By the time she reached my office, she was still in significant pain. Her history immediately raised concern, and it didn’t sound like a simple incidental cyst. The intensity of her symptoms, the timing, and how she described the pain all pointed toward something more involved.

I performed a pelvic ultrasound myself. The mass had the appearance I often associate with an endometrioma, a complex cystic structure with hemorrhagic content, features that, over time, become recognizable when you’ve treated enough of these cases.

Because of the discrepancy and to further characterize the mass, an MRI was ordered. The report came back suggesting a dermoid cyst.

At that point, we had three different interpretations of the same problem:

• CT scan identifying a mass
• Ultrasound suggesting endometrioma
• MRI favoring dermoid

This is exactly the kind of situation where it’s easy to lean heavily on MRI and treat it as the final word. I’ve learned to be careful with that.

We proceeded with laparoscopic surgery, a minimally invasive approach that allows for direct visualization of the pelvis and, when necessary, definitive treatment at the same time.

What we found was an endometrioma, along with stage III endometriosis. There was clear evidence of a broader disease process—adhesions, inflammation, and involvement beyond just the ovary.

It was not a dermoid.

Cases like this are a good reminder that MRI, while powerful, has limitations, especially when it comes to complex adnexal masses. Endometriomas and dermoids can overlap in their imaging characteristics more than people expect. Chronic blood products, varying signal intensities, and the way these lesions evolve over time can make interpretation less straightforward than it appears on paper. In radiology, expert interpretation is invaluable, not just technology.

One of the more common pitfalls I see is relying too heavily on a single imaging modality without stepping back and asking whether the entire clinical picture makes sense.

In this case, it didn’t.  Her history and level of pain, the clinical exam, and what I was seeing on ultrasound did not align cleanly with a dermoid. 

Ultrasound, when done carefully and in the right hands, often provides more real-time, functional information than static imaging. MRI adds another layer of detail, but it doesn’t replace clinical judgment. CT, in this setting, is often just the starting point.

What ultimately led to the correct diagnosis was the combination of history, exam, imaging, and experience with how this disease actually presents in real patients.

RELATED: Symptoms of Endometriosis: What I see in My Patients Every Day

Endometriosis, particularly at stage III, is not just an ovarian finding. It is a pelvic disease. If you focus only on the cyst and not the broader process, you miss the diagnosis. History of bloatedness, pain progressively worse over time with her cycles, urinary frequency, and urgency around the time of menstruation was telling.

There’s a tendency to treat imaging as definitive. In reality, it should be part of a larger conversation. In order to make the best of each modality, it is necessary to understand each strength and weakness and not just rely on interpretation. 

That’s where clinical experience comes in.

If you’ve been told you have an ovarian cyst, especially if different imaging studies are giving you different answers, and your symptoms feel more severe than what you’ve been told, it’s worth taking a closer look.

In my practice, I focus on complex pelvic pain and advanced endometriosis, and I routinely perform minimally invasive laparoscopic endometriosis surgery in Los Angeles to both diagnose and treat the disease when appropriate. I also see patients in Beverly Hills and Glendale, with the goal of addressing the full extent of disease, not just what appears on an imaging report.

Appointments: 310-446-4440 | 818-265-9499

The post Why MRI Can Miss Endometriosis: A Case That Reinforced an Old Lesson appeared first on Best Uro-Gynecologist Los Angeles, OB/GYN Glendale | Dr. Michael Tahery.

The reality is that endometriosis can produce a wide range of symptoms, and they are often more complex than most people realize. Recognizing these symptoms early is one of the most important steps toward proper treatment and relief.

Pelvic Pain That Goes Beyond Normal Menstrual Cramping

The most common symptom I see in women with endometriosis is pelvic pain. While menstrual cramps are common, endometriosis pain is often more severe, longer-lasting, and can occur outside of the menstrual cycle.

Many of my patients describe pain that begins days before their period and continues long after it ends. Others experience pelvic pain throughout the month. It can be sharp, stabbing, or deep and aching, and it may worsen with certain movements or activities.

What makes endometriosis pain particularly frustrating is that the severity of symptoms does not always match the extent of disease. I have treated patients with minimal visible disease who have debilitating pain, while others with extensive endometriosis have milder symptoms.

Pain During Intercourse

Pain with intercourse, known medically as dyspareunia, is another symptom that frequently raises my suspicion for endometriosis.

This pain is often described as deep pelvic pain that occurs with deeper penetration. It can persist for hours or even days afterward. When endometriosis involves the uterosacral ligaments, the cul-de-sac, or the pelvic sidewalls, intercourse can trigger significant discomfort.

Many patients hesitate to bring this symptom up, but it is an important clue that helps guide further evaluation.

Heavy or Irregular Menstrual Bleeding

Endometriosis does not always cause heavy periods, but many women experience changes in their menstrual bleeding patterns. Some report unusually heavy bleeding, prolonged periods, or bleeding between cycles.

