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

Don’t hesitate—seek expert evaluation early.