Dermoid cysts, medically called mature cystic teratomas, develop from germ cells in the ovary. They are formed from primitive cells that have the potential to develop into many different types of tissue in the body. These cells have not become specialized yet, like a skin or brain cell. Because of this origin, dermoid cysts can contain a mixture of tissues such as fat, hair, skin, and occasionally even teeth or bone. These cysts are typically benign and slow-growing.

Many dermoid cysts cause no symptoms at all. In fact, I frequently diagnose them incidentally when imaging is performed for another reason. When symptoms do occur, they are usually related to the size of the cyst or the pressure it places on surrounding structures. Some women describe a dull pelvic ache, a sense of fullness, or intermittent discomfort on one side of the pelvis. Others may notice pain with certain movements, physical activity, or with intercourse. 

One of the main reasons we pay attention to dermoid cysts is the risk of ovarian torsion. Because these cysts can become relatively heavy, they can cause the ovary to twist around its base and blood supply. When that happens, patients typically experience sudden and severe pelvic pain, often accompanied by nausea or vomiting. Ovarian torsion is considered a surgical emergency because prolonged loss of blood flow can damage the ovary.

RELATED: Types Of Ovarian Cysts

Diagnosis usually begins with a pelvic ultrasound. Dermoid cysts often have a distinctive appearance on ultrasound because of their fat content and mixed tissue components. Radiologists frequently recognize these patterns immediately. In situations where imaging is unclear, an MRI can provide additional detail and help confirm the diagnosis before deciding on treatment.

Management depends on several factors, including the size of the cyst, the presence of symptoms, the patient’s age, and fertility considerations. Small dermoid cysts that are not causing symptoms can sometimes be monitored with periodic imaging. However, once a cyst grows beyond a certain size, the risk of complications such as torsion increases, and surgical removal may be recommended.

When surgery is necessary, the goal is usually to remove the cyst while preserving as much normal ovarian tissue as possible. This procedure is called an ovarian cystectomy. In many patients, it can be performed laparoscopically using minimally invasive techniques. Through small incisions, the cyst is carefully separated from the ovary and removed while maintaining the remaining healthy ovarian tissue. Preserving ovarian function is particularly important in younger women who may wish to have children in the future. 

Occasionally, if the cyst is very large or if the ovary has been extensively damaged, removal of the ovary may be necessary. Fortunately, this situation is relatively uncommon. In most cases, we are able to successfully remove the dermoid cyst while leaving the ovary intact and preserving fertility.

Recovery after minimally invasive surgery is generally smooth. Most patients return home the same day and resume normal activities within one to two weeks. After surgery, the cyst is examined by a pathologist to confirm the diagnosis.

Patients often ask whether dermoid cysts can recur. Once a dermoid cyst has been removed from an ovary, that specific cyst does not return. However, because these cysts arise from germ cells, it is possible for a new dermoid cyst to develop later in either ovary, although this does not happen frequently. There is a 15% chance of recurrence is reported. 

The most important point is that dermoid cysts are common, usually benign, and highly treatable. With proper diagnosis and appropriate management, most women recover fully and continue to have normal ovarian function.

In my practice, I encourage women not to ignore persistent pelvic pain, pressure, or unexplained symptoms. Early evaluation allows us to identify ovarian conditions such as dermoid cysts before complications develop. 

If you have been diagnosed with an ovarian cyst or are experiencing persistent pelvic symptoms, we can help determine whether monitoring or treatment is the appropriate next step. Book a consultation today or give us a call (818) 265-9499.

The post Dermoid Cysts of the Ovary: Understanding the Diagnosis and Treatment Options appeared first on Best Uro-Gynecologist Los Angeles, OB/GYN Glendale | Dr. Michael Tahery.

The stage reflects how much disease is present anatomically. It does not measure how much it hurts.

HOW STAGING IS DETERMINED?

The system most surgeons use is the revised American Society for Reproductive Medicine classification. During laparoscopy, we assign points based on the number of implants, how deeply they invade, whether adhesions are present, and whether the ovaries are involved.

That scoring places the disease into Stage 1 through Stage 4.

This classification is surgical. It cannot be confirmed by symptoms alone, and early disease is often invisible on imaging.

Stage 1 (Minimal)

Stage 1 usually consists of small, superficial implants scattered along the pelvic lining. There is little or no scar tissue. The anatomy remains largely undistorted.

This is the stage most likely to be dismissed. Imaging is often normal. Patients are told their pain is hormonal or functional.

Yet I have seen Stage 1 lesions sitting directly over sensitive nerve pathways that produce significant pain. Location matters more than surface area.

Stage 2 (Mild)

Stage 2 reflects a greater number of implants and slightly deeper invasion. Mild adhesions may begin to form, though the pelvic organs are still mobile.

Pain often becomes less predictable at this point. It may extend beyond menstruation. Intercourse may become uncomfortable. Patients sometimes describe a heaviness or pressure rather than cramping alone.

Although categorized as “mild,” symptoms are not necessarily mild.

Stage 3 (Moderate)

By Stage 3, scar tissue becomes more substantial. The ovaries may adhere to the pelvic sidewall or uterus. Endometriomas, blood-filled ovarian cysts,  are common.

This is often the stage where fertility questions emerge. The fallopian tubes may be tethered. The ovaries may not move freely.

Chronic pelvic pain becomes more common, but again, the degree varies widely from patient to patient.

Stage 4 (Severe)

Stage 4 involves dense adhesions and deep implants. Organs may become fused together, sometimes creating what surgeons refer to as a “frozen pelvis.”

The bowel or bladder can be involved. Dissection becomes technically demanding. These are the cases where surgical experience matters most.

Interestingly, I have operated on Stage 4 patients whose primary complaint was infertility rather than pain.

RELATED: Endometriosis Vs Menstrual Cramps: What’s The Difference?

WHY STAGE DOES NOT EQUAL PAIN

Pain is influenced by depth of infiltration, nerve involvement, inflammation, and individual pain processing. A small implant infiltrating near a uterosacral nerve can produce disproportionate symptoms. Meanwhile, broad superficial disease may be less symptomatic.