This occurs because the inflammatory environment created by endometriosis can disrupt normal hormonal signaling and uterine function.

Patients sometimes assume this is simply part of getting older or related to stress, but when it occurs alongside pelvic pain, it deserves further investigation.

Pain With Bowel Movements or Urination

One of the more specific symptoms of endometriosis occurs when lesions affect the bowel or bladder.

Patients may experience pain during bowel movements, particularly during their menstrual cycle. Others report painful urination during their period or a sense of pressure deep in the pelvis.

When endometriosis involves the rectovaginal septum, bowel, or bladder surface, these symptoms can become quite pronounced.

In severe cases, patients may even notice cyclic rectal bleeding or urinary symptoms that worsen with their menstrual cycle.

Infertility

Endometriosis is also strongly associated with infertility. In fact, a significant portion of women who seek evaluation for infertility are ultimately found to have endometriosis.

The condition can interfere with fertility in several ways. It can distort pelvic anatomy, cause inflammation that affects egg quality and sperm function, and interfere with implantation.

Some women have no symptoms at all and only discover they have endometriosis when they begin trying to conceive.

Chronic Fatigue and Systemic Symptoms

Something I often discuss with my patients is that endometriosis is not simply a localized pelvic condition. It is an inflammatory disease.

Many women report persistent fatigue, brain fog, and generalized malaise, particularly during their menstrual cycle. These symptoms are frequently overlooked but can significantly affect quality of life.

The chronic inflammatory state associated with endometriosis likely contributes to these systemic symptoms.

Lower Back and Leg Pain

Because endometriosis can involve pelvic nerves, patients may experience pain that radiates beyond the pelvis.

Lower back pain is common, particularly around the time of menstruation. Some patients develop pain that travels into the hips, buttocks, or down the legs. When the disease involves the sciatic nerve or nearby structures, this pattern can become more pronounced.

These symptoms are sometimes mistaken for orthopedic or spinal problems.

RELATED: Endometriosis Diet: What To Eat And What To Avoid?

When Symptoms Should Raise Suspicion

Over the years, I have learned that certain symptom patterns strongly suggest endometriosis.

Pelvic pain that worsens with menstruation, pain with intercourse, infertility, and bowel or bladder symptoms that fluctuate with the menstrual cycle should always prompt a deeper evaluation.

Unfortunately, it is not uncommon for patients to wait seven to ten years before receiving a diagnosis.

Why Diagnosis Can Be Delayed

One reason endometriosis is difficult to diagnose is that imaging studies are often normal. Ultrasound and MRI can detect some forms of the disease, but superficial implants may not be visible.

The gold standard for diagnosis remains laparoscopic surgery, where the disease can be directly visualized and treated.

However, careful history-taking and symptom recognition are often the most powerful tools we have for identifying patients who may be affected.

A Final Thought

Endometriosis is not simply “bad cramps.” It is a complex inflammatory condition that can affect many aspects of a woman’s health and quality of life.

If you or someone you know is experiencing persistent pelvic pain, painful periods, pain with intercourse, or difficulty conceiving, these symptoms should not be ignored.

Early recognition and proper treatment can dramatically improve quality of life.

As a physician who treats endometriosis regularly, I believe one of the most important steps we can take is simply listening carefully to patients and taking their symptoms seriously.

What To Do Next

If you are experiencing symptoms such as severe menstrual pain, chronic pelvic pain or discomfort, pain with intercourse, bowel or bladder pain during your cycle, or difficulty conceiving, it may be time for a more thorough evaluation. In my practice, I specialize in the diagnosis and treatment of endometriosis and other causes of chronic pelvic pain using advanced minimally invasive pelvic surgery when appropriate. I see patients throughout Los Angeles, Beverly Hills, and Glendale, and my goal is always to help women find answers, relieve pain, and restore their quality of life. If you believe endometriosis may be affecting you, I encourage you to seek expert evaluation and care.

For an appointment, call 3104464440 or 8182659499.

The post Symptoms Of Endometriosis: What I See In My Patients Every Day 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.

The Initial Presentation: When Pain Doesn’t Fit One Box

In Dr. Tahery’s practice, pelvic pain is approached by first understanding the pattern of symptoms rather than relying on one test or diagnosis. Pelvic pain that is deep, persistent, and present both during and outside of the menstrual cycle often points to more than one source. Pain that worsens with intercourse, bladder fullness, bowel movements, or pelvic muscle activation suggests that the uterus, pelvic floor muscles, nerves, and surrounding organs may all be involved.

A Long List of Prior Interventions and Why That Matters

Many patients have already tried hormonal treatments, surgery, pelvic floor physical therapy, or even vascular procedures before seeing Dr. Tahery. When these treatments do not bring relief, it does not mean the pain is untreatable. It often means that the underlying cause has not been fully identified, or that the pain has evolved over time. Chronic pelvic pain can change the way nerves communicate with the brain, making pain persist even after an initial trigger has been treated.

