Association Between Cesarean Scar Mobility and Menstrual Pain in Post-Cesarean Women

Cesarean section is one of the most frequently performed surgical procedures worldwide. Although generally safe, postoperative scar formation and fascial adhesions may result in long-term alterations in tissue mobility and biomechanics. These changes have been suggested to contribute to persistent symptoms, including menstrual pain, chronic pelvic pain, abdominal tenderness, and functional impairment. Despite increasing interest in cesarean scar assessment, the relationship between scar mobility and menstrual pain severity has not been sufficiently investigated.

Restricted scar mobility may influence the mechanical behavior of the abdominal wall and surrounding fascial structures, potentially contributing to altered force transmission, increased tissue sensitivity, and pain during menstruation. Understanding this relationship may improve the clinical evaluation of women presenting with post-cesarean menstrual pain and assist in identifying patients who may benefit from targeted rehabilitation interventions.

This observational cross-sectional study aims to investigate the association between cesarean scar mobility and menstrual pain severity in women following cesarean section. Baseline measurements will be obtained to assess cesarean scar mobility, menstrual pain severity, pressure pain threshold, and selected demographic and obstetric characteristics. Correlation and regression analyses will be performed to determine whether cesarean scar mobility is associated with menstrual pain severity and whether it independently predicts menstrual pain after controlling for potential confounding variables.

The findings of this study are expected to improve understanding of the clinical significance of cesarean scar mobility in women with menstrual pain and provide evidence to support comprehensive scar assessment as part of women's health physical therapy practice.

Inclusion criteria

• Females aged 20-35 years.
• History of at least one cesarean section.
• Regular menstrual cycles.
• Presence of menstrual pain during the previous three menstrual cycles.
• Body mass index (BMI) between 18.5 and 29.9 kg/m².
• Willingness to participate and provide written informed consent.

Exclusion criteria

• Current pregnancy.
• History of pelvic or abdominal surgery other than cesarean section.
• Endometriosis or adenomyosis.
• Uterine fibroids associated with pelvic pain.
• Pelvic inflammatory disease.
• Congenital uterine anomalies.
• Neurological disorders affecting pain perception.
• Current use of hormonal therapy or medications affecting pain perception.
• Active skin infection or open wound over the cesarean scar.
• Malignancy.
• Inability to complete study assessments.