This is why staging is helpful for surgical planning and fertility counseling, but limited in predicting suffering.

TREATMENT CONSIDERATIONS

Management depends on symptoms, age, reproductive goals, and disease distribution. Hormonal suppression can reduce the stimulation of implants. Surgical excision removes visible disease and releases adhesions. In women seeking pregnancy, preserving ovarian reserve is critical.

Each plan has to be individualized. There is no single algorithm that applies to every stage.

WHEN TO SEEK EVALUATION

Severe menstrual pain, pain with intercourse, bowel or bladder pain during cycles, or unexplained infertility warrant proper evaluation. These symptoms are not simply part of being a woman.

For more than three decades, I have treated women with complex pelvic pain and endometriosis in Los Angeles and Glendale. Staging helps determine what must be addressed surgically and what should be monitored long-term.

If your symptoms have been minimized or your diagnosis feels incomplete, a thorough consultation can clarify the situation and outline appropriate next steps.

The post What Are the 4 Stages of Endometriosis? appeared first on Best Uro-Gynecologist Los Angeles, OB/GYN Glendale | Dr. Michael Tahery.

One of the most common mesh complications is mesh erosion, also called mesh exposure or extrusion. This occurs when the synthetic material placed to support pelvic tissues gradually works its way into surrounding structures. The mesh may become exposed through the vaginal lining or, less commonly, erode into adjacent organs such as the bladder, rectum, or urethra. The FDA has issued safety communications outlining these potential complications.

Another mesh complication is mesh shrinkage or contraction. In some cases, mesh placed to support the bladder or rectum can contract over time, placing tension on surrounding tissues, including the vaginal wall. Infection, chronic inflammation, or seroma formation may also occur.

Symptoms vary from patient to patient, but certain patterns are common.

Persistent vaginal pain or burning is often one of the earliest signs. It may feel like rawness, sharpness, or constant irritation that was not present before. Some women describe it as feeling like something is scratching internally.

Pain with intercourse is another frequent complaint. Partners may feel a sharp or rough sensation during intimacy. In other cases, the patient experiences deep or superficial pain that gradually worsens.

Unexplained vaginal bleeding or spotting can occur, even years after surgery. Women may notice bleeding unrelated to their menstrual cycle, bleeding with intercourse, or postmenopausal bleeding. This may result from mesh irritating or penetrating vaginal tissue. Recurrent infections or abnormal discharge may develop because exposed mesh can act as a foreign body, triggering chronic inflammation.

If erosion involves the bladder or urethra, patients may develop urinary urgency, frequency, pain with urination, recurrent urinary tract infections, urinary incontinence, or difficulty emptying the bladder.

Mesh complications do not necessarily mean the original surgery was performed incorrectly. Several factors can contribute, including tissue thinning over time (especially after menopause), smoking, impaired wound healing, chronic inflammation, mechanical tension on the mesh, and individual variation in tissue response to foreign material. As with any implanted device, some patients may have a stronger inflammatory response than others.

One of the more concerning aspects of mesh complications is delayed recognition. Early symptoms are often nonspecific and mild. Imaging studies may be inconclusive. As a result, patients are sometimes reassured that their discomfort is unrelated to prior surgery. However, pelvic pain that begins after mesh placement, particularly pain during intercourse, new bleeding, or persistent discharge, warrants careful evaluation. ACOG has published committee guidance regarding the evaluation of mesh complications ACOG committee guidance. A thorough pelvic examination by a clinician experienced in diagnosing mesh-related problems is often diagnostic. In some cases, cystoscopy, pelvic ultrasound, or additional testing may be necessary.

Management options depend on the extent and severity of the problem. Small, superficial exposures may respond to topical estrogen therapy in postmenopausal patients. Limited trimming of exposed mesh may be appropriate in selected cases. When symptoms are persistent, extensive, or involve adjacent organs, surgical mesh removal may be required. AUGS has issued joint position statements outlining management considerations.

Mesh removal surgery can be complex. Mesh may involve multiple organs, and scar tissue often forms around the implant. Complete removal must balance symptom relief with preservation of pelvic support and bladder function. In more complicated cases, a multidisciplinary approach may be necessary.

Beyond the physical symptoms, there is often an emotional toll. Many women with mesh complications, particularly those with chronic pain, feel dismissed or frustrated after months or years without clear answers. Chronic pelvic pain, especially when it affects intimacy or urinary function, can erode confidence, strain relationships, and significantly impact quality of life. Mental and emotional well-being are often affected as well.

If you have had vaginal mesh placement and are experiencing persistent pelvic pain, pain with intercourse, unexplained bleeding, recurrent urinary symptoms, or a sensation of something sharp or protruding, a thorough evaluation is appropriate. Mesh complications may be contributing to your symptoms. With accurate diagnosis and appropriate management, many patients experience meaningful improvement.

Frequently Asked Questions (FAQ)

How common is mesh erosion?

Rates vary depending on the type of mesh and surgical approach. Vaginally placed mesh historically carried higher exposure rates than abdominally placed mesh. While not every patient develops complications, erosion is well-documented in medical literature.

Can mesh erosion happen years after surgery?

Yes. Some patients develop symptoms within months, while others present several years after the original procedure.

Will imaging show mesh erosion?

Not always. A detailed pelvic examination is often more informative. If the bladder or urethra is involved, cystoscopy may be necessary.

Is mesh removal always required?

No. Small, asymptomatic exposures may be managed conservatively. However, persistent pain, bleeding, urinary symptoms, or partner discomfort typically require intervention.

If the mesh is removed, will prolapse or leakage return?

It can. This risk should be discussed before surgery. In some cases, alternative reconstructive options can be considered at the time of removal.

Is removal surgery risky?

Revision surgery is often more complex than the original procedure due to scar tissue and involvement of surrounding organs. It should be performed by a surgeon experienced in pelvic reconstructive and mesh revision surgery.

When should I seek a second opinion?

If symptoms began after mesh placement and are ongoing, worsening, or affecting your quality of life, particularly if your concerns have been minimized, seeking evaluation by a specialist is reasonable.