Why “Normal Imaging” Doesn’t End the Conversation

One of the most common misconceptions about pelvic pain is that normal imaging or negative surgical findings mean nothing is wrong. Dr. Tahery frequently sees patients whose ultrasounds, MRIs, or prior surgeries did not reveal a clear answer. Conditions such as adenomyosis, deep endometriosis, pelvic floor dysfunction, and nerve-related pain may not always appear on imaging studies. A normal test does not rule out a real and significant source of pain.

Pelvic floor muscles often play an important role in chronic pelvic pain, but they are not always the original problem. Over time, pain from the uterus or pelvic organs can cause the pelvic floor muscles to tighten and spasm as a protective response. Treating the muscles alone may not be enough if the pain is being driven by deeper sources or by nerve sensitization.

RELATED: Pelvic Floor Disorder Symptoms in Women

Reframing the Differential: Overlap, Not Competition

Many women with chronic pelvic pain also experience bloating, constipation, bladder pressure, or discomfort that improves temporarily after emptying the bladder or bowels. These symptoms are often related to shared nerve pathways between pelvic organs rather than separate gastrointestinal or urinary conditions. Dr. Tahery carefully evaluates how these systems interact instead of viewing them in isolation.

As pelvic pain continues over months or years, the nervous system itself can become more sensitive. This process, known as pain sensitization, means that the body continues to generate pain signals even when inflammation or structural disease is minimal. For this reason, effective treatment usually requires a layered approach that addresses hormonal factors, muscle coordination, nerve pain, and central pain processing together.

Visit-to-Visit Evolution: Paying Attention to What Changes

Dr. Tahery believes that chronic pelvic pain is not something patients simply have to live with. When previous treatments have failed, a thoughtful reevaluation can often explain why they did not work and open the door to better options. By focusing on patterns, triggers, and the way pain has changed over time, it is possible to develop a more targeted and individualized plan. Chronic pelvic pain is not a diagnosis by itself. It is a signal that multiple systems in the pelvis are interacting in a way that sustains pain. With careful evaluation and an integrated approach, many patients can finally begin moving toward meaningful relief and a better quality of life.

The post How I Evaluate Complex Chronic Pelvic Pain When Prior Treatments Have Failed appeared first on Best Uro-Gynecologist Los Angeles, OB/GYN Glendale | Dr. Michael Tahery.

Research suggests that more than 11 percent of American women between ages 15 and 44 have endometriosis. Unfortunately, many women suffer with painful symptoms for years before receiving a diagnosis. They may feel confused and frustrated. Some women feel like doctors dismiss their pain as totally normal. Dr. Tahery believes pelvic pain deserves to be taken seriously and evaluated thoughtfully, especially when symptoms are severe, recurrent, or worsening. Many women resort to online searches about what causes endometriosis.

There isn’t one sole cause of endometriosis. Instead, research shows that several factors work together to create a perfect storm. Hormones, immune system function, genetics, and environmental influences can play a role in the development of this condition. When patients understand what may be driving their symptoms, they often feel more empowered and confident about their care, an approach Dr. Tahery emphasizes during patient education and treatment planning.

HIGH ESTROGEN

High levels of estrogen are one of the most important contributing factors. Estrogen provides the fuel that allows endometrial-like tissue to grow and persist outside the uterus. If you have a higher level of estrogen or an increased sensitivity to estrogen, this can allow abnormal tissue to survive and spread, something Dr. Tahery considers when discussing symptom patterns and flares.

Some women naturally produce more estrogen, while others respond more strongly to its effects. This hormonal environment promotes inflammation and makes it harder for the body to break down abnormal tissue. Over time, this process can intensify symptoms such as pelvic pain, heavy periods, bloating, and pain during intercourse, symptoms Dr. Tahery commonly evaluates during a comprehensive pelvic pain assessment.

Estrogen alone does not cause endometriosis, but it strongly influences how the condition progresses and why symptoms often worsen without treatment. Dr. Tahery explains this connection so patients understand why hormonal balance and inflammation control are central to managing symptoms.

IMMUNE SYSTEM DYSFUNCTION

Immune system dysfunction is another important contributor. Normally, the immune system removes cells that grow where they do not belong. In women with endometriosis, the immune system may not recognize or eliminate misplaced endometrial-like tissue. Dr. Tahery often discusses how immune response and chronic inflammation affect symptom severity and disease progression.

When abnormal tissue remains in the pelvis, it can trigger ongoing inflammation. That inflammation contributes to pain and encourages lesions to grow. Many women with endometriosis also show signs of heightened inflammatory responses, which may explain symptoms such as fatigue, widespread discomfort, and pelvic pressure, factors Dr. Tahery considers when tailoring individualized care.

