Background and Aims Pelvic pain from an episiotomy could be a debilitating and painful condition affecting women giving birth vaginally. Various treatments have been used in clinical practice to relieve pelvic pain with little efficacy. (1) We report the case of a patient with chronic pelvic pain after episiotomy conditioning sexual dysfunction submitted to pudendal radiofrequency using a modified approach, with a great improvement.

Methods A 31 year-old female was referred to Pain Medicine Unit due to pelvic pain in the local of episiotomy scar. She referred intense pain with neuropathic characteristics since her last pregnancy, in 2017. She was initially medicated with conducting inhibitors with a mild improvement, being also submitted to someoff-labeltreatments in another Pain Medicine Unit. After the first evaluation in our Unit she was medicated with pregabaline and magnesium supplements, being proposed to pudendal nerve radiofrequency. An anterior approach of left pudendal nerve was performed by anatomic references. Due to high level of fibrosis and high tissue impedance, a modified approach using two needles in parallel position was performed. Radiofrequency was complemented with scar infiltration with ropivacaine and dexamethasone.

Results After the procedure the patient maintained asymptomatic.

Conclusions Episiotomy is still often performed in the context of vaginal deliveries. It is often associated with increased morbidity, and is currently included in situations of obstetric violence. Chronic pelvic pain associated with episiotomy is relatively frequent and its treatment could be truly challenging. We report the successful case of chronic pelvic pain treatment using a modified approach of pudendal radiofrequency.