To schedule a consultation about mesh complications with Dr. Michael Tahery, please call 310-446-4440 or 818-265-9499 for appointments in Los Angeles or Glendale.

The post What Vaginal Mesh Complications Feel Like appeared first on Best Uro-Gynecologist Los Angeles, OB/GYN Glendale | Dr. Michael Tahery.

Endometriosis is one of the most common causes of pelvic pain, yet it does not always present the same way and at times mimics other conditions. Likely, it’s because endometriosis is not a single, uniform disease. It presents differently from one patient to another, and the severity of symptoms does not always match what we see on imaging or even during surgery. I’ve treated patients with extensive disease who had relatively mild symptoms, or I discovered by accident during surgery, treating another condition, and others with debilitating pain whose disease was subtle but strategically located. This disconnect is one of the main reasons endometriosis is so often overlooked or dismissed.

Before ordering tests or reviewing prior records, I focus on the patient’s history. Most times, patients are able to provide clues to their condition. I want to understand when the pain began, how it has changed over time, and whether it follows a cyclical pattern. Pain that worsens around menstruation raises different concerns than pain that is constant, provoked by movement, random, or triggered by intercourse, bowel movements, or bladder filling.

Equally important is understanding what has already been tried. Hormonal treatments, physical therapy, prior surgeries, and injections. What helped, what didn’t, and what made symptoms worse or was not implemented correctly or long enough to make a difference. Failed treatments, just as successful ones, often provide critical clues about what is really driving the pain.

A pelvic exam in the setting of chronic pelvic pain is very different from a routine gynecologic exam. I assess pelvic floor muscle tone, focal tenderness, uterine mobility, and pain along specific ligaments or nerve pathways. Pain mapping can reveal patterns that suggest deep endometriosis, pelvic floor dysfunction, or nerve involvement. Also, many times in patients with pelvic pain, multiple organ systems are affected, which makes finding evidence for endometriosis challenging.

At the same time, a normal exam does not rule out endometriosis. Some of the most symptomatic patients I see have minimal findings on exam, which is why history, exam, and finally clinical judgment, guide decision-making.

Ultrasound and MRI are useful tools, particularly for identifying ovaries affected with endometriosis or endometrioma, deep infiltrating endometriosis, sometimes bowel adhesions, or associated conditions such as adenomyosis. However, superficial disease and peritoneal implants are frequently invisible on imaging. When I review imaging, I do so in the context of the patient’s symptoms and exam findings. A report that reads “unremarkable” does not mean the pain isn’t real or that endometriosis isn’t present.

RELATED: What Causes Endometriosis?

One of the most important aspects of evaluating pelvic pain is recognizing that endometriosis rarely exists in isolation. Chronic pelvic pain is often multifactorial. Pelvic floor muscle dysfunction, bladder pain syndromes, bowel hypersensitivity, nerve entrapment, and scar tissue from prior surgeries commonly coexist, and endometriosis may have involved many organ systems.

Focusing on endometriosis alone without addressing these overlapping conditions often leads to incomplete or disappointing results. This is why I frequently involve pelvic floor physical therapists and, when appropriate, pain specialists or other subspecialists as part of a comprehensive approach.

Surgery can be both diagnostic and therapeutic, but it should never be automatic. When I recommend surgery, it is because the overall picture of symptoms, exam findings, prior treatment response, and imaging suggests that surgical excision has a reasonable chance of improving quality of life. When surgery is performed, complete excision of the disease is essential. Incomplete treatment or superficial ablation often leads to persistent pain and repeated procedures, which can compound pelvic dysfunction over time.

Just as important is knowing when not to operate. Not every patient benefits from surgery, and honest conversations about expectations and alternatives are a critical part of responsible care. The key is proper diagnosis, honest conversation, and a comprehensive plan that treats the condition, prevents regression, and restores patients’ control over their lives.

Frequently Asked Questions:

How is endometriosis diagnosed?

Endometriosis is diagnosed using a combination of symptom history, physical examination, imaging, and, when appropriate, surgical evaluation. There is no single test that can diagnose all cases.

Can ultrasound or MRI rule out endometriosis?

No. Imaging can identify certain forms of endometriosis, but many patients with significant symptoms have normal imaging studies.

Is surgery required to confirm the diagnosis?

Not always. Surgery is considered when symptoms are severe, progressive, or unresponsive to conservative treatment, or when the diagnosis remains unclear after thorough evaluation.

Why does pelvic pain persist even after treatment?

Pelvic pain is often multifactorial. Endometriosis may be one contributor, but pelvic floor dysfunction, nerve sensitization, bladder or bowel pain, and prior surgical scarring can all play a role.

Does the severity of endometriosis match the severity of pain?

No. The amount of visible disease does not reliably correlate with pain intensity.

Is surgery a cure for endometriosis?

Surgery can significantly improve symptoms for many patients, but endometriosis is a chronic condition that often requires long-term management.

Who should evaluate suspected endometriosis-related pelvic pain?

Patients benefit most from evaluation by a surgeon with specialized training in pelvic pain and endometriosis excision.

If you are experiencing persistent pelvic pain, have been told your tests are “normal,” or feel your symptoms have not been fully explained, a comprehensive evaluation can make a meaningful difference.

To schedule a consultation with Dr. Michael Tahery, please call 310-446-4440 or 818-265-9499 at his offices in Los Angeles and Glendale.

The post How I Evaluate Pelvic Pain When Endometriosis Is Suspected appeared first on Best Uro-Gynecologist Los Angeles, OB/GYN Glendale | Dr. Michael Tahery.

Persistent pelvic pain, recurrent infections, unexplained vaginal bleeding, especially with penetration, or difficulty urinating after vaginal mesh placement are not normal, even when symptoms appear soon after surgery or months or years later. I often meet patients who were told to wait, reassured that nothing was wrong, or made to feel that these symptoms were simply something they had to live with. As a urogynecologist, I am very familiar with mesh usage and have significant experience detecting and treating mesh-related problems.