ENVIRONMENTAL FACTORS

Environmental factors may also play a role. Certain chemicals can disrupt hormone balance and interfere with immune function. Dr. Tahery may review lifestyle and environmental exposure considerations as part of a broader, whole-person approach to endometriosis care.

These substances, often referred to as endocrine disruptors, are found in some plastics, pesticides, and industrial products. Over time, exposure may increase estrogen activity or alter immune responses. Environmental exposure alone does not cause endometriosis, but it may increase risk or worsen symptoms in women who already have a genetic or hormonal predisposition, an interaction Dr. Tahery explains so patients understand how multiple factors overlap.

RETROGRADE MENSTRUATION

Retrograde menstruation is one of the most commonly discussed theories behind endometriosis. During menstruation, blood is meant to flow out of the body. When menstrual blood flows backward through the fallopian tubes into the pelvic cavity, it can carry endometrial cells with it. Dr. Tahery frequently reviews this concept when patients ask how endometriosis begins.

These cells may attach to pelvic organs and begin to grow. While many women experience some degree of retrograde menstruation, only a subset develop endometriosis. This suggests that additional factors, such as immune response and hormonal environment, determine whether those cells survive and continue to grow. For this reason, Dr. Tahery evaluates the entire clinical picture rather than focusing on any single cause.

RELATED: Pelvic Floor Disorder Symptoms in Women

ENDOMETRIOSIS RISK FACTORS

There are also several risk factors that increase the likelihood of developing endometriosis. Genetics play a significant role. Endometriosis often runs in families, and a history of heavy periods or pelvic pain in close relatives can increase risk. Dr. Tahery routinely asks about family history because it can provide valuable diagnostic clues.

Age

Age is another factor. Many women experience painful periods from adolescence but are not diagnosed until their 30s or 40s. Painful intercourse or concerns about fertility often prompt more thorough evaluation later in life. Dr. Tahery encourages earlier assessment when symptoms interfere with daily function or quality of life.

Immune Disorders

Women with immune system disorders or chronic inflammatory conditions may also face a higher risk. When the immune system struggles to regulate inflammation, it becomes harder for the body to clear abnormal tissue. This is another reason Dr. Tahery takes a detailed medical history when evaluating persistent pelvic pain.

Menstrual Cycle Characteristics

Menstrual cycle characteristics can also increase risk. Women with endometriosis often experience early onset of menstruation, short cycles, heavy or prolonged bleeding, and severe cramps. These patterns may increase estrogen exposure and raise the likelihood of retrograde menstruation details, which Dr. Tahery reviews carefully during evaluation.

Endometriosis is a complex condition that can significantly affect daily life. No two cases are exactly the same, and symptoms can change over time. You do not have to power through chronic pain or disruptive symptoms. Dr. Tahery focuses on thoughtful evaluation and individualized care to help patients gain clarity and move toward meaningful relief.

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

Dr. Tahery recognizes that chronic pelvic pain does not always point to one obvious cause. Some women experience pain that shifts in intensity or location from day to day. One day, you may feel bloated or achy. Next, you may notice sharper pain in your lower abdomen or pelvis. Changes in diet, activity, or over-the-counter medications often provide little relief.

Pain signals in the pelvis can overlap in complex ways. As Dr. Tahery explains, the pelvic floor muscles, nerves, connective tissue, reproductive organs, bladder, and bowel all sit close together. When one area becomes irritated, pain can spread or feel deeper than its true source. This overlap makes chronic pelvic pain especially challenging to diagnose through imaging or lab tests alone.

To address these challenges, Dr. Michael Tahery uses pelvic pain mapping to better understand each patient’s symptoms. When standard testing does not provide clear answers or treatments have not helped, this method allows Dr. Tahery to focus on how pain presents and where it originates. This approach recognizes that symptoms can exist even when imaging appears normal and helps create a more complete picture of your experience.

WHAT IS PELVIC PAIN MAPPING?

Pelvic pain mapping is a structured method used by Dr. Tahery to evaluate chronic pelvic pain by examining specific pelvic regions in a careful, step-by-step way. This approach recognizes that pelvic pain often involves more than one structure and rarely stems from a single cause.

During the evaluation, Dr. Tahery assesses different areas of the pelvis while you provide real-time feedback. You help identify which areas feel tender, uncomfortable, or familiar. This process allows Dr. Tahery to determine which structures reproduce your pain and which do not. He then organizes this information into a clear pattern that shows how pain distributes across the pelvis.

For women with chronic pelvic pain, Dr. Tahery uses pain mapping to distinguish muscle-related pain from nerve irritation, organ sensitivity, or pain referred from nearby structures. This distinction matters because overlapping symptoms can easily lead to incorrect assumptions. Mapping helps you and Dr. Tahery speak the same language when discussing your pain.

