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.

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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.

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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.

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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.

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Labiaplasty has become one of the most commonly requested cosmetic gynecology procedures in recent years. Women of different ages seek labiaplasty for both physical comfort and personal confidence. Increased awareness, advances in surgical techniques, and reduced stigma around women’s intimate health have all contributed to its growing popularity.

According to Dr. Michael Tahery, a board-certified OB-GYN and urogynecologist in Los Angeles and Glendale, California, many patients considering labiaplasty have lived with discomfort or self-consciousness for years before discussing it with a physician.

“Most women don’t come in impulsively,” says Dr. Tahery. “They’ve usually thought about their concerns for a long time before scheduling a consultation.”

GROWING AWARENESS OF LABIAPLASTY AND WOMEN’S HEALTH

Open discussions about women’s health have become far more common. Topics that were once avoided, such as changes after puberty, childbirth, weight loss, hormonal shifts, and aging, are now openly discussed in medical settings. This cultural shift has made it easier for women to ask about labiaplasty and understand whether it may help address their symptoms.

In Dr. Tahery’s practice, women most often inquire about labiaplasty due to irritation, discomfort with clothing, difficulty exercising, or concerns about symmetry. Cosmetic appearance may be part of the discussion, but comfort and quality of life are often the primary motivators.

ADVANCES IN LABIAPLASTY TECHNIQUES

Modern surgical techniques have played a major role in the increased interest in labiaplasty. Earlier approaches were more invasive and often required longer recovery times. Today, refined methods allow for precise tissue reshaping while preserving natural anatomy.

Dr. Michael Tahery explains that most labiaplasty procedures are now performed as outpatient surgeries. Many patients undergo the procedure under local anesthesia and return home the same day. Improved surgical tools and planning help reduce swelling, limit discomfort, and support predictable healing.

These advances make labiaplasty more accessible to women who balance work, family, and daily responsibilities.

HIGH PATIENT SATISFACTION AFTER LABIAPLASTY

Patient satisfaction is one of the strongest drivers behind labiaplasty’s popularity. When patients receive clear education and realistic expectations before surgery, outcomes are often very positive.

After healing, many patients report improved comfort during walking, exercise, and daily activities. Clothing irritation is often reduced, and some women feel more confident in intimate settings. Dr. Tahery notes that relief from physical discomfort can have a meaningful impact on overall well-being.

“When a chronic source of irritation is resolved, patients often feel a sense of relief that affects many aspects of daily life,” he says.

REDUCED STIGMA AROUND GENITAL HEALTH

The stigma surrounding women’s genital health has decreased significantly. Physicians now encourage open, respectful conversations about anatomy, symptoms, and personal concerns. Education plays an important role in helping patients understand that labial appearance varies widely and that there is no single “normal.”

At the same time, Dr. Tahery emphasizes that concerns should not be dismissed when anatomy causes ongoing discomfort or emotional distress. A supportive consultation allows patients to make informed decisions based on personal needs rather than embarrassment or outside pressure.

RELATED: Will Insurance Cover Labiaplasty?

WHO CONSIDERS LABIAPLASTY?

Women consider labiaplasty at many stages of life. Some notice concerns during adolescence, while others experience changes after childbirth, significant weight loss, hormone therapy, or menopause. Genetics also influence labial size and symmetry.

According to Dr. Tahery, age alone rarely determines candidacy. Overall health, anatomy, and goals are far more important. A thorough consultation helps determine whether labiaplasty is appropriate and which surgical approach would be most beneficial.

PERSONALIZED LABIAPLASTY TREATMENT

Labiaplasty is not a one-size-fits-all procedure. Each surgery is customized to the patient’s anatomy and symptoms. Some women seek reduction of excess tissue, others desire improved symmetry, and some focus primarily on reducing irritation.

Dr. Michael Tahery works closely with each patient to develop an individualized treatment plan. Preoperative counseling, recovery planning, and follow-up care are essential parts of achieving natural-appearing, comfortable results.

LABIAPLASTY WITH DR. MICHAEL TAHERY IN LOS ANGELES

The rising popularity of labiaplasty reflects progress in women’s healthcare. Better education, safer surgical options, and open communication allow women to address concerns that affect both comfort and confidence.

Dr. Michael Tahery, OB-GYN and UroGynecologist in Los Angeles and Glendale, provides patient-centered labiaplasty care with a focus on function, comfort, and natural results.

The post Why Is Labiaplasty So Popular? appeared first on Best Uro-Gynecologist Los Angeles, OB/GYN Glendale | Dr. Michael Tahery.