Vaginal mesh is commonly used to treat pelvic organ prolapse and stress urinary incontinence. Its use for prolapse and stress incontinence is common and, in selected cases, has been considered a standard or effective treatment option. Complications may include erosion into the vagina, chronic pain, infection, unexplained vaginal bleeding, or obstruction of the urinary tract. When this occurs, mesh removal may be necessary to restore comfort and function. In my experience, deciding whether to remove mesh and how much to remove requires individualized clinical judgment rather than a standardized approach.

Vaginal mesh is a synthetic material placed to support pelvic organs such as the bladder, urethra, or uterus. The mesh acts as a scaffold that allows the body to form connective tissue around it, creating support for the prolapsed organ. In some patients, this process is effective and stable. In others, the mesh can tighten, migrate, or erode through surrounding tissue, leading to pain, inflammation, sexual discomfort, or urinary symptoms. I commonly see patients whose pain occurs intermittently at first, then progresses, often becoming more noticeable during intercourse.

RELATED: Pelvic Floor Disorder Symptoms in Women

Not every patient with mesh requires removal, but ongoing or worsening symptoms should not be dismissed and should be investigated, especially when they begin after mesh placement. Symptoms that warrant evaluation include persistent pelvic pain, abnormal vaginal discharge or bleeding, recurrent vaginal or urinary infections, difficulty initiating urination, incomplete bladder emptying, or pain with intercourse. A detailed and complete evaluation is needed to correctly diagnose the problem, including a thorough history, careful examination, and targeted testing to help determine whether symptoms are mesh-related and whether partial or complete removal is appropriate.

Mesh extrusion occurs when the mesh erodes through the vaginal tissue and becomes exposed. Patients may notice irritation, discharge, bleeding, or a sharp or rough sensation in the vagina, sometimes treated by physicians as a recurrent vaginal infection. Pain with intercourse is common. In my clinical experience, extrusion does not resolve on its own. Surgical removal of the exposed mesh is often necessary to prevent ongoing inflammation, infection, and further tissue damage.

In some cases, mesh becomes a chronic source of infection. Patients may experience pelvic pain, swelling, fever, or recurrent infections that respond only temporarily to antibiotics. When I see repeated infections in the setting of mesh, treating with antibiotics alone is rarely effective, even though it may provide short-term symptom relief. Mesh removal is often required to address the underlying cause rather than repeatedly treating symptoms.

FAQs:

Is pelvic pain normal after vaginal mesh surgery?

No. Persistent pelvic pain, pain with intercourse, bleeding, or urinary difficulty after mesh placement is not normal and should be evaluated.

What are common symptoms of mesh complications?

Symptoms may include pelvic pain, vaginal bleeding, recurrent infections, pain during intercourse, urinary obstruction, difficulty emptying the bladder, or abnormal vaginal discharge.

Can vaginal mesh cause urinary obstruction?

Yes. Mesh can tighten, migrate, or scar around the urethra or bladder, leading to difficulty urinating or incomplete bladder emptying.

Do all problematic meshes need to be removed?

Not always. Some patients benefit from partial mesh removal, while others require complete excision. The decision depends on symptoms, mesh location, and surrounding tissue involvement.

Can mesh erosion heal on its own?

No. Once mesh erodes or extrudes through vaginal tissue, it typically does not resolve on its own.

Why don’t antibiotics fix mesh-related infections?

Mesh can act as a foreign body that harbors bacteria. Antibiotics may provide temporary relief, but definitive removal requires mesh removal.

How long after surgery can mesh complications appear?

Symptoms can occur months or years after the original mesh placement.

Who should evaluate mesh-related pelvic pain?

Evaluation should be performed by a urogynecologist experienced in mesh removal and complications, as these cases require specialized expertise.

If you have symptoms that are not going away, our offices are located in Westwood and Glendale in Los Angeles, and we specialize in helping women navigate these exact complications. Book an appointment or reach us at 310 446 4440 and 818 265 9499 to discuss your history and find a path forward.

The post Mesh Removal for Pelvic Pain and Urinary Obstruction appeared first on Best Uro-Gynecologist Los Angeles, OB/GYN Glendale | Dr. Michael Tahery.

CANDIDATES FOR VAGINAL PROBIOTICS

Vaginal probiotics are not meant to replace an exam, diagnostic testing, or prescription treatment when an infection is present. However, they may be helpful for women who feel that their vaginal health is easily thrown off or who want extra support during menopause or medical treatments.

Women With Recurrent BV or Yeast Infections

Bacterial vaginosis, or BV, occurs when bad bacteria overtake the good Lactobacillus bacteria in the vagina. Many women mistakenly believe BV is a sexually transmitted infection. While sexual activity can lead to imbalance, there are other possible causes, including antibiotics, smoking, IUDs, and scented soap. BV doesn’t always cause symptoms, but you may notice unusual vaginal discharge or odors. You may notice irritation and itching.

A yeast infection occurs when Candida yeast becomes overgrown in the vagina. When you have a yeast infection, you may notice intense itching and burning. Your vaginal discharge may develop a texture like cottage cheese. It may also have an unusual smell.

Both bacterial vaginosis and yeast infections can be persistent, recurring problems. Even though treatments can improve the symptoms, you may find that the condition returns weeks or months later. In this case, your underlying vaginal microbiome may still be off balance. Vaginal probiotics may help support the return of beneficial bacteria. Some research suggests that consistent use may help lower the risk of recurrence, particularly when probiotics are used after standard treatment.

Women With Hormonal Shifts

Women experience many hormonal changes throughout life. Menstrual cycles, puberty, the postpartum period, perimenopause, and menopause can all change the vagina’s microbiome. Hormonal shifts can affect vaginal tissue, pH, and bacterial growth. As estrogen levels decline in perimenopause and menopause, Lactobacillus levels may decline as well. Some women notice more dryness, irritation, or odor. Probiotics can help support the vaginal microbiome during hormonally sensitive periods.