In more complex cases, Dr. Tahery may also use pain mapping to guide decisions about additional testing, referrals, or treatment options. When he understands which structures contribute most to your symptoms, the next steps can be chosen thoughtfully rather than relying on broad or unnecessary evaluations.

RELATED: Pelvic Floor Disorder Symptoms in Women

BENEFITS OF PELVIC PAIN MAPPING

If you have been living with unexplained chronic pelvic pain, pelvic pain mapping with Dr. Tahery offers several important benefits. It shifts the focus from guesswork to careful observation and meaningful communication.

Better Diagnosis

Chronic pelvic pain rarely fits neatly into a single diagnosis. Many women arrive at appointments with a theory about what is causing their symptoms, yet treatments aimed at that condition may not work.

Dr. Tahery uses pain mapping to directly connect pain responses with specific pelvic structures. This process often reveals that pain involves multiple regions rather than one isolated source. Understanding this complexity helps explain why previous treatments did not provide relief and allows Dr. Tahery to refine your diagnosis.

A clearer diagnosis can also feel validating. When your pain patterns make sense, many patients feel more confident and hopeful moving forward with care under Dr. Michael Tahery’s guidance.

Directed Treatment

Once Dr. Tahery understands the primary contributors to your pain, treatment can become more precise. Pain mapping supports a targeted approach instead of repeated or generalized therapies.

Some women benefit from pelvic floor physical therapy. Others may need nerve-focused care, hormonal management, or additional medical treatments. Dr. Tahery designs personalized treatment plans that reduce unnecessary interventions and focus on addressing your specific symptoms.

Better Surgical Planning

Pelvic pain mapping plays an important role when surgery becomes a consideration. Imaging studies or prior diagnoses may suggest that surgery could help, yet uncertainty often remains about which procedure would be most appropriate.

Dr. Tahery uses pelvic pain mapping to evaluate how specific pelvic structures relate to pain before making surgical decisions. This careful assessment helps avoid unnecessary procedures and reduces the risk of repeated surgeries that do not improve symptoms. When surgery is appropriate, Dr. Tahery uses pain mapping to guide careful planning and set realistic expectations.

Treatment Monitoring

Pelvic pain mapping also supports ongoing care. Dr. Tahery may repeat the evaluation over time to track changes in pain patterns and adjust treatment as needed.

For women with chronic pelvic pain, this process provides reassurance that Dr. Tahery is actively monitoring their symptoms rather than dismissing or generalizing them. This approach supports long-term management, better outcomes, and a thoughtful path forward.

The post Pelvic Pain Mapping For Chronic Pelvic Pain appeared first on Best Uro-Gynecologist Los Angeles, OB/GYN Glendale | Dr. Michael Tahery.

Vulvar Vestibulitis Symptoms

Pain is the primary vulvar vestibulitis symptom. Pain generally radiates in the vulva and opening of the vagina. However, pain location and intensity aren’t necessarily universal for all women with VSS. Pain can either be broad or localized. Certain activities may also trigger more pain and discomfort than others. Here’s a look at vulvar vestibulitis symptoms:

•  Burning, stinging, and irritation
•  Rawness or soreness
• Strong, sharp knife-life pain
• Aching and throbbing pain
• Swelling
• Pain triggered by biking or sitting for long periods of time
• Pain from tight clothing
• Pain from workouts or physical activity
• Pain when trying to use a tampon
• Pain during sex
• A sensation that you need to pee suddenly
• Unusual vaginal discharge
• Red blotches around the opening of the vagina

Vulvar vestibulitis symptoms are constant for some women. They may experience pain and swelling to some degree around the clock. For others, symptoms may only flare up when the vulva is irritated by touch, rigorous activity, or wearing ill-fitting clothing.

Causes of Vulvar Vestibulitis

Causes of vulvar vestibulitis aren’t fully known. However, there are several factors that are believed to play roles in VVS. For example, one school of thought is that some women simply have more nerves in the vulva area. This results in heightened sensitivity caused by nerves that send pleasure and pain signals through the nervous system to the brain.

Women may be at higher risk for developing VVS if they have a history of infections in the vagina. Past injury and irritation involving the nerves of the vulva can also increase risks. A sudden onset of VVS could potentially be an allergic reaction to fabrics or detergents. Finally, VVS could be caused by weakened pelvic floor muscles caused by childbirth, surgery, or physical injury.

Vulvar Vestibulitis Misdiagnosed as Vaginismus or Vulvodynia

VVS is sometimes misdiagnosed as a condition called vaginismus that’s characterized by involuntary muscle spasms that interfere with vaginal intercourse or penetration. While vaginal pain is a shared symptom of both, the pain experienced with vaginismus is caused by the tightening of pelvic floor muscles. Meanwhile, VVS specifically involves provoked or unprovoked pain of the vulva. Vulvar vestibulitis and vulvodynia are quite similar. VVS is technically a subset of vulvodynia. However, vulvodynia is a much broader diagnosis that refers to pain that can be experienced in the clitoris, labia majora, labia minora, urethra opening, vestibular bulbs and vestibule, urethra opening, vaginal opening, Bartholin’s gland, and more.

