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A woman in her 60s had been experiencing discomfort and pain in the pelvic region and had consulted gynecology and urology departments. She was also suffering from pelvic organ prolapse, for which she recently underwent mesh surgery. After the surgery, her pain worsened, and she reached out to us for consultation.

Based on the keywords “No issues detected by gynecology or urology!” I immediately thought of “interstitial cystitis,” “GSM,” and “myofascial pelvic pain syndrome (MPPS).”

Upon performing a cystoscopy, Hunner’s ulcers were found, and upon examination, pain was detected in the obturator internus muscle. The vaginal mucosa showed signs of atrophy, dryness, and the pH was 6.5, leading to a diagnosis of GSM.

So why did the pain worsen after mesh surgery?!
Here’s my hypothesis:

The patient already had pain symptoms from interstitial cystitis. The mesh surgery likely triggered inflammation around the bladder, intensifying the pain. This inflammation spread to the surrounding fascia, causing decreased mobility. As a result, the pain likely compounded with the effects of myofascial pelvic pain syndrome.

Now, the order of treatment:

1. Hydrodistention and electrocoagulation for interstitial cystitis
2. Physical therapy for MPPS
3. Local hormone therapy and laser treatment for GSM

In terms of priority, starting with (1) is essential, and rehabilitation should follow immediately. (3) can be addressed more gradually.

Many patients arrive after starting with (3), but doing things out of order can lead to a longer treatment journey, though that’s still a valid approach (with some frustration, of course).

Unfortunately, diagnostic methods are not yet widespread, and the healthcare system is not meeting patient needs.

I apologize 🙇

I hope to nurture many guardians who can help guide this process. ^ ^

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