Preventative Support During and After Antibiotics

Antibiotics are sometimes necessary, but they do not differentiate between harmful bacteria and beneficial ones. As a result, Lactobacillus levels may drop during or after treatment. This disruption can leave the vaginal environment more vulnerable, which helps explain why BV or yeast symptoms sometimes follow antibiotic use.

Experiencing Foul Odor

A sour or fishy vaginal odor can be a warning sign that you have bacterial vaginosis. It can also indicate other conditions, such as a yeast infection, trichomoniasis, or a urinary tract infection. If you are diagnosed with BV, vaginal probiotics may help with your recovery. These specially formulated probiotics can help create a healthier balance of vaginal bacteria.

BENEFITS OF VAGINAL PROBIOTICS

Vaginal probiotics can boost the healthy bacteria in the vaginal microbiome rather than simply mask symptoms. Probiotics can offer both preventative and supportive benefits for overall vaginal health.

pH Balance

Lactobacillus bacteria help maintain the acidic pH that supports vaginal health. When your pH rises, anaerobic bacteria are more likely to thrive. Supporting Lactobacillus levels may help encourage a pH range that promotes comfort and stability over time.

Bacterial Vaginosis (BV) Prevention and Treatment

Bacterial vaginosis occurs when an overgrowth of harmful bacteria changes the vaginal microbiome. Prescription medications are the standard treatment for BV, but this condition can return if the microbiome isn’t rebalanced.

Vaginal probiotics can encourage the return of Lactobacillus-dominant flora. Probiotics may also reduce the likelihood of a recurrence in some women. The results depend on the type and formula of probiotics.

For women who experience recurrent BV, this rebuilding phase matters. Feeling better does not always mean the vaginal microbiome has fully stabilized.

Alleviate Menopause Symptoms

During perimenopause and menopause, estrogen levels drop. Many women notice discomfort from vaginal dryness, thinning tissue, and irritation. During this time, some women find that mild symptoms improve with the help of vaginal probiotics.

Yeast Infection Prevention and Treatment

Antibiotic use, hormonal changes, and stress can all lead to Candida overgrowth. Vaginal probiotics can help you maintain a pH level that is less favorable to yeast overgrowth.

Supports Reproductive Health

A stable vaginal microbiome supports the health of vaginal and cervical tissue. This can be especially important for women trying to conceive or preparing for gynecologic procedures. Supporting Lactobacillus dominance is one way to promote overall reproductive wellness.

Lowers the Risk of Urinary Tract Infections

The health of your vagina and urinary tract is closely connected. When harmful bacteria throw off the vaginal microbiome, these bacteria can enter the urinary tract, leading to a urinary tract infection. Maintaining a healthier vaginal environment may help reduce this risk in women who are prone to recurrent issues.

Related: Management Of Recurrent UTIs in Women

TYPES OF VAGINAL PROBIOTICS

Some vaginal probiotics focus on delivering a single strain of helpful bacteria to the vagina. Other probiotics combine multiple strains of bacteria or add prebiotics to support multiple systems. Depending on the type of probiotics you choose, they may be available as an oral capsule or vaginal suppository.

Lactobacillus

Lactobacillus bacteria are the foundation of a healthy vaginal microbiome. This bacterium creates a mildly acidic environment that limits the growth of harmful bacteria. Most probiotics for the vagina help boost Lactobacillus to maintain a healthy vagina.

Bifidobacterium

Bifidobacterium is more commonly associated with gut health but may be included in certain vaginal probiotic blends. It is typically used as part of a broader, multi-strain approach rather than on its own.

Blended Probiotics

Blended probiotics have multiple strains of bacteria. If you have mixed symptoms or recurrent episodes of BV, you may want to try a blended probiotic. These probiotics can help balance your system from multiple angles.

CAN YOU INSERT VAGINAL PROBIOTICS?

Vaginal Probiotic suppositories for insertion

Yes, vaginal probiotics can be inserted if the probiotics are labelled as safe for vaginal insertion. Vaginal suppositories are often the better choice for vaginal health because they provide direct support for most vaginal issues. You should never insert oral probiotic capsules in your vagina.

If you are pregnant or experiencing persistent symptoms like odor, discharge changes, burning, or irritation, you should schedule a doctor’s appointment before starting probiotics. Contact us for our medical-grade probiotics, research-based and designed to restore vaginal health and balance.

The post Vaginal Probiotics! Should You Be Taking Them? appeared first on Best Uro-Gynecologist Los Angeles, OB/GYN Glendale | Dr. Michael Tahery.

INFLAMMATORY PCOS

Inflammatory PCOS is a broad form of PCOS that can include widespread chronic inflammation throughout the body that’s accompanied by classic PCOS symptoms. The underlying issue is that ovaries are producing excess amounts of testosterone.

Many people with inflammatory PCOS experience general inflammation-related pain that can include headaches and joint pain. There could also be digestive and bowel issues related to food sensitivities and irritable bowel syndrome (IBS). Inflammatory PCOS symptoms may even manifest as skin rashes and eczema. Fatigue is also common. Inflammatory PCOS symptoms can be present across all types of PCOS.

Lifestyle changes and anti-inflammatory diets can be beneficial for treating inflammatory PCOS. For example, cutting out refined carbohydrates, dairy, processed meats, alcohol, and specific food preservatives help many women to tame symptoms. Exercise has also been proven beneficial for improving ovarian function.

INSULIN-RESISTANT PCOS

Roughly 70% of women with PCOS have insulin-resistant PCOS. Insulin-resistant PCOS occurs when higher-than-normal amounts of insulin released by the pancreas trigger the body to drive up production of androgens.

Common symptoms of insulin-resistant PCOS include weight gain, stubborn excess fat in the abdomen and midsection, brain, fog, and sugar cravings. It’s also common to experience irregular or absent periods. Elevated androgen production can also produce excess hair growth, hair loss, darkening of the skin, and acne.

With insulin-resistant PCOS, getting blood-sugar levels under control is key. In fact, glucose testing to get a read on fasting insulin levels is commonly used to confirm insulin-resistant PCOS. Adopting a low-sugar, low-carb diet is often beneficial for managing symptoms. Exercise can also be beneficial. Certain supplements can also be used to aid in glucose metabolism. In cases where fertility is a concern, doctors often prescribe a medication called metformin that helps to regulate insulin levels to help restore regular periods and ovulation.