RELATED: Sex After Menopause | What Should You Know?

Treatment for Vulvar Vestibulitis

Due to the fact that VVS can have different underlying causes and triggers, treatment for vulvar vestibulitis is handled on a patient-by-patient basis. Once your care provider has established a VSS diagnosis, they may work with you to identify potential causes of vulvar vestibulitis that apply for you. Potential vulvar vestibulitis treatment options can include:

• Medications that treat inflammation and atrophy
• Switching to hypoallergenic detergents and soaps
• Avoiding some fabrics
• Avoiding tight-fitting pants and shorts
• Pelvic floor exercises or physical therapy
• Diet modification to reduce inflammation
• Injection therapies
• Laser therapies
• Surgery

Finally, it’s important to know that itching is not a sign of VVS. If you’re experiencing itching that’s accompanied by pain and other VVS symptoms, it’s so important to rule out infection or illness with the help of a care provider.

If you’re interested in learning more about treatment for vulvar vestibulitis, Dr. Michael Tahery is here to help you understand this diagnosis better. Dr. Tahery is an Obstetrician-Gynecologist (OB-GYN) and Urogynecologist in Los Angeles and Glendale, CA with more than 25 years of experience. Dr. Tahery and his staff are leaders in gynecology, urogynecology, and cosmetic care here in the Los Angeles area. Book an appointment today!

The post What is Vulvar Vestibulitis? Symptoms, Causes, Misdiagnosis, and Treatment appeared first on Best Uro-Gynecologist Los Angeles, OB/GYN Glendale | Dr. Michael Tahery.

While some discomfort is normal, many women unknowingly have endometriosis. This condition affects an estimated 11 percent of women between the ages of 15 and 44. It can develop in women only a few years after the first menstrual period. But many will be asymptomatic until the condition is severe. Furthermore, the signs of endometriosis are easy to mistake for other conditions, and it’s common for women to mistake them for standard period pain.

So, what are the differences between endometriosis vs menstrual cramps?

Normal Menstrual Cramps

Cramps are a relatively normal part of the menstrual cycle. Not everyone experiences them. Some have no discomfort at all, while others only navigate mild issues during their cycles. But for some women, cramps can cause debilitating pain lasting several days.

Typically, menstrual cramps begin one to three days before your period. They can peak within 24 hours after your period starts before subsiding a few days into menstruation.

Cramps occur when the body produces high levels of a hormone-like substance called prostaglandins. Prostaglandins are necessary for menstruation because they trigger your uterus to contract and shed its lining. The period pain you feel during this time is the byproduct of those contractions. It can create a throbbing sensation in the lower abdomen. Higher levels of prostaglandins can lead to severe cramps.

Fortunately, the pain and discomfort are temporary, and there are many ways to address cramps. But for women who suffer from substantial period pain, it can be difficult to distinguish endometriosis vs. menstrual cramps.

RELATED: Pelvic Pain: When is it Serious?

Signs and Symptoms of Endometriosis

Endometriosis occurs when tissue or cells from the uterine lining move and proliferate outside the uterus. Endometrial tissue can end up somewhere in the pelvic cavity, bowel, bladder, fallopian tubes, ovaries, and other pelvic organs. Those implants can grow and bleed inside the abdomen as hormones from the ovaries feed them.

The body responds to the tissue, resulting in inflammation. The pain women feel with endometriosis is the byproduct of that inflammation.

The symptoms of endometriosis can vary. What’s worse is that endometriosis may not cause symptoms at all. It’s common for women to live with this condition for many years until it gets severe enough to cause debilitating pain.

The most common sign of endometriosis is experiencing a painful period every cycle. Timing is an important factor when determining whether discomfort results from endometriosis vs. menstrual cramps, timing is an important factor. Menstrual cramps typically begin several days before the period starts. But with endometriosis, pain occurs throughout your period.=

Women also often feel pain during intercourse. Some feel it during a bowel movement or urination. Every woman experiences endometriosis differently, and the pain level depends on how severe the issue is. In most cases, period pain is cyclical. However, it can also be chronic and debilitating.

Endometriosis may also cause menstrual irregularity. That can include heavy bleeding and unpredictable cycles. A recurring painful period becomes common over time as the condition worsens. Eventually, the proliferating tissue in the abdomen can damage nearby organs and cause infertility.

RELATED: Endometriosis Diet: What To Eat And What To Avoid

Endometriosis vs. Menstrual Cramps Treatment

There are significant differences in treating endometriosis vs. menstrual cramps.

