Treating Persistent Pelvic Pain with Dry Needling

Persistent Pelvic Pain (PPP) in women is defined as pain that may or may not be cyclic in nature that occurs without or without pathology. In more than half of the patients that suffer from PPP, the cause of their pain is multifactorial. Dysfunctions may occur at the level of the muscles, reproductive and/or digestive system as well as taking into consideration mental health factors. The areas someone feels pain may extend beyond the genitals and pelvic floor muscles to include the muscles around the buttocks, abdominal region, and lower back. This makes treatment require a multifaceted approach from providers that include physicians and pelvic floor physical therapists and extend beyond just surgery and medications. Dry needling (DN) is another treatment method that both physicians and certified physical therapists can use to reduce pain, reduce tightness in muscles and even improve function.

Dry needling involves the use of acupuncture needles with a western approach that takes into the biomechanics and neuromuscular system to determine a treatment plan. DN sometimes is used in conjunction with electrical current, to “reset” the nervous system, resulting in reduced pain and tightness and improved muscle function.

Dry needling techniques may target hypersensitive muscles, often referred to as trigger points, or utilize an indirect approach by inserting needles into the sacral area, where the sacral nerves (S2-S4) directly innervate the pelvic floor muscles. The same sacral nerves are associated with the parasympathetic nervous system- the “rest and digest”  part of our nervous system. Indirect treatment to these nerves reduces tightness at the pelvic floor muscles but then can induce a relaxation effect, reduce anxiety and improve sleep.

I typically begin with an indirect approach to alleviate anxiety about needles being placed near sensitive areas like the vulvar/perineal region. Using transcutaneous electrical nerve stimulation (TENS) in conjunction with needles has shown to prolong pain relief and reduce local muscle soreness.

Dry needling is not typically employed as a standalone treatment. It should be complemented with patient education on pain management and exercises aimed at improving posture, muscle strength, mobility, and reducing sensitivity to functional movement. Additional techniques such as soft tissue mobilization through massage and myofascial release may also be incorporated.

Sessions typically last between 30-45 minutes, with symptom alleviation often occurring immediately, though 2-6 weekly sessions are typically required for sustained benefits. Common side effects of dry needling include bruising, mild bleeding, and post-session soreness. Patients with active infections, bleeding disorders, reduced sensation, active cancer, and those with a fear of needles are generally not suitable candidates for this treatment.

It is key to get to the root cause of how those suffering experience pain. While dry needling is not a “miracle” treatment, it represents a valuable tool for healthcare providers and patients coping with chronic pelvic pain.

Dr. Melanie Llanes is a Doctor of Physical Therapy, a long time yoga teacher and the owner of Best Self Wellness, providing wellness services, specializing in pelvic health PT, prenatal and restorative yoga as well as strength and conditioning services.