POST-PILL PCOS

Pill-induced PCOS symptoms begin after hormonal birth control methods are stopped. In some cases, pill-induced PCOS is caused by a surge in androgens that occurs as the body readjusts. Unlike other PCOS types, this form doesn’t involve insulin resistance. It may also resolve on its own after a few months. In other cases of pill-induced PCOS, symptoms may appear to come on out of the blue because hormonal birth control was actually hiding PCOS symptoms.

Like other types of PCOS, post-pill PCOS can cause irregular periods, excess hair growth, oily skin, weight gain, and acne. It’s also possible to experience enlarged ovaries or ovarian cysts that were not present before beginning birth control.

Treatment of post-pill PCOS varies based on the symptoms and underlying origins. Diet, exercise, and stress management can all be important for helping to stabilize hormone levels after coming off of hormonal birth control. Supplementation and medications may also be useful in balancing excessive androgens.

Related: 4 Common Reasons You Might Be Experiencing Irregular Periods

ADRENAL PCOS

Adrenal PCOS is also known as stress-induced PCOS. Unlike other types of PCOS, adrenal PCOS doesn’t actually start in the reproductive system. It’s caused by the excessive release of adrenaline, caused by an abnormal stress response. Overactive adrenal glands are responsible for the overproduction of androgens that create PCOS symptoms. With other types of PCOS, the ovaries produce excess androgens.

The most common adrenal PCOS symptoms include weight gain, hair loss, excess hair growth, and acne. Changes in the menstrual cycle are also common. Absent or inconsistent periods are considered telltale signs. However, it’s also possible that adrenal PCOS can cause heavier or more frequent periods.

Stress management is even more important for adrenal PCOS than other types of PCOS. It can be helpful to mitigate stressors using mindfulness or meditation exercises. In general, any mental or physical practices that support the nervous system can also benefit stress-induced PCOS. While exercise is recommended, excessive exercise or high-intensity workouts can actually tax the body’s stress response and adrenals. Lifestyle changes that include limiting caffeine and sugar may also be helpful. A provider may also recommend supplementing with vitamins, minerals, and botanicals that support and balance the nervous system.PCOS can signal a serious hormonal imbalance that is linked with insulin resistance or adrenal overload. Regardless of whether or not you are planning to become pregnant, PCOS should be treated. Dr. Michael Tahery is a Los Angeles obstetrician-gynecologist (OB-GYN) and urogynecologist specializing in women’s health. Dr. Tahery and his team offer several approaches for diagnosing and treating PCOS. Book a consultation today.

The post What Are The 4 Types Of PCOS? Their Symptoms and Treatments appeared first on Best Uro-Gynecologist Los Angeles, OB/GYN Glendale | Dr. Michael Tahery.

WHY PLUMP THE LABIA?

Getting a plump or full labia Is generally a matter of personal preference. Some women are unhappy with changes that don’t make them feel like themselves. Others want plump labia after a lifetime of dissatisfaction. For better results, always talk to your doctor about your reasons for wanting this procedure. The most common reasons for wanting a plump labia are regaining a youthful appearance, concerns about the sudden loss of labia volume, the saggy appearance of the vagina, and labia being asymmetrical.

Youthful Appearance

Like the rest of the soft tissue throughout the body, labia can lose the plumpness and suppleness that we associate with vitality and youthfulness. For many, visual changes to the labia simply represent unwanted signs of aging.

Loss of Labia Volume

As fleshy folds, labia protect the vagina. They also contribute to sexual stimulation and lubrication. Thinning labia could cause irritation and discomfort.

Saggy Appearance

It can be jarring to discover that your formerly puffed labia now appear deflated or stretched. As estrogen and collagen levels dip with age, the labia can undergo noticeable sagging.

Asymmetrical Labia

There’s no “right” size or shape for labia. While minor asymmetry of the inner and outer lips of the vagina is relatively common, noticeable differences in size, shape, or position from one side to the other can make you feel self-conscious. If one side of the labia is severely inflated, this is known as labial hypertrophy. In many cases, asymmetry or enlargement on one side of the labia has been present since birth. However, most women only notice asymmetry when the labia increase in size during puberty.

In addition to creating cosmetic concerns, labia asymmetry can cause irritation or pain when wearing underwear or snug-fitting pants if one side of the labia is much larger. Some women also experience discomfort when riding bikes, horseback riding, exercising, or engaging in sexual activity.

LABIA PLUMPING CANDIDATES

Anyone who is unsatisfied with the appearance of their labia or simply desires plump labia is a candidate. However, most don’t even consider the procedure until they notice changes at key points in life. Most women will consider labia plumping during an after menopause, after giving birth, and when they see noticeable signs of aging.

During and After Menopause

Decreasing estrogen levels that occur both leading up to and after menopause can turn formerly plump labia saggy. During menopause, estrogen decline causes some degree of vaginal atrophy for most women. When this occurs, the labia thin out and lose elasticity. In addition to shrinking, the lips can also appear loose or wrinkled.

After Giving Birth

Pregnancy hormones and the birthing process can both dramatically change the appearance of the labia. It’s common to experience stretching and loosening of the labia minora (inner lips) or labia majora (outer lips) following childbirth. Additionally, tearing or an episiotomy during labor can lead to scarring and visual changes to the labia.

Aging Women

With age, hormonal changes and decreased blood flow to the labia can create dramatic changes. The most common complaints are labia thinning and reduced fullness. Meanwhile, the body’s natural slowdown in collagen production after age 30 can make the labia lose firmness and begin to wrinkle. In some cases, the inner folds of the labia may actually begin to atrophy to further reduce volume and definition of the outer vaginal lips.

Related: What Are The Vaginal Atrophy Treatment Options?

WHAT IS A LABIA FILLER?

