This study aims to determine the effect of the myofascial release combined with acupressure on BL23 on chronic perineal pain.

Perineal pain is a typical sequel vaginal delivery, affecting up to 42% of women at ten days postpartum and persisting in 10% at 18 months. As the fibers of scar tissue form, however, they are typically weaker, with more limited movement and less oxygen circulation than normal skin tissue. This lack of skin and muscle elasticity around an episiotomy or perineal scar can result in side effects, such as pain during sex or when passing a stool, urinary or fecal incontinence, pelvic organ prolapse, and ongoing infections. Moreover, chronic perineal pain can affect the woman psychologically and impact the transition to parenthood, the sexual relationship with her partner, and their ability to breastfeed.

Pharmacological therapies are effective; however, they have side effects as they can pass into breast milk and subsequent harm to the neonate. So, studies need to test and support the effectiveness and safety of some non-pharmacological techniques that could benefit a wide range of women suffering from postpartum perineal pain.

Perineal massage enhances perineal results by stretching the tissues of the vagina, facilitating perineal relaxation, and increasing tissue circulation. Acupressure is a noninvasive method whose nature is similar to acupuncture. This method is effective in sedating pain and reducing its intensity. Some researchers believe that acupressure prevents the transfer of pain stimulators, increases blood endorphin levels, and reduces pain.

Therefore, this study will be carried out to verify the effect of myofascial release and acupressure on postpartum perineal pain.

To our knowledge, this study is the first to investigate the effect of myofascial release combined with acupressure on chronic postpartum perineal pain. Therefore, this study will be conducted to provide physiotherapists with updated scientific knowledge concerning the effect of adding the myofascial release to acupressure on chronic perineal pain, aiming to improve quality of life and decrease pain. This study may expand the role of physiotherapy in women's health.

Inclusion Criteria:

1. All women will be diagnosed with chronic perineal pain from episiotomy scar and referred by the gynecologist.
2. Their age will range from 18 to 30 years.
3. They should not have skin irritation/inflammation at the perineum.
4. They should not receive epidural anesthesia, ice packs, or non-steroidal anti-inflammatory drugs during the treatment sessions.
5. They should not suffer from major physical problems such as spinal fractures or disc Hernias.

Exclusion Criteria:

1. Having a laceration other than an episiotomy.
2. Having an operative vaginal delivery (forceps, vacuum).
3. Chronic disease (diabetes mellitus, thyroid, hypertension).
4. Regular medication use or any postnatal complication in the newborn.