Treatment for menstrual cramps often involves over-the-counter pain relievers. Regularly taking these medications starting the day your period begins can help manage pain. For more serious cases, your doctor may prescribe non-steroidal anti-inflammatories.

Many women also turn to breathing exercises, heating pads, and muscle-relaxing activities to address discomfort.

Treating endometriosis is a different process. Some techniques for dealing with menstrual cramps may provide relief, but successful treatment involves addressing the tissue causing inflammation. Depending on the severity of the case, doctors may recommend hormonal birth control or medications to stunt tissue growth. However, the most effective treatment is often surgical.

Dr. Michael Tahery performs minimally invasive laparoscopy to diagnose and remove endometriosis. While other diagnostic approaches can indicate endometriosis, laparoscopy is the proper way to diagnose the condition. Dr. Tahery can perform the laparoscopy through the belly button to analyze the tissue. If appropriate, Dr. Tahery can remove the excess tissue growing outside the uterus.

Individualized treatment is crucial for painful periods or endometriosis. So If you’re unsure whether your pain is a product of endometriosis vs. menstrual cramps, you can turn to Dr. Michael Tahery. Dr. Tahery has over two decades of experience treating women in the Los Angeles area. He’s a board-certified OB/GYN, a member of the Cedars Sinai Center of Excellence in minimally invasive surgery, and an expert in treating endometriosis. You can trust Dr. Tahery to take care of your needs and provide the personal treatment you need. Contact our offices today to schedule an appointment with Dr. Tahery and discuss your period pain or endometriosis worries

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Unfortunately, some experience infections more often than others. About a quarter of women suffer from recurrent UTIs, turning an occasional bout of pain and discomfort into repeated frustration and concern.

Because of their prevalence, these infections are a common source of concern in women’s health circles. Misdiagnosis and mistreatment happen relatively frequently. As a result, women can’t address the underlying issues or take steps to prevent recurrent infections.

Recurrent urinary tract infections require careful management. Poorly managed, a UTI will continue to affect your quality of life and health.

What are the Symptoms of Recurrent UTIs?

A UTI is a bacterial infection in the urethra or bladder. Typically, they occur when bacteria enter the urethra and travel up the bladder. The bacteria can come from many sources, but bacteria from the anal area are the most common culprit.

The symptoms of recurrent infections are the same as a standard UTI. These include:

• Burning pain during urination
• A constant urge to urinate
• Decreased urine output
• Cloudly or colored urine
• Strong and unpleasant urine odor
• Pain and pressure in the pelvic area

In addition to a painful burning sensation, women often first notice signs of an infection by observing the cloudy appearance of the urine. In many cases, a UTI may cause red, pink, or brown discoloration.

So how often is too often? Generally, women who experience two or more UTIs in six months, or those who have three more infections during a year, are considered to have recurrent UTIs.

Proper UTI treatment can help reduce the effects of the infection. However, symptoms can persist for up to two weeks. In complex cases, the infection can spread to one or both kidneys.

With this UTI being so common, many believe that it’s a minor condition. However, a spreading infection presents a genuine risk for permanent kidney damage, reduced function, and overall failure.

RELATED: Is Your Pelvic Pain Caused by Your Bladder?

Diagnosis of Recurrent UTI’s

The biggest obstacle with urinary tract infections is diagnosis. When symptoms develop, the condition can progress quite rapidly. As a result, most women turn to primary care providers, urgent care facilities, or even the emergency room for evaluation.

Unfortunately, it’s not uncommon for medical professionals to misdiagnose UTIs based solely on symptoms. As a result, women are sent home with antibiotics and simple care instructions or given antibiotics over the phone without a proper evaluation.

However, there’s a lot of overlap between UTIs and other common conditions, such as vaginal infections, sexually transmitted infections, pelvic inflammatory changes, or irritable bladder. The improper evaluation, lack of appropriate testing, and understanding the many conditions that could result in symptoms similar to a UTI results in frequent misdiagnosis and poor treatment outcomes.

One study published by the American Society of Microbiology found that less than half of women diagnosed with a UTI had one. To make matters worse, physicians missed about 37 cases of sexually transmitted infections. Most of those women got the wrong diagnosis of a UTI.

The most reliable symptoms of a UTI are burning during urination and blood in the urine. Other common symptoms such as urinary frequency, urgency, vaginal itching, and abnormal odor are less dependable. 

The best test to truly diagnose a UTI is to analyze a urinary sample. A urinary tract infection specialist will examine the urine under a microscope to look for bacteria or white blood cells. The presence of white blood cells indicates that the body is attempting to fight off an infection. Specialists may also take a urine culture to identify bacteria and yeast that could cause an infection.

It’s also critical to discuss these infections openly with a healthcare provider. Unless you’re vocal about recurrent UTIs, diagnosing physicians have no way of knowing that these infections are a regular thing. For this reason, many assume that it’s a single episode.