CANDIDATES FOR VAGINAL PROBIOTICS

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

Women With Recurrent BV or Yeast Infections

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

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

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

Women With Hormonal Shifts

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

Preventative Support During and After Antibiotics

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

Experiencing Foul Odor

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

BENEFITS OF VAGINAL PROBIOTICS

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

pH Balance

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

Bacterial Vaginosis (BV) Prevention and Treatment

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

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

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

Alleviate Menopause Symptoms

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

Yeast Infection Prevention and Treatment

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

Supports Reproductive Health

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

Lowers the Risk of Urinary Tract Infections

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

Related: Management Of Recurrent UTIs in Women

TYPES OF VAGINAL PROBIOTICS

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

Lactobacillus

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

Bifidobacterium

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

Blended Probiotics

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

CAN YOU INSERT VAGINAL PROBIOTICS?

Vaginal Probiotic suppositories for insertion

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

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

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WHAT ARE KEGEL EXERCISES?

Kegel exercises were developed as a nonsurgical treatment for urinary incontinence in the 1940s by a gynecologist named Dr. Arnold H. Kegel. These exercises were designed around the findings that strengthening the pelvic floor, vaginal wall, and surrounding supportive systems could prevent urinary incontinence and genital organ prolapse.

While Kegel exercises are generally considered very easy to do, it’s essential to locate the right set of muscles to exercise in order to get results. Experts recommend that women utilize the techniques of pretending they are trying to avoid passing gas or pretending to tighten the vagina around a tampon in order to identify the muscles that need to be engaged during Kegels.

To do a Kegel, contract your pelvic floor muscles for three to five seconds before relaxing for three to five seconds. For best results, repeat the contract-relax cycle 10 times per session. While engaging pelvic muscles, it’s important to keep abdominal, leg, and buttocks muscles relaxed. The pelvis should not be visibly moving during Kegel routines.

BENEFITS OF STRONG PELVIC FLOOR MUSCLES

Kegel muscles help to strengthen the muscles that support the bladder, uterus, small intestine, and rectum. In addition to preventing incontinence, this type of pelvic floor muscle training can also improve quality of life.

Improved Bladder Control

Kegel exercises are ideal for people struggling with something called stress incontinence. Stress incontinence occurs when a few drops of urine leak as a result of coughing, laughing, sneezing, or bending to stretch or lift heavy objects. Kegels can also help to reduce the strong, sudden urge to urinate called urge incontinence that can also result in small urine leaks.

Better Sexual Function

Using Kegel exercises to strengthen the pelvic floor muscles can lead to improved sexual function and greater sexual satisfaction. For women, stronger pelvic floor muscles can improve sexual arousal and increase orgasm intensity. In addition, Kegels also increase blood flow to the pelvic area to boost overall arousal and sensitivity.

Faster Postpartum Recovery

After getting clearance from your doctor, beginning Kegel exercises a few days or weeks following vaginal or C-section delivery can help to speed up recovery. During pregnancy, a combination of the increased weight of a growing baby, hormonal changes that soften pelvic ligaments, and an expanding uterus will generally weaken the pelvic muscles. Kegel exercises can help to strengthen muscles that have stretched or become weak during pregnancy and delivery.

Better Bowel Control

Kegels can help with improving bowel control and stopping fecal incontinence. By contracting and relaxing sphincter muscles, Kegels can make it easier to hold in stool and gas. In addition, strengthening pelvic floor muscles provides better support for the rectum.

Related: When Do You Need Vaginal Rejuvenation?

Pelvic Floor Muscles

FASTER ALTERNATIVES TO KEGEL EXERCISES

Kegel results can vary depending on a person’s muscle strength, how consistent they are with exercises, and the severity of the pelvic floor damage. While Kegels are considered ideal for minor incontinence, they may not work as effectively or quickly enough to produce the results someone suffering with more extreme incontinence or muscle weakness would like to achieve. Several surgical and laser procedures are available for more extreme situations.

Vaginoplasty

Vaginoplasty is any surgical procedure used for the construction of the vagina. Vaginoplasty is commonly used to repair pelvic organ prolapse. It can also be used to repair stretching and looseness following childbirth, restore shape and appearance following radiation or other medical treatments, or correct congenital abnormalities affecting the function or appearance of the vagina.

Vaginal Rejuvenation

Vaginal rejuvenation refers to a number of procedures that improve appearance, function, or comfort. In many cases, several rejuvenation procedures are combined. This might include labiaplasty or surgical hood reduction. There are even options for noninvasive vaginal laser rejuvenation. For example, laser treatments that trigger collagen production, radiofrequency (RF) vaginal rejuvenation that uses RF waves to heat and tighten tissue, and platelet-rich plasma (PRP) injections that use platelets from a patient’s own blood to promote tissue healing.

Perineoplasty

Perineoplasty is a surgical procedure that’s commonly used to repair damage done by childbirth or trauma. This procedure repairs and tightens muscles and tissue in the area between the vagina and anus that’s known as the perineum. In addition to restoring the appearance of the perineum, perineoplasty can help to reduce urinary incontinence and restore sexual function.

Are you interested in learning more about Kegel exercises and other options for tightening the pelvic floor? For more than two decades, Dr. Michael Tahery has been a leading obstetrician-gynecologist (OB-GYN) and urogynecologist serving the Los Angeles and Glendale areas. Dr. Tahery offers the latest in surgical and laser procedures. Contact Dr. Tahery’s office for a consultation today.

