For millions of new mothers each year, the arrival of a baby is followed by weeks of a pain that few people talk about: the burning, stinging and aching of a bruised, torn or surgically cut perineum. According to the authors of a sweeping new review published in BMC Complementary Medicine and Therapies, postpartum perineal pain affects up to 90 percent of women after vaginal delivery, and roughly 37 percent describe it as moderate to severe. Yet the standard answer—paracetamol, non-steroidal anti-inflammatory drugs, and in more stubborn cases opioids—leaves many patients undertreated, particularly those who want to avoid medication while breastfeeding. The review, led by Joanna Wojtas and colleagues at the Medical University of Gdańsk, maps the entire landscape of non-drug therapies tested for this pain and finds that a handful of surprisingly simple physical treatments, chief among them cold therapy, may offer real relief.
The team conducted a scoping review, a study design intended to chart the breadth and quality of existing evidence rather than pool it into a single statistical estimate. The researchers searched PubMed, EBSCO, CINAHL, Ovid and Google Scholar for studies published between May 2012 and February 2025, structuring their search around the PICO framework—population, intervention, comparison, outcome—and assessed the methodological rigor of each study using the quality assessment tools developed by the United States National Heart, Lung, and Blood Institute. The haul amounted to 35 individual investigations: 27 randomized controlled trials, three randomized pilot studies, four pre-post studies and one case series. That breadth matters, because perineal pain is not a niche complaint. Assisted deliveries, episiotomies and perineal lacerations all increase both the intensity of pain and the amount of medication women need afterward, making effective conservative options a genuine public health question.
The clearest signal in the review came from an almost old-fashioned remedy. Eight studies supported cold therapy—ice packs, cold gel pads and similar applications—for short-term relief of perineal pain. The technique is physiologically plausible: cooling the tissue slows local nerve conduction, reduces swelling and dampens inflammatory signaling in the damaged perineal wound. The catch, the authors note, is that the studies used markedly different protocols, varying in how long the cold was applied, how often, and with what devices. Without standardized treatment regimens, clinicians have little guidance on how to translate the positive findings into practice, even though the direction of the evidence is consistent and the intervention carries essentially no pharmacological risk to a nursing mother.
Light-based therapies produced a far more skeptical verdict. Five studies examined light therapy, split between low-level laser therapy and far-infrared radiation, and most showed no superiority over placebo or no treatment. Low-level laser therapy delivers non-thermal red and near-infrared light intended to stimulate cellular repair, while far-infrared devices emit gentle radiant heat; neither convincingly outperformed sham treatment in the trials reviewed. This stands in contrast to the enthusiasm that light-based wound-healing devices sometimes attract, and it underscores a recurring theme of the review: plausible mechanisms do not guarantee clinical benefit, and rigorous randomized comparisons frequently deflate early promise.
Electricity fared considerably better. Four trials of transcutaneous electrical nerve stimulation, or TENS, showed the technique’s superiority over placebo despite varying stimulation protocols. TENS works through electrodes placed on the skin that deliver low-voltage electrical pulses, thought to activate inhibitory pain pathways in the spinal cord—the gate-control mechanism that competes with pain signals before they reach consciousness. Trials tested both high-frequency and low-frequency stimulation, and while protocols were again inconsistent, the consistent finding across studies was meaningful pain reduction. For women reluctant to take any systemic drug in the early postpartum days, a wearable electrical device offers an appealing, drug-free adjunct or alternative.
Radiofrequency therapy, a less familiar option to most patients, also emerged as a candidate worth watching. Two randomized controlled trials of radiofrequency treatment reported reduced perineal pain and discomfort in certain positions. The reviewed studies included capacitive and resistive energy transfer systems, which heat deeper tissue layers to promote circulation and healing. The evidence base is thin—just two trials—but both pointed in the same direction, prompting the authors to place radiofrequency alongside cold therapy and TENS among the most promising conservative treatments. One additional study found therapeutic ultrasound delivered with gel pads more effective than gel pads alone or laser therapy, adding a further physical modality to the shortlist, though a single trial is far from definitive.
