After childbirth, TENS eases perineal pain where laser and ultrasound fail

Perineal trauma, whether from a tear or an episiotomy cut, is one of the most common consequences of vaginal childbirth, and the pain that follows can slow a new mother's recovery at exactly the moment she needs to be mobile. Maternity units offer a range of physical therapies for it, from electrical stimulation to laser, ultrasound and simple cooling. Yet the randomised evidence behind these options has been fragmented and hard to compare, leaving both women and clinicians guessing about which approaches actually help. This review set out to pull that scattered evidence together and rank the drug-free options against each other.

The authors conducted a systematic review and meta-analysis following PRISMA 2020 guidance. They searched PubMed/MEDLINE, Embase, CENTRAL, CINAHL, ClinicalTrials.gov and ICTRP from inception to April 7, 2026, looking for randomised controlled trials of physical or electrophysical rehabilitation after episiotomy or childbirth-related perineal trauma. The outcomes of interest were perineal pain, wound healing and oedema. Nine trials met the criteria, seven of which contributed data that could be pooled, and the quality of each trial was assessed with the Cochrane Risk of Bias 2 tool.

TENS significantly reduced short-term postpartum perineal pain compared with control, and the pooled effect was substantial. Low-level laser therapy showed no significant benefit, and therapeutic ultrasound produced no significant reduction in persistent pain. Evidence that could not be pooled pointed to favourable effects of cooling interventions on oedema, immediate pain relief and maternal satisfaction. Trial quality was mixed: two studies were judged at low risk of bias, five raised some concerns and two were at high risk of bias.

The authors describe this as the first comparative synthesis of randomised evidence across physical and electrophysical options for postpartum perineal recovery. It strengthens the case for TENS as the modality with the best current support, and it complicates the position of laser and ultrasound, which showed nothing significant here. Cooling comes out looking reasonable for local symptom management, though that rests on narrative rather than pooled evidence. With only nine trials in total and most carrying at least some quality concerns, the authors are explicit that larger, more rigorous trials are needed.

If you or someone close to you is recovering from a perineal tear or episiotomy, this is a reason to think the drug-free options on offer are not all equal. Electrical nerve stimulation currently has the best randomised backing for easing pain in the days after birth, while laser and ultrasound have little to show for themselves in this synthesis. Simple cooling appears to be a sensible option for swelling and immediate relief. The evidence base remains small, so these conclusions could shift as larger trials arrive, and any recovery plan is still a conversation to have with a midwife or physiotherapist.