Like the injectables that are used to volumize and plump the face, labia filler or vaginal filler is a treatment that plumps and rejuvenates the labia. This cosmetic procedure adds fullness and improves the symmetry of the labia majora (outer lips). Patients enjoy enhanced aesthetic appeal and improved body confidence. For more dramatic and longer-lasting results, some patients prefer fat transfers to the labia.

Hyaluronic Acid Filler

This is the most common option for achieving plump labia. During treatment, a dermal filler made with hyaluronic acid (HA) is injected into the labia majora. People who’ve had facial fillers will recognize that HA is the same ingredient used in many name-brand fillers. HA is a gel-like substance that boosts volume and fills in wrinkles while also triggering the body’s own natural collagen production. Prior to injection, anesthetia is applied to the outer labia. Next, labia filler injections are made in strategic areas of the labia using a fine needle. No downtime is needed. Results from labia filler typically last 6 to 12 months.

Silicone Fillers

Silicone fillers are no longer recommended for labia puffing due to potential risks and complications.

Fat Grafting Labia Filler

A labia fat transfer volumizes the labia by borrowing your own fat cells from other parts of your body. Benefits include a more natural feel and lower risk of allergic reaction and rejection. Fat grafting also offers results that can last for years. Fat grafting to plump labia is more invasive than using injectable labia filler. Fat cells are extracted from the thigh, buttocks, or other area of the body using liposuction. Following extraction, fat cells are injected into the labia.

Would you like to learn more about labia puffing procedures? Dr. Michael Tahery is a leading board-certified obstetrician-gynecologist (OB/GYN) and urogynecologist serving the Los Angeles area. Dr. Tahery and his team offer a variety of noninvasive treatment options. Book your consultation today.

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WHAT EXACTLY IS A QUEEF?

A queef is simply air moving out of the vagina. The sound made by a queef is the sound of trapped air being released. One of the reasons why so many people find queefing embarrassing is that they mistake it for passing gas. Unlike farts, queefs are odorless because they are not passing through the digestive system before exiting.

WHAT CAUSES QUEEFING?

Queefing is caused by any activity that can cause air to become trapped within the vaginal canal. In everyday life, things like exercising, sitting with your legs crossed, or removing a tampon or menstrual cup can all trigger queefing. There’s generally no cause for alarm if you experience occasional queefing with any of these activities. However, there are some underlying issues that could be causing chronic queefing.

Weak Pelvic Floor

Weak pelvic floor muscles can increase vaginal flatulence. The pelvic floor consists of muscles and connective tissue that hold and support the bladder, large intestine, and internal reproductive organs. Things like pregnancy, injury, and age can all weaken the pelvic floor. It’s not uncommon to experience an increase in queefing following pregnancy and childbirth. Declining estrogen levels during menopause that decrease the pelvic floor’s elasticity and strength can also increase queefing frequency.

Hormonal Changes

As estrogen declines during menopause, it often reduces blood supply and collagen production in the vaginal canal and surrounding tissue. The loss of muscle strength that accompanies this can allow gas to slip through more frequently. It’s common for increased queefing to be just one of many symptoms when dipping estrogen levels begin affecting sexual health. The other two main ones are urinary incontinence and vaginal dryness. Queefing can also become more common due to hormonal changes that take place during pregnancy. Even normal hormonal shifts that occur during ovulation and menstruation that loosen the vaginal muscles can also increase queefing.

Prolapse

Vaginal prolapse happens when the vagina slips out of position. While most common following multiple vaginal deliveries, prolapse can occur whenever pelvic tissues and muscles are overstretched and weakened. Causes can include repeatedly lifting heavy objects as part of your job, undergoing a hysterectomy, and aging. When the top portion of the vagina shifts from its normal position, the organs it was supporting also shift out of place. In most cases, prolapse is accompanied by a lump or bulging sensation. The reason why queefing often becomes more frequent following vaginal prolapse is that the shifting of the vagina creates gaps that can make it easier for air to become trapped in the vagina.

Movements Positions During Exercise or Sex

Frequent queefing isn’t always caused by medical conditions or physiological changes. Most of the time, queefing is simply the result of air becoming trapped during physical movement. Your love of exercise could be behind the persistent queefing you’re experiencing. During running, yoga, and other common exercises, pressure changes make it easier for air to be pulled into the vagina. Rapid changes in position during exercises make it easy for the air to escape.

Queefing during sex is both common and normal. Vaginal contractions that occur during sex can cause queefing. Additionally, air is often pushed inside the vagina whenever something is inserted into the vagina during sex. When the object is removed, the air can make an audible sound as it is also pushed out. Air can also become trapped in the vagina when moving positions.

Related: How Much Does Vaginoplasty Cost?

PREVENTION AND TREATMENT OF QUEEFING

In general, there’s no need to take measures to prevent occasional queefing that happens as a result of exercise or sexual activity. This is considered a perfectly normal biological response to trapped air! Overall, having a healthy pelvic floor is the best way to minimize spontaneous queefing. However, there are several things you can do if you’re concerned about frequent or disruptive queefing.

Vaginoplasty

Also known as vaginal tightening surgery, vaginoplasty is a procedure to restore the look and function of the vagina. It is commonly used to treat vaginal prolapse or weakened pelvic floor muscles. In addition to reducing persistent vaginal gas, vaginoplasty can help to restore comfort and sexual satisfaction.

Kegel Exercises

The most common way to control queefing is to do Kegel exercises. Also known as pelvic floor exercises, Kegels are like workouts for the pelvic floor muscles. They consist of slowly tightening and releasing the muscles in the pelvic floor. To do a Kegel exercise, simply lift, hold, and relax the pelvic floor muscles. Each hold should last for up to five seconds. It’s recommended to try to consistently do at least three sets of 10 Kegels per day.

Laser Rejuvenation Of The Vagina

Nonsurgical vaginal rejuvenation with lasers can help to restore the elasticity and strength of vaginal tissue without the need for recovery or downtime. These procedures can be done during short office visits. Laser rejuvenation tightens and tones the vaginal area. It can also increase collagen production to make vaginal tissue firmer and more resilient.