The post Kegel Exercises For Pelvic Floor Muscles appeared first on Best Uro-Gynecologist Los Angeles, OB/GYN Glendale | Dr. Michael Tahery.

While research is still emerging on the relationships between GLP-1 medications and birth control, fertility, and pregnancy, manufacturers of these popular weight-loss drugs have provided recommendations for women who are currently taking oral contraceptives to avoid pregnancy.

WHAT EXACTLY ARE GLP-1 MEDICATIONS?

Glucagon-like peptide-1 (GLP-1) receptor agonists are medications that have been used to treat type 2 diabetes for years. More recently, they gained approval for the treatment of obesity. GLP-1 medications work by mimicking the body’s natural GLP-1 hormones that regulate blood sugar, insulin release, digestion, and appetite. GLP-1 medications are commonly prescribed under the brand names of Ozempic, Wegovy, Mounjaro, Trulicity, and Zepbound. Within the past few years, GLP-1 prescriptions for non-diabetes patients have risen by more than 700%.

INTERACTION BETWEEN GLP-1 AND BIRTH CONTROL PILLS

Can GLP-1 medications make birth control less effective? There’s some evidence to suggest that popular weight-loss medications can affect how oral birth control works. For example, one study found evidence that a GLP-1 medicine called tirzepatide, that is sold under the brand name of Mounjaro had a greater impact on absorption of oral hormonal contraceptives than other GLP-1 medications. The study found that patients taking Mounjaro and oral contraceptives together resulted in a 20% decrease in overall exposure to oral contraceptives. Currently, there is no evidence suggesting that GLP-1 medications reduce effectives of non-oral contraception.

In response to findings on GLP-1 medications and birth control, manufacturers have put out usage recommendations for women taking oral contraceptives. Due to risks for decreased bioavailability of birth control pills, the manufacturer of Mounjaro (tirzepatide) recommends that patients either use barrier contraception for four weeks after initiation or dosage increase or switch to a non-oral contraceptive. Due to risks for diminished therapeutic effects of oral birth control pills, the manufacturer of Bydureon (exenatide) recommends taking birth control at least one hour prior to exenatide. The manufacturer of Adlyxin (lixisenatide) recommends taking oral birth control at least one hour prior or 11 hours after lixisenatide for the same reason. Currently, all other manufacturers of GLP-1 agonists assert that their products have no effect on the bioavailability of oral contraceptive pills.

Related: Ozempic Vagina: What Are The Side Effects Of Semaglutide?

ALTERNATIVES TO BIRTH CONTROL PILLS

Patients concerned about interactions between GLP-1 medications and birth control should talk to their care providers to make sense of manufacturer recommendations and learn about alternatives to oral contraceptives. Non-oral forms of contraception that bypass the digestive system are not believed to be affected by GLP-1 medications. This includes options like intrauterine devices (IUDs), injections, implants, rings, and patches. Patients should also be aware of the potential for increased fertility that stems from the weight loss and general health changes that many people experience after beginning GLP-1 medications. For women who have had difficulty conceiving due to obesity, it may be important to speak with your doctor about the potential for an unexpected pregnancy if birth control has not been a part of the equation due to perceived or assumed low risk for pregnancy.

GLP-1 WHILE PREGNANT

The simple answer is that women should not take GLP-1 while pregnant or attempting to conceive. Currently, there is a lack of long-term data on the safety of GLP-1 medications while pregnant. Recent studies show that exposure to GLP1-RA in the first trimester is not associated with a risk of major birth defects when compared with diabetes or obesity. While these findings offer reassurance in cases of inadvertent exposure to GLP-1 medications during the first trimester of pregnancy, larger trials are needed for more conclusive results. Additionally, animal studies have found that exposure to glucagon-like peptide-1 receptor agonists in pregnancy resulted in adverse outcomes for offspring that included decreased fetal growth, skeletal and visceral anomalies, and embryonic death.

The Food and Drug Administration (FDA) currently advises women to stop taking GLP-1 medications like Ozempic at least two months prior to trying to conceive. While the amount of time it takes the body to metabolize medication can vary by person, it takes an average of six weeks for most GLP-1 medications to be gone from the body in healthy, non-pregnant women. Patients who discover that they are pregnant while still taking a prescription GLP-1 medication should contact their care providers right away.

If you’re looking for more information on interactions between GLP-1 medications and birth control or how taking weight-loss medications may impact your fertility, Dr. Michael Tahery is a leading Obstetrician-Gynecologist (OB-GYN) and Urogynecologist serving the Los Angeles and Glendale areas. Book a consultation today.

The post GLP-1 Medications and Birth Control Pills | How Do They Interact? appeared first on Best Uro-Gynecologist Los Angeles, OB/GYN Glendale | Dr. Michael Tahery.