Temperature-based care during and after labor received mixed marks. Two studies found that heat therapy applied during labor was effective for short-term pain relief, and two observational studies examined water immersion, but the latter were judged to be of low quality, leaving their findings uncertain. One study that combined cold application, heat application and pelvic floor muscle training showed significant benefits lasting up to seven days after delivery, suggesting that multi-component conservative care may outperform any single technique. Intriguingly, the reviewers found that no study has yet tested pelvic floor muscle training on its own for postpartum perineal pain relief—an conspicuous gap, given how widely the exercises are prescribed for pelvic floor recovery after childbirth.
The review was less kind to hands-on and needle-based traditions. A single study of manual therapy produced results the authors described as unclear, and its quality was rated low. Seven trials of acupuncture and acupressure—needle stimulation and finger pressure at defined points, respectively—were of poor to fair methodological quality, with mixed findings on whether the techniques reduced pain or the need for pain medication. With no high-quality randomized evidence to lean on, the reviewers declined to endorse these approaches, a sobering conclusion for a family of therapies often assumed to be well supported. Similarly, the single study touching on osteopathic manipulative treatment left the question of its value essentially open.
The methodological weaknesses that run through the evidence base are as important as any individual result. Only a minority of the 35 studies were fully powered randomized controlled trials, blinding is inherently difficult when the treatment involves visible ice packs or electrical devices, and outcome measures varied from visual analogue and numerical rating scales to composite wound-healing scores such as the REEDA scale and questionnaires on postpartum comfort and sexual function. The authors’ conclusion is deliberately cautious: the evidence supports cold therapy, TENS and radiofrequency as emerging options, but the limited number of robust studies means clinicians and patients should interpret even the positive findings carefully until larger, protocol-standardized trials are completed.
Still, the practical implications are significant for a condition that touches nearly every vaginal delivery. Perineal pain in the first weeks after birth interferes with breastfeeding, infant care, sleep, mobility and early sexual recovery, and up to 37 percent of affected women rate their pain as moderate to severe even while taking conventional analgesics. A structured, evidence-informed toolkit of cooling, electrical stimulation and possibly radiofrequency could meaningfully reduce reliance on opioids and other systemic drugs at a time when many mothers are anxious about medication passing into breast milk. The Gdańsk team’s review does not declare any of these treatments a cure, but it does something arguably more useful: it separates the therapies with converging randomized evidence from those riding on hype, and it lays out exactly where the next generation of trials should focus. For postpartum women and the clinicians who care for them, the message is that sometimes the most effective medicine for childbirth’s most common overlooked pain may be found not in the pharmacy, but in the freezer, the physiotherapy suite and the low-voltage electrode.
Subject of Research: Non-pharmacological management of postpartum perineal pain
Article Title: When analgesics are not enough for postpartum perineal pain—a scoping review of the non-pharmacological, conservative therapies
Article References: Wojtas, J., Sotomska, Z., Pietrzak, J., Waldman, A., Wydra, D., & Grzybowska, M. E. (2026). When analgesics are not enough for postpartum perineal pain—a scoping review of the non-pharmacological, conservative therapies. BMC Complementary Medicine and Therapies. https://doi.org/10.1186/s12906-026-05544-7
Image Credits: AI Generated
DOI: 10.1186/s12906-026-05544-7
Keywords: postpartum perineal pain, cold therapy, TENS, radiofrequency, scoping review, pain management, non-pharmacological therapies, low-level laser therapy, acupuncture, acupressure, pelvic floor, childbirth recovery
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Ophelia Keating. (September 26, 2026). Cold Packs, Nerve Stimulation and Radiofrequency Emerge as Drug-Free Options for Postpartum Perineal Pain. Scienmag. https://scienmag.com/cold-packs-nerve-stimulation-and-radiofrequency-emerge-as-drug-free-options-for-postpartum-perineal-pain/
Ophelia Keating. “Cold Packs, Nerve Stimulation and Radiofrequency Emerge as Drug-Free Options for Postpartum Perineal Pain.” Scienmag, 26 September 2026, https://scienmag.com/cold-packs-nerve-stimulation-and-radiofrequency-emerge-as-drug-free-options-for-postpartum-perineal-pain/. Accessed 26 September 2026.
Ophelia Keating. “Cold Packs, Nerve Stimulation and Radiofrequency Emerge as Drug-Free Options for Postpartum Perineal Pain.” Scienmag. September 26, 2026. https://scienmag.com/cold-packs-nerve-stimulation-and-radiofrequency-emerge-as-drug-free-options-for-postpartum-perineal-pain/
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