To investigate recurrent issues, consulting a urogynecologist, who specializes in diagnosing and treatment of urinary issues in women is needed.  A urogynecologist may adopt more detailed and sophisticated methods of examination. For example, they might take a closer look at the urethra, bladder, and surrounding organs using an ultrasound machine or cystoscopy techniques.

RELATED: Treating Vaginal Infections

Management and Treatment of Recurrent UTI’s

Proper UTI treatment is about more than just taking antibiotics. One of the biggest complaints about misdiagnosing cases is the reliance on repeated antibiotic therapy. Not only can antibiotics have unwanted side effects, but they can also lead to the bacteria developing resistance.

Even though when properly used antibiotics can be useful, overuse of antibiotics also damages the healthy bacterial environment in the vagina, intestines, and bladder which results in recurrent vaginal infections, poor digestions, and abnormal intestinal bacterial growth, as well as recurrent UTI’s. In my practice, I use antibiotics infrequently and strategically when absolutely necessary. In most cases, I use natural treatment options to help our bodies restore the normal environment and eliminate conditions that lead to recurrent infection. 

Ultimately, recurrent UTI treatment is about adopting healthier preventative habits and addressing any underlying health issues. All women are different, but standard management techniques include encouraging frequent urination and more water intake. Specialists can also recommend taking supplements, probiotics, or vaginal estrogen for postmenopausal women.

Dealing with recurrent UTIs is not easy. But, you can manage the condition with a little help. It all starts with proper diagnosis and management.

If you experience UTIs regularly, contact the offices of Dr. Michael Tahery today. Dr. Tahery is a urogynecologist with experience in both women’s health and urology. His expertise in the field can help women in Los Angeles and the surrounding areas find relief. Give our office a call to book a consultation and learn more about possible treatment options.

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Contrary to popular belief, pelvic floor dysfunction is not a rare occurrence. Issues can arise at any point during a woman’s life. While these issues usually aren’t life-threatening, they can have a debilitating effect on a woman’s quality of life. There are a few types of disorders. Here are the most common that affect women and their accompanying symptoms.

Urinary Incontinence Symptoms

Urinary incontinence is the most widespread pelvic floor disorder. It results in complete or partial loss of bladder control. When this occurs, the muscles that control the bladder valve weaken. Usually, the issue is that the pelvic floor muscles are unable to relax. Women may experience a loss of muscle coordination, preventing at-will urination and frequent accidents.

At first, symptoms can be as innocent as slight urine loss during a sneeze or cough. However, pelvic floor dysfunction can worsen and cause regular involuntary loss.

Symptoms of urinary incontinence can vary widely from one person to the next. However, they often include:

• A feeling of pressure on the bladder
• Frequent urination
• Difficulty urinating at will
• Accidents when laughing, coughing, or sneezing
• Urine loss or leakage
• Inability to empty bladder completely

RELATED: Urinary Incontinence Specialist in Los Angeles

Pelvic Organ Prolapse Symptoms

Pelvic organ prolapse is one of the more alarming forms of pelvic floor dysfunction. It occurs when the pelvic floor muscles and tissue weaken. The otherwise supportive sling can become thin or tear completely, resulting in the organs “falling” out of place.

Prolapse can cause significant discomfort for women. Not only that, but the standard function of the fallen organs become compromised. The organs can herniate into the vaginal wall, resulting in a visible bulge. It is a cystocele when the bladder herniates and a rectocele when the rectum herniates.

Some of the most common symptoms for this type of pelvic floor disorder include:

• Weighty feeling in the pubic area
• Dragging discomfort in the vagina
• Visible bulges in the vagina
• Pain or discomfort during sex
• Difficulty with urination or bowel movement

RELATED: Organ Prolapse Treatment in Los Angeles

Fecal Incontinence

Fecal incontinence is similar to urinary incontinence. The difference, however, is that this pelvic floor disorder involves a loss of bowel control. The pelvic floor muscles controlling the bowels and rectum do not perform efficiently, resulting in numerous problems.

Women can suffer from passive incontinence, which refers to the sudden passing of stool without any control. Or, they can suffer from urge-related incontinence. This form of pelvic floor dysfunction pertains to constant muscle contraction that prevents the passage of stool.

Fecal incontinence can affect women at any age. However, it’s most common in seniors and women recovering after childbirth. Some common symptoms include:

• Sudden accidents
• Periodic stool or mucus leakage
• Difficulty passing stool
• Chronic constipation
• Frequent bouts of diarrhea

Pelvic floor disorders can negatively impact your day-to-day life. But, they are highly treatable. Dr. Tahery is a practicing urogynecologist in Los Angeles. He can create a custom treatment plan to mitigate these disorders’ effects. Contact us today to schedule your consultation with Dr. Tahery, learn more about pelvic floor dysfunction, and address your symptoms once and for all.

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