In my practice, I focus on restoring normal pelvic support while preserving function and, when appropriate, preserving the uterus. Over time, I’ve developed a vaginal, minimally invasive approach that allows me to correct even advanced prolapse without removing the uterus, with reliable and durable results.

UNDERSTANDING SEVERE PROLAPSE

Pelvic organ prolapse is typically a combination of defects rather than a single issue. Most patients present with:

• Loss of apical support (uterine descent)
• Anterior vaginal wall weakness (cystocele)
• Posterior vaginal wall defects (rectocele or enterocele)

Similar to the four walls in a room, addressing only one vaginal wall often leads to recurrence. A successful repair requires identifying and correcting each level of support.

WHY I PRESERVE THE UTERUS

The uterus itself is not the cause of prolapse. The underlying issue is failure of the supporting ligaments and connective tissue.

I often see patients who previously underwent a hysterectomy and later developed vaginal vault prolapse. Removing the uterus does not correct the underlying support problem.

In appropriately selected patients, preserving the uterus allows for restoration of normal anatomy without removing an organ unnecessarily. It also maintains native support relationships within the pelvis.

VAGINAL RETROPERITONEAL MCCALL CULDOPLASTY

A key part of my approach is a modified vaginal retroperitoneal McCall culdoplasty, adapted to suspend the uterus. I began using this little-used technique many years ago in patients who medically were not able to tolerate a long surgical procedure requiring the removal of the uterus, and soon adapted the procedure to help those who did not want their uterus removed. 

Using a vaginal approach, I access the uterosacral ligaments through the retroperitoneal space and use them as suspension points. Sutures are placed to elevate the uterus back into its natural position, and the cul-de-sac is closed to reduce the risk of enterocele.

This provides strong apical support without the need for abdominal surgery or mesh.

VAGINAL RECONSTRUCTION

In the same operation, I address the anterior and posterior vaginal walls based on each patient’s specific defects.

Anterior repair focuses on restoring the pubocervical fascia to support the bladder. Care is taken to avoid overcorrection.

Posterior repair involves reconstruction of the rectovaginal fascia and, when needed, the perineal body. This improves both support and function.

Each repair is tailored to the individual. There is no standardized template that works for everyone.

WHY THE VAGINAL APPROACH

Whenever possible, I prefer a vaginal approach. It allows direct access to the defects and avoids abdominal incisions. Patients typically experience less pain and a smoother recovery compared to abdominal procedures.

In most cases, this approach also allows me to avoid the use of synthetic mesh or, in some cases, address urinary incontinence issues at the same time. 

RELATED: Urinary Incontinence and Vaginal Prolapse After Vaginal Delivery

OUTPATIENT SURGERY AND RECOVERY

A significant portion of these procedures can be performed on an outpatient basis. Many patients go home the same day.

Recovery is generally straightforward. Most patients are up and walking within a day, and activity gradually increases over the following weeks. Avoiding abdominal surgery plays a large role in this.

OUTCOMES

The goal is not just anatomical correction, but meaningful improvement in quality of life. Vaginal repairs have been shown to have high success rates and patient satisfaction. 

Durable outcomes depend on proper identification of all defects, solid apical support, and a balanced reconstruction that preserves function. When these principles are followed, patients tend to do very well.

FINAL THOUGHTS

Pelvic organ prolapse is a support problem, not a uterine problem. In many cases, it can be corrected without removing the uterus.

A well-executed vaginal repair using retroperitoneal McCall culdoplasty, combined with anterior and posterior reconstruction, can restore support in a durable and minimally invasive way.

If you have prolapse that is affecting your quality of life or if you’ve been advised to undergo a hysterectomy and want a second opinion about preserving your uterus, you should know that other options exist. Contact us to book a consultation. 

The post Repairing Severe Vaginal and Uterine Prolapse Without Hysterectomy: A Uterus-Preserving Approach appeared first on Best Uro-Gynecologist Los Angeles, OB/GYN Glendale | Dr. Michael Tahery.

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.

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.

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.

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