Dr. Michael Tahery is a leading board-certified obstetrician-gynecologist (OB/GYN) and urogynecologist in the Los Angeles area. Dr. Tahery is happy to answer all of your questions! If weak pelvic floor muscles or hormonal issues are causing excessive vaginal flatulence, Dr. Tahery and his team can recommend a variety of surgical and noninvasive treatment options. Book an appointment today.

The post Why Do I Queef? Everything You Need To Know About Queefing appeared first on Best Uro-Gynecologist Los Angeles, OB/GYN Glendale | Dr. Michael Tahery.

CAUSES AND RISK FACTORS

A clitoral adhesion happens when the protective fold that conceals the clitoris becomes stuck to the exposed portion of the clitoris. Known as the clitoral hood, this fold protects the tender, delicate flesh of the clitoris from exposure to friction and bacteria. Here’s a rundown of the factors that can cause the hood to become stuck to the clitoris.

Lichen Sclerosus and Lichen Planus

Both lichen sclerosus and lichen planus belong to a family of noncommunicable inflammatory skin conditions. People with these conditions generally experienced thick, stiff, or “leathery” skin. The primary symptom with lichen planus is a rash-like presentation anywhere on the body. The rash can even occur in the genitals. Meanwhile, lichen sclerosus exclusively affects the genitals and anal area. We also know that postmenopausal women are at higher risk for developing lichen sclerosus.

Lichen sclerosus and lichen planus contribute to clitoral adhesions by thinning and scarring skin on the clitoral hood. The underlying cause for these conditions isn’t fully known. However, factors ranging from genetics to immune response are believed to be in play.

Hormonal Changes

Hormonal changes that occur with age or changes in sexual health can contribute to clitoral adhesions. This may be why adhesions are often seen in women during menopause. In these situations, dipping estrogen is the key driver of adhesions because of the loss of natural moisture and elasticity.

Trauma

Scarring caused by surgery, illness, or a traumatic injury can increase your vulnerability to clitoral adhesions. When vaginal tissue is damaged, the scar tissue that forms can be rough or irregular in nature. Scar tissue is also more likely to “fuse together” as it heals.

Bad Hygiene

Hygiene habits can irritate or inflame the skin of the clitoral hood and clitoris. Poor hygiene practices or infrequent bathing could allow for stool contamination that causes infection or inflammation of clitoral tissue. Even women who are vigilant about their personal hygiene could inadvertently increase their risk for adhesions by using products containing harsh additives or fragrances that irritate sensitive vaginal tissue.

DO I HAVE CLITORAL ADHESIONS?

Clitoral adhesions have been found in up to 22% of women seeking evaluation for sexual dysfunction. If you suspect adhesions, an in-person exam with a care provider is the only way to confirm your diagnosis. Here are some telltale signs that should prompt you to book an exam.

Pain

Pain and discomfort are the top symptoms of clitoral adhesions. In addition to acute pain, you may experience hypersensitivity or irritation. It’s also common for the dry, thick scar tissue connecting the hood and clitoris to be itchy.

Discomfort During Sex

Pain during sexual intercourse or other activities that stimulate the clitoris is also common. The clitoris is likely to feel raw and tender.

Inability to Fully Expose the Clitoris

When an adhesion is present, it often becomes impossible to retract the clitoral hood to expose the clitoris. In addition, the entire area may be too swollen for you to retract the hood.

Increased or Decreased Sensitivity

Many women with adhesions experience dulled sensation during clitoral stimulation. This can greatly decrease both arousal and the ability to achieve orgasm. In other cases, hypersensitivity that increases clitoral sensitivity can make sexual contact overstimulating.

RELATED: What is Vulvar Vestibulitis? Symptoms, Causes, Misdiagnosis, and Treatment

TREATMENT OPTIONS FOR CLITORAL ADHESIONS

Many minimally invasive options can be used to heal clitoral adhesions. However, severe adhesions may require surgical separation.

Nonsurgical Lysis

In many cases, adhesions can be separated without the need for surgery. Using nonsurgical lysis, your doctor will use specialized forceps to separate the hood and clitoris after applying a topical numbing agent. Once separated, the hood will be gently stretched to knead out adhesions. Research on nonsurgical lysis for treating adhesions shows that 93% of participants would recommend this procedure to a friend with the same condition.

Hormonal Therapy

Hormonal therapy that boosts estrogen levels can be used to restore natural vaginal lubrication. In some cases, addressing dryness and “thinning” of vaginal tissue can be enough to heal adhesions.

Shockwave Therapy

Shockwave therapy has long been used for scar and wound healing throughout the body. It works by increasing blood flow to scar tissue that is starved of the nutrients needed for cell turnover. With repeated shockwave treatments, increased blood flow helps to promote cellular regeneration that helps to break up adhesions.

Topical Creams

With mild to moderate adhesions, topical creams can help to soothe and moisturize scar tissue that has turned dry and scaly. By softening the clitoral hood, creams allow you to gently separate the hood from the clitoris without tearing. Additionally, topical treatments can help to moisturize the hood to reduce the likelihood of future adhesions.

Surgery

Surgical lysis to remove adhesions is often recommended for more severe cases. During this procedure, adhesions are surgically separated. Any scar tissue that is still attached to the clitoris and hood is cleaned away. Depending on the extent of the scar tissue present, an incision may be made in the hood to clear out scarring in order to reduce the likelihood of a future adhesion.

Living with painful adhesions dramatically reduces quality of life and sexual satisfaction. Treating adhesions before they worsen is important. If you suspect that scarring is the cause of the discomfort, pain, or unexplained decrease in sexual satisfaction you’re experiencing, speak with Dr. Michael Tahery about treatment options. Specializing in women’s health and offering noninvasive surgical options, Dr. Tahery is an esteemed Los Angeles obstetrician-gynecologist (OB-GYN) and urogynecologist with more than 21 years of experience. Book an appointment today.

The post What Are Clitoral Adhesions? Symptoms and Treatment appeared first on Best Uro-Gynecologist Los Angeles, OB/GYN Glendale | Dr. Michael Tahery.