Why was it necessary to make my vagina smaller when having total hysterectomy and bladder sling placed?

9 weeks ago I had a total hysterectomy a bladder mesh placed, since the uterus, cervix, tubes, and ovaries were removed. I am a breast cancer survivor and it was felt that a complete hysterectomy would be safest for me. I purchased vaginal dilators, but they are not helping. My husband and I had a healthy sexual relationship until now. Why was the vagina smaller and what else can I do? I was told to expect pain with intercourse.

Doctor Answers 4

Not clear why your vagina is smaller

Hysterectomy can sometimes shorten the vagina if too much vaginal skin is taken during the procedure. Dilators might help, but at 9 weeks out, you're still healing. Coupled with removal of the ovaries, the vagina can shrink further from atrophy. Mesh can sometimes be painful with sex. You really need a thorough exam to see exactly what the problem is.

Jersey City OB/GYN
4.6 out of 5 stars 24 reviews

Small vagina

Dear ArleneYvette:

It is very difficult to say why you are having pain without an evaluation.  Most surgeons do not understand that mesh can create pain because usually it does not.  However we can not make an assumption it is indeed the mesh causing pain in your situation.  If it feels like the vagina is too small this might be due to the fact the surgeon shortened the vagina which can happen even in the best surgeons hands. It is also difficult to assess you as we don't really know the exact surgery you had.  Some mesh is for cough leakage and this is called a sling which lifts the urethra ( now most doctors will just say we are lifting the bladder but they are just really lifting the urethra)  and the other utilized in this area is much larger and has a greater chance of causing pain and this is actually used to lift the bladder.  So these are two potential reasons for having pain with sex ( but doesn't mean they are the problem).  Another reason is it is possible to shorten the vagina with a hysterectomy.  

If the mesh is the problem it will need to be removed. If the vagina is shortened then your vagina will most likely need to be lengthened (Davydov procedure).  All of these techniques i.e. treatments can be found on my website.  I have removed more than 1000 pieces of mesh in my career but I promise you I would NOT remove it unless we feel >99 % confident it is causing pain.  Please investigate you next evaluation wisely.  Now it is possible you had more surgery than you are telling us about ( this is very common ) the next doctor is going to need your previous operative report and will need to evaluate you. I doubt the pain with intercourse is due to a lack of lubrication ( this is what the Mona Lisa) is helping to treat as mentioned by others below.  Why do I not think this is your problem?  Because you would have most likely been suffering from pain with intercourse before your hysterectomy too. You are only 9 weeks out of surgery most women do not lose the effects of estrogen that fast that you would want to rejuvenate using a laser therapy. Now I might be wrong but having operated 1000's of women in my career the most likely reasons for pain will be a direct mechanical effect of the surgery you just had

Best of luck in your care

John R Miklos MD 
Urogynecologist & Cosmetic Vaginal Surgeon
Atlanta ~ Beverly Hills ~Dubai

John R. Miklos, MD, FPMRS, FACS
Atlanta Urogynecologist
5.0 out of 5 stars 19 reviews

Small tight vagina after vaginal surgery with mesh

First, there is absolutely no reason for a hysterectomy as a positive therapeutic modality for a breast CA survivor; the uterus has no negative place in the risk of recurrence. If you are BrCa I or II or mutation gene positive, it definitely can be argued that your survival may be enhanced, and of course risk of ovarian cancer lowered, by having a laparoscopic oophorectomy. As for vaginal mesh, this is generally contraindicated in women who wish to remain sexually active secondary to the great risk both of mesh erosion and the vaginal stiffness with loss of pliability when mesh is introduced. I would question your counselling and therapeutic choices... YOU SHOULD BE PAIN-FREE!

That said, here you are. My strong recommendation is for either an in -person or "virtual" (telephone) consultation with a practitioner who is savvy with both vaginal atrophy, sexual medicine, hormonal issues, and working with breast cancer survivors towards healthy, happy, ongoing sexual joy and health after surgical procedures. A PERSONAL consultation is necessary: "one size definitely does not fit all."  YES(!), there are several options, including dilatations and laser, but the vaginal opening and vaginal canal must be specifically prepared beforehand. There are several viable options-- find out what suits YOUR NEEDS specifically...

Very best wishes,

Michael P Goodman, MD
Davis, CA, USA

Vagina smaller post op?

You need to talk with your OBGYN about this. If you are not allowed to use estrogen vaginal cream/ring then a MONALISATOUCH is an alternative.E- String was developed for patients like you. Your mesh--was it TOT, TVT (good for MLT) or full mesh suspension of bladder,rectum, and vaginal apex (contraindication for MLT)? Pain with intercourse forever? Not the usual prediction with this--look into MonaLisaTouch please.

Lawrence Eisenhauer, MD
Encinitas OB/GYN
5.0 out of 5 stars 2 reviews

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