Pelvic pain and endometriosis are significant health concerns for women. Berghmans et al. (1) highlight the underutilized potential of physiotherapy in diagnosing and treating pelvic pain. The common symptoms associated with a decrease in activity and quality of life include dysmenorrhea, cyclical and non-cyclical lower abdominal pain, dysuria, dyschezia, and dyspareunia. With time, nociceptive pain often changes into neuropathic pain. 
Physiotherapists can use EMG and manometry in combination with vaginal and rectal palpation for diagnosis and treatment (2). It is also essential to consider the affected points in the patient's history and include any reflexive changes in movement during the diagnosis.
This abstract provides an overview of the role of physiotherapy in the treatment of endometriosis. It explores the various physiotherapy interventions, including pelvic floor muscle therapy, manual therapy, triggerpoint treatment, exercise, and pain management techniques, electrical stimulation, that can help alleviate the physical and emotional burden of endometriosis.

We conducted a literature search on Pubmed and Medline Ovid for the period between 2018 and 2024 using the keywords "Pelvic pain," "Dysmenorrhea," "Trigger points," " Dyspareunia" and "Electrical stimulation." The purpose of the search was to create an overview of the positive impact of conservative interventions. Additionally, we have conducted two studies on Electrotherapy - Biofeedback and Pelvic Pain (2).

Various therapy options for dysmenorrhea, Chronic Pelvic Pain (CPP), vulvodynia and dyspareunia have been confirmed with a high level of evidence. These include yoga, aerobics, heat application, TENS  (transcutaneous electrical nerve stimulation) therapy and various techniques for targeted and controlled muscle training with the aid of EMG and manometry, as well as electrical stimulation and manual trigger point therapy for pain relief. The positive effect of these therapies is undisputed and very good effects have been shown in combination with training by Muallem et al. In the context of physiotherapy, the strengthening of the perineal muscles, TENS application, and manual trigger point therapy have been confirmed to provide reliable results for pain relief.
Based on the search results provided, here is a summary of the key research on physiotherapy for endometriosis: 
1. A small randomized study of 22 women with endometriosis found that TENS can be helpful in reducing chronic pelvic pain by about 3 points on a pain scale and deep pain during sex (dyspareunia) by about 50%, though it did not improve period pain.
2. Systematic reviews have found some evidence for the following physiotherapy interventions for endometriosis-associated pain:
Psychological and mind-body therapies (including yoga) appear promising to treat endometriosis-related pain, anxiety, depressive symptoms, stress, and fatigue. Acupuncture has shown effectiveness for pain relief, based on 4 randomized controlled trials.
3. Pelvic floor physiotherapy has improved superficial dyspareunia, chronic pelvic pain, and pelvic floor muscle relaxation in women with deep infiltrating endometriosis.
One study described the efficacy of a non-invasive soft tissue physical therapy treatment in opening bilateral occluded fallopian tubes in infertile women with endometriosis. However, the current evidence specific to endometriosis-associated pain is still limited, and more research is needed. The impact of exercise on pain perception in women with endometriosis has been reviewed, with only two randomized controlled trials included, indicating no evidence of benefit on pain. In summary, the research suggests physiotherapy interventions like TENS, psychological/mind-body therapies, acupuncture, and pelvic floor therapy may be beneficial for managing endometriosis symptoms, but the evidence is still limited, and more high-quality studies are needed in this area

This abstract provides an overview of the role of physiotherapy in the treatment of endometriosis in addition to medication and surgery. It explores the various physiotherapy interventions, including pelvic floor muscle therapy, manual therapy, exercise, and pain management techniques, that can help alleviate the physical and emotional burden of endometriosis. The study situation points to the need for the importance of a multidisciplinary approach, where physiotherapists work in collaboration with other healthcare professionals, such as gynecologists, pain specialists, and mental health professionals, to provide comprehensive care for individuals with endometriosis. Furthermore, the abstract highlights the growing body of research that supports the efficacy of physiotherapy in improving the quality of life, reducing pain, and enhancing the overall well-being of individuals with endometriosis. It emphasizes the need for increased awareness and integration of physiotherapy as a complementary treatment option within the broader management strategies for endometriosis.

Segmental stabilizing pelvic floor and trunk muscles by biofeedback training, electrotherapy and manual therapy, thus improving the Female Sexual Index and reducing pain (3) very effective in a interprofessional setting.
In conclusion, this abstract underscores the pivotal role of physiotherapy in the holistic management of endometriosis, providing a comprehensive understanding of the various physiotherapy interventions and their potential benefits for individuals living with this complex and debilitating condition.

Berghmans B. Physiotherapy for pelvic pain and female sexual dysfunction: an untapped resource. International urogynecology journal. 2018;29(5):631-8.
Kadah S, Soh SE, Morin M, Schneider M, Ang WC, McPhate L, Frawley H. Are pelvic pain and increased pelvic floor muscle tone associated in women with persistent noncancer pelvic pain? A systematic review and meta-analysis. J Sex Med. 2023 Aug 25;20(9):1206-1221. doi: 10.1093/jsxmed/qdad089. PMID: 37507352.
Wójcik M, Szczepaniak R, Placek K. Physiotherapy Management in Endometriosis. Int J Environ Res Public Health. 2022 Dec 2;19(23):16148. doi: 10.3390/ijerph192316148. PMID: 36498220; PMCID: PMC9740037. Format: