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Background: Frequently, the women affected by the genitourinary syndrome of menopause experience genitourinary dysfunctions that profoundly influence their overall health. Even though the symptoms do not jeopardize the women's lives, the urinary and sexual dysfunctions significantly impact their quality of life. Isolated treatments focused on the main causes of the dysfunctions, such as pelvic floor muscle training (PFMT) and photobiomodulation have shown significant improvements in genitourinary dysfunctions. So, the association of PFMT with photobiomodulation may generate additional effects in the genitourinary area. This study aims to create a PFMT protocol isolated and associated with photobiomodulation therapy in women affected by the genitourinary syndrome of menopause. Methods: It is a randomized, controlled, double-blind clinical trial protocol study that will include women experiencing genitourinary symptoms related to menopause, sexually active, never practiced pelvic floor muscle exercise or photobiomodulation treatment, and do not use hormone replacement therapy for at least 3 months. The randomization will allocate the women to three groups: PFMT group, PFMT associated with active intracavitary photobiomodulation group, and PFMT associated with sham intracavitary photobiomodulation group. A total of 16 sessions will be conducted twice a week. The assessments will occur before interventions, after the sixteenth session, and 1 month after the sixteenth session (follow-up). The evaluation will include the pelvic floor muscle vaginal manometry as the primary outcome. Also, the international consultation on incontinence questionnaire—short form, the female sexual function index, the Utian Quality of Life scale, the patient global impression of improvement, the modified Oxford scale, and the vaginal health index will be the secondary outcomes. Discussion: Despite there are gold standard treatments such as PFMT, to alleviate genitourinary symptoms, interventions mirroring clinical practice are needed. This study protocol might show a groundbreaking and viable method to potentiate the effects of a gold-standard treatment associated with photobiomodulation. Conclusion: We expect this protocol to demonstrate that the use of PFMT and photobiomodulation strategies is feasible and able to potentiate the recovery of women affected by the genitourinary syndrome of menopause. The Ethics Committee of the Federal University of Rio Grande do Norte approved the study (n° 6.038.283), and the clinical trials platform registered the protocol (n° RBR-5r7zrs2). [ABSTRACT FROM AUTHOR]

The aim of this study is to assess the effect of photobiomodulation therapy (PBMT) on functional performance concerning strength, fatigue, and functional capacity in healthy individuals. This systematic review with meta-analysis involved searches on data platforms and active searches of randomized clinical trials, focusing on PBMT as the sole intervention. Primary outcomes assessed included strength, fatigue, and functional capacity. Three reviewers screened studies by title and abstract using Rayyan, and data were extracted using a specific form. Bias risk was assessed using RoB2, and confidence in the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). The RevMan was used for meta-analysis. Sixteen studies were included, totaling 340 individuals (183 males and 157 women). Most articles presented a low risk of bias. Variability was observed in device types and application domains, including wavelengths (655–905 nm), power (10–200 nW), energy (0.6–30 J per point), and time (30–100 s per point). PBMT improved fatigue recovery (mean difference: 5.87; 95% CI 3.83, 7.91). There was no enhancement in strength (peak torque: mean difference 12.40; 95% CI -5.55, 30.55; one-repetition maximum test: mean difference 39.97, 95% CI -2.44, 82.38; isometric and isokinetic strength: mean difference 2.77, 95% CI -14.90, 20.44) nor improvement in short-term (mean difference 0.67, 95% CI -0.58, 1.91) and long-term (mean difference 18.44, 95% CI -55.65, 92.54) functional capacity. PBMT may aid in favoring fatigue recovery in healthy individuals; however, there's no evidence to support PBMT enhancing strength or improving functional capacity. [ABSTRACT FROM AUTHOR]

In the narrative review, the authors addressed several neuromodulation techniques, such as sacral neuromodulation, conus medullaris stimulation, dorsal root ganglion stimulation, dorsal column spinal cord stimulation, and pudendal nerve stimulation [[1]]. 2019; 16; 1: 1-29. 10.1186/s12984-019-0581-1 8 Vaseghi B, Zoghi M, Jaberzadeh S. How does anodal transcranial direct current stimulation of the pain neuromatrix affect brain excitability and pain perception? Keywords: Transcranial direct current stimulation; Chronic pain; Women's health EN Transcranial direct current stimulation Chronic pain Women's health 1095 1097 3 06/27/23 20230801 NES 230801 This comment refers to the article available online at https://doi.org/10.1007/s40122-022-00430-9. [Extracted from the article]

