Monopolar Capacitive-Resistive Radiofrequency for Pelvic Floor Hypertonia and Vaginismus: A Case Series

Pelvic floor hypertonia is an important musculoskeletal contributor to chronic pelvic pain and may be associated with genito-pelvic pain/penetration disorders, including vaginismus. We describe a prospective case series of three women aged 31, 32, and 45 years with pelvic floor hypertonia and vaginismus who underwent six weekly treatment sessions using a monopolar capacitive-resistive radiofrequency device (C200; Capenergy Medical, S.L., Sant Joan Despí, Barcelona, Spain). Each session consisted of a 20-minute intracavitary application using the MJS (Medical Jet System) handpiece combined with simultaneous application of an automatic pelvic plate. Outcomes were assessed before treatment and at follow-up using pain scores, the Female Sexual Function Index (FSFI), pelvic floor examination, and functional assessment of vaginal penetration. Baseline pain scores ranged from 8 to 9 out of 10 and decreased to 0 to 1 at follow-up. FSFI total scores increased from a baseline range of 8.3-12.4 to 28.9-31.8 at follow-up. All three patients showed improvement in clinically assessed pelvic floor muscle hypertonia and regained pain-free vaginal penetration, with satisfactory penetrative intercourse reported during follow-up. In this small uncontrolled case series, monopolar capacitive-resistive radiofrequency treatment was associated with clinically relevant improvements in pelvic pain, pelvic floor examination findings, and sexual function. These findings are preliminary and hypothesis-generating and cannot establish treatment efficacy. Larger controlled prospective studies using standardized treatment protocols, objective pelvic floor assessments, and predefined long-term follow-up are needed to determine the efficacy, safety, and appropriate clinical role of this intervention.