control Theory: The electrical impulses “close the gate” on pain signals travelling to the brain, essentially blocking them before they are perceived.
• Endorphin Release: TENS may stimulate the body’s natural pain-relieving chemicals (endorphins), providing a soothing effect.
• Muscle Relaxation: Low-frequency settings can help reduce muscle spasm and improve local blood flow to tense tissues.

TENS can be used for period pain, vulvodynia, bladder pain, post-surgical pelvic pain, and generalised pelvic discomfort. It is safe, portable, and can be used at home once you have been trained in correct pad placement and settings.

Evidence for Biofeedback in Pelvic Pain

Research supports biofeedback as an effective component of pelvic pain management:

• A systematic review in the Cochrane Library found that pelvic floor muscle training with biofeedback significantly improved symptoms in women with chronic pelvic pain and dyspareunia.
• Studies on levator ani syndrome show that biofeedback combined with manual physiotherapy reduces pain intensity and improves quality of life.
• NICE guidance on chronic pain recognises biofeedback as a valid therapeutic option when delivered by trained professionals.

However, success depends on regular practice, skilled therapist guidance, and integration with other treatments such as cognitive behavioural therapy or topical hormones if relevant.

Evidence for TENS in Pelvic Pain

TENS has a moderate evidence base for certain pelvic pain conditions:

• For dysmenorrhoea (period pain), multiple trials show that TENS reduces pain intensity and the need for painkillers during menstruation.
• In vulvodynia, some small studies suggest TENS may reduce hypersensitivity and burning sensations, though larger trials are needed.
• TENS is recommended by the International Pelvic Pain Society as a complementary therapy for chronic pelvic pain when combined with physiotherapy and psychoeducation.

TENS is considered very safe, with minimal side effects. The main limitation is that it provides temporary relief rather than addressing the root cause, so it works best as part of a broader treatment strategy.

Which One is Right for You?

The choice depends on your specific pain pattern and goals:

• Choose Biofeedback if: Your pain is linked to muscle tension, spasm, or difficulty relaxing the pelvic floor; you want to learn long-term self-management skills; you are motivated to practise regularly with a specialist physiotherapist.
• Choose TENS if: You need immediate, on-demand pain relief; your pain is nerve-related or cyclical (e.g., with periods); you prefer a device you can use independently at home.
• Combine Both if: You have mixed muscular and nerve pain; your physiotherapist recommends a multi-modal approach; you want to maximise non-drug pain control strategies.