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.