Objective The aim of this trial was to investigate the effects of five consecutive sessions of anodal transcranial direct current stimulation (tDCS) over the motor cortex (M1) on pain, mood, and physical performance in patients with primary dysmenorrhea (PDM). Design This is a double-blind randomized controlled trial. Subjects Twenty-two participants with PDM according to the No. 345-PDM Consensus Guideline were included. Methods Eleven active treatment and 11 sham stimulation patients received five applications over a one-week period. The primary outcome measures were pain evaluated by numeric rating scale (NRS) and McGill Questionnaire score. Secondary outcomes measures were responses to the Positive and Negative Affect Schedule (PANAS), Hamilton Anxiety Scale (HAM-A), grip strength, and six-minute walk test (6MWT). Baseline data were performed during the first menstrual cycle, and during the second menstrual cycle, participants were conducted to tDCS treatment, and postintervention data were collected. Results The intervention provided significant improvements on NRS in active tDCS, shown as an interaction between group intervention vs pre/postintervention vs days of menstrual cycle (Wald x2 = 10.54, P = 0.005), main effect of days of menstrual cycle (Wald x2 = 25.42, P < 0.001), and pre/postintervention (Wald x2 = 6.97, P = 0.008). McGill showed an interaction effect between pre/postintervention and group of stimulation (Wald x2 = 18.45, P = 0.001), with a large reduction in active tDCS (P < 0.001, d  = 0.75). Psychological and functional outcomes did not differ between groups or pre/postintervention. Conclusions tDCS could provide pain relief in subjects with PDM. These results provide some preliminary evidence for the potential role of tDCS as a contributor to the management of symptoms of PDM. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the effect of low-level laser therapy (LLLT) on immediate postpartum pain relief during cesarean section. A randomized, parallel controlled trial was carried out. In total, 88 women with immediate postpartum were divided into 4 groups: control group (n = 22), placebo group (n = 22), experimental group I (n = 22, dose of 4 J/cm2), and experimental group II (n = 22, dose of 2 J/cm2). The pain measured by Numeric Rating Scale (NRS), algometry, and Global Change Perception Scale (GCPS) was assessed at 12, 20-24, and 44-48 h postpartum. Two LLLT sessions were performed at 12 and 24 h postpartum. A significant interaction was observed between time versus group for NRS F (2.40) = 36.80, p < 0.001 and algometry F (1.70) = 27.18, p < 0.001. GCPS revealed a significant difference between the groups during second (p = 0.04) and third evaluation (p = 0.04). The NRS and algometry presented a large effect size for the experimental groups. LLLT is an efficient method to reduce pain and enhance the GCP in postcesarean section. No significant clinical differences were found between the laser doses. [ABSTRACT FROM AUTHOR]

Aims: To describe a pelvic floor muscle training (PFMT) isolated and associated with game therapy (PFMT + GT) for women facing mixed urinary incontinence (MUI) during climacteric period. Methods: To standardize a randomized controlled clinical trial intervention, a protocol was created, in an attempt to decrease women's symptomatology generated by MUI, through pelvic floor and abdomino‐loin‐pelvic muscles strength, and endurance. This study protocol will be composed of 32 volunteers, divided into two groups of 16. They will perform PFMT isolated or PFMT + GT, twice a week during 8 weeks. Interventions will last 40 minutes and will be divided into warming (5 minutes), training (30 minutes), and 5 minutes will be composed of resting time between exercises (1 minute each). Isolated PFMT sessions will be performed through four modalities of exercises: diaphragmatic, bridge, abdominal (plank), and pelvic mobility. PFMT + GT training will be carried out by using Wii Fit Plus games, such as Lotus Focus, Penguin Slide, Basic Step, and Hula Hoop from Wii equipment. Assessments will occur before, after, and 1 month after interventions. Vaginal manometry, 1‐hour Pad Test, International Consultation on Incontinence Questionnaire—Short Form (ICIQ‐SF), and Patient Global Intervention (PGI) will be used to evaluate the sample. Conclusions: It is expected greater increase on pelvic floor muscle (PFM) strength, endurance, vaginal pressure for PFMT + GG. Moreover, it is supposed that PFMT + GT volunteers present better treatment adherence due to games motivational inclusion. [ABSTRACT FROM AUTHOR]

Background: Primary dysmenorrhea is a common and often debilitating condition affecting 40– 90% of menstruating women. This condition reduces functionality, quality of life, and social activities. Transcranial direct current stimulation (tDCS) has been used in many chronic pain syndromes, with evidence of improved pain, functionality, and mood in women with primary dysmenorrhea. The objective of this study was to determine whether tDCS could offer clinical benefits on pain, anxiety, affectivity, and functionality in women with primary dysmenorrhea. Methods: This parallel, sham, randomized, double-blind trial was conducted with 26 women randomized into sham tDCS and active tDCS. Anodal tDCS was applied for 5 consecutive days over F3 corresponding to the left dorsolateral prefrontal cortex (DLPFC) and the cathode electrode over Fp2 for 20 min with an intensity of 2 mA. A numeric rating scale (NRS) was used to assess pain, anxiety, positive and negative affect, and submaximal aerobic performance during two consecutive menstrual cycles. Results: No significant interaction was found between intervention and time on the NRS [F(2,44) = 1.358, p =  0.26], and a significant main effect of time [F(2,44) = 4.446, p =  0.01] was found. The active group showed a significant reduction in anxiety (p =  0.03) with a mean difference of 5.12 (95% CI 0.79 to 11.05). No significant differences in positive and negative affect were found (p =  0.95 and p =  0.15, respectively). Submaximal aerobic performance was significantly greater in the active group [F(2,21) = 5.591, p =  0.02], with a mean difference of 70.87 (95% CI 8.53 to 133.21). Conclusion: Anodal tDCS over the DLPFC seems to be an effective therapeutic approach for improving anxiety and functionality in women with primary dysmenorrhea. [ABSTRACT FROM AUTHOR]