Mapping Interventions Targeting the Microbiome in Chronic Pelvic Pain: A Scoping Review

Background and/or Objectives: Chronic Pelvic Pain (CPP) is a complex condition with limited effective treatments. Emerging research suggests a potential role for the gut-vaginal microbiome axis, but no high-level evidence has assessed microbiome-targeted therapies. This study aims to evaluate existing clinical evidence on these interventions and identify gaps in the literature. There is also no consensus on whether these therapies are effective as standalone treatments or offer synergistic benefits when combined with standard care.

Design: A systematic search (2000–2025) of multiple databases identified studies on microbiome-targeted therapies for female pelvic pain conditions. Included were randomized control trials, observational studies, systematic reviews, and case series involving interventions like pre/probiotics, dietary changes, antibiotics, and pelvic floor stimulation. Studies were excluded if they involved animals or addressed unrelated conditions. Data were narratively synthesized.

Setting : Literature-based systematic review conducted using electronic databases from a remote research setting.

Participants : Female patients with chronic pelvic pain conditions (e.g. endometriosis) as described in the included studies.

Interventions: Microbiome-targeted therapies including probiotics, prebiotics, dietary modifications, antibiotics, and pelvic floor electrical stimulation.

Main Outcome Measures: Pain severity, quality of life, changes in microbiome composition, and inflammatory biomarkers.

Results: Microbiome-targeted therapies showed modest to mixed benefits. Oral probiotics modestly reduced NSAID use but did not improve quality of life. Probiotics combined with HIIT offered no added pain relief beyond exercise. Pelvic floor electrical stimulation consistently improved symptoms, enriched lactobacillus-dominated vaginal flora, and reduced pro-inflammatory cytokines. Local therapies (e.g., vaginal estrogen, Cerviron ovules) showed no significant effects. Omega-3 supplementation was associated with reduced endometriosis-related pain.

Conclusions: Microbiome-targeted therapies such as oral probiotics and omega-3 supplements offer modest or mixed benefits for pelvic pain. More consistent improvements are seen with pelvic floor electrical stimulation, which alleviates symptoms and modulates vaginal microbiota and inflammation. Local therapies showed limited efficacy. Interventions targeting both neuromuscular function and microbial balance may offer the greatest potential for symptom relief.