“I had a hysterectomy in my late 40s. Since then, sex has become painful, and we’ve become sexually inactive…”
A woman came to our clinic, not for pain or intimacy, but because of repeated urinary tract infections (UTIs).
During the exam, we found her vaginal pH was 7.5, and her vaginal health index was low.
Using a camera, we observed thin, fragile vaginal tissue—so delicate that it bled just from gentle contact.
“Everything changed after the hysterectomy…”
Some women feel just fine after a hysterectomy. But others, like this patient, experience significant changes.
Removing the uterus may disrupt vaginal blood flow—especially via the descending branches of the uterine artery. This can lead to vaginal atrophy, dryness, and even pain during intercourse.
In her case, the pain led to sexual avoidance, and over time, a deep emotional wound.
As we reviewed her vaginal images together, she wept:
“It wasn’t supposed to be like this…”
As healthcare providers, what can we do?
We must always ask:
How can we better support women after hysterectomy so they don’t have to face this kind of pain and isolation?
But for those already experiencing symptoms, we don’t need “what ifs.”
We need real strategies—starting now.
A Strategy to Restore Vaginal Health
To prevent further UTIs and hopefully revive intimacy if she desires, we discussed a personalized plan:
• Local estrogen therapy
• Vaginal moisturizers
• IntimaLase® laser therapy (starting with low energy settings)
→ To gently stimulate collagen, improve tissue elasticity and blood flow
These treatments not only help with infection prevention, but also support the return of comfort and confidence.
Let’s stop blaming ourselves.
“Why didn’t I ask for help sooner?”
“Why is this happening to me?”
You don’t need to carry those questions alone.
Whether it’s pain, dryness, or feeling disconnected from your partner—there is help, and there is hope.
Today, a patient visited us for follow-up after undergoing native tissue repair (NTR) due to painful vaginal mesh exposure.
This patient had previously undergone robot-assisted laparoscopic sacrocolpopexy (RASC) for pelvic organ prolapse. After surgery, she began experiencing vaginal pain and sought help at a local women’s clinic. There, she was diagnosed with genitourinary syndrome of menopause (GSM) and underwent three sessions of vaginal laser therapy.
However, rather than improving, her pain worsened. Concerned and anxious, she came to our clinic for a second opinion.
Upon examination using speculum and endoscopic inspection, we discovered mesh exposure inside the vagina accompanied by infection—a finding that explained her persistent pain.
It is important to note that applying laser treatment to an infected mesh site may worsen symptoms. In this case, the true cause of the pain wasn’t GSM but a complication from the mesh. The right treatment wasn’t more laser—it was mesh removal and reconstruction using native tissue.
We performed laparoscopic mesh excision and NTR. Her recovery was smooth, and after the inflammation subsided, we proceeded with carefully adjusted Intima laser therapy (3 sessions).
The results were remarkable:
Her vaginal pH improved from 8.0 to 4.5, and her pain significantly decreased, leading to a noticeable improvement in her quality of life.
Key Takeaway:
Not all vaginal pain in postmenopausal women is GSM.
If we hastily assume GSM without thorough evaluation, we may miss the true underlying cause.
Diagnosis and the order of treatment matter.
Vaginal mesh exposure, especially when infected, is a serious complication that requires careful assessment and individualized treatment planning.
If you’re experiencing:
• Persistent pain after laser therapy
• Worsening symptoms instead of improvement
• A sense of foreign body or unusual discharge from the vagina
“I suddenly feel the urge to urinate and can’t hold it…”
“I’ve tried all the medications for overactive bladder, but nothing works…”
A woman in her late 60s had been struggling with this issue for over 10 years.
Despite trying every available medication for overactive bladder (OAB), she saw little improvement. There were times when her symptoms settled down, but they never truly went away.
So, was her bladder really the problem?
A closer examination revealed some surprising findings.
✅ The issue wasn’t OAB, but rather “Vaginal Tightness” (MPPS) and Hormonal Changes (GSM).
✅ Pelvic floor rehabilitation + local hormone therapy can significantly improve symptoms.
✅ Cutting-edge treatments offer additional support for long-term relief.
If OAB medications haven’t worked, it might not be a bladder issue at all.
Instead of just managing symptoms, addressing the underlying causes could be the key to lasting relief!
A woman in her 60s developed cystitis upon arriving in the U.S. during a trip. Her cystitis did not fully resolve, leading to urinary frequency every 10 minutes. She urgently returned to Japan, visiting urologists and gynecologists, but none of the various medications were effective.
On a pelvic exam, just touching the obturator internus muscle caused significant pain. Vaginal pH was 8.5, and there were signs of inflammation on the vaginal mucosa.
She understood that this condition was likely triggered by prolonged sitting during the flight and GSM (with an alkaline vaginal pH).
The treatment plan involved addressing MPPS (vaginal muscle tightness) and GSM. She had been deeply anxious, worrying if it was some strange disease, and her anxiety only worsened.
However, once a clear treatment plan was established, it seemed to provide her with a sense of relief and reassurance.
Last month, a patient came in with frequent urination and urge incontinence. She had hip issues and was advised by an orthopedic surgeon to undergo surgery.
During the examination, I found “strong trigger points in both obturator internus muscles.” I performed myofascial release on the spot and connected them to pelvic floor rehabilitation for further treatment.
When the “vaginal tightness” was relieved, her difficulty in even turning around improved, and the hip surgery was canceled. Her symptoms of frequent urination also improved. She returned for a follow-up, saying that if I neglected treatment, the same symptoms would likely return, so she hoped to continue rehabilitation.
Today, around 40 years woman consulted our clinic because she is suffering from bladder pain and frequent urination since August.
She had already visited both gynecology and urology departments, and had been prescribed painkillers and overactive bladder medications, but they were ineffective. Due to the severity of her pain, she even visited an emergency center.
Specialists at various facilities could not identify the cause of her pain. She mentioned that the symptoms varied depending on the day and time, with some days so severe that she couldn’t leave the bathroom.
An ultrasound only revealed a Bartholin gland cyst. During the pelvic exam, trigger points pain was observed in both obturator internus muscles, particularly on the right side, which also caused radiating pain to the lower abdomen. Given that she had urinary retention symptoms, it is possible that she was unable to relax her pelvic floor muscles.
Despite performing myofascial release, the tense fascia and muscles did not relax easily, so pelvic floor rehabilitation was introduced. Considering that the pelvic blood vessels were slightly engorged, it might be beneficial to prescribe herbal medicine (to treat blood stasis) or, if opting for Western medicine, a drug with muscle relaxant properties.
In any case, the main focus will be on approaches targeting the pelvic floor muscles.
日本橋骨盤底診療所 