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Hello Ms. L,
It’s not possible to accurately diagnose anyone over the internet, but I sounds like you might benefit from a conversation with your gynecologist about the sexual benefits of low dose vaginal estrogen therapy in women who’ve gone through premature menopause. After menopause, no matter how menopause comes about, the estrogen levels plummet, and estrogen-senstive vaginal skin may turn thin, brittle and stiff, tending to crack, bleed and be painful with sexual penetration, even if your lover is gentle. Take a look at http://www.urogynics.org/blog/2010/08/when-rejuvenate-relubricate. Keep me posted!
Dr. R

Hello Dr. Claudia Merli,
I hereby publicly plead ignorance as to the identities current researchers in the field of genital cutting. My lack of scholarship now properly exposed, I thank you for enlightening and updating my perspective, and take this opportunity to thank contemporary colleagues laboring on the front-lines of this phenomenon, including the aforementioned Janice Boddy, Ellen Gruenbaum, and of course, yourself, for carrying on work related to that of Fran Hosken, be she criticized, ostracized, or honored by the current FGC elite.
The dated FGC stagings I transcribed into the blogpost come direct from the Proceeds of the 1st International Symposium on Circumcision, held in Anaheim California in March, 1989. Apparently, as with most medical/clinical stagings, the categorizations have been modified over time, and I acknowledge here that the stagings listed in this blogpost are historic, inconsistent with currently recognized and utilized WHO stagings for Female Genital Cutting.
The practice of labial elongation, with which I’m familiar as it’s a common practice in the Eastern region of the Democratic Republic of Congo where I often work , is the inverse and, to my Western / N. American perspective, bizarre cousin of FGC, worthy of separate blogpost, as I’m sure readers will find it equally fascinating and, arguably, a smidge less horrifying.
Not intended as a position statement on the entirety of global genital altering practices, the blogpost does indeed further fail to mention or debate the merits/demerits of male circumcision. It may please you to know that I personally do not advocate male circumcision, find it outrageously brutal, and have, on principle, refused, in the entirety of my now rather long career, to perform a single excision of neonatal foreskin, which, for a Stateside board certified obstetrician gynecologist, is most rare.
Thank you for reaching out with these important points of consideration.

Hello Ms. C,

A warning is not the same as a recall, and to this day, Prolene mesh remains on hospital shelves everywhere. As with many medications and surgical materials, it works great in some places and for some problems, but can cause major headaches in others. That’s the situation with Prolene – there’s been no recall for any indication. My worry as a surgeon is that it will eventually be recalled for all indications, and that would be a real shame. It’s a good graft material, but some of the current vaginal applications, as you are now living proof, fail to function on the right side of the risk:benefit ratio. I am sorry this happened to you. Make sure your next surgeon is experienced, talented and prepared to revise/remove to your best benefit. Keep me posted.

Dr. R

Hello Ms. R,
I can’t diagnose you over the internet, but one thing that comes to mind from your description is estrogen deprivation of the urogenital skin. This happens after menopause due to declining estrogen levels, and often responds to tiny doses of vaginal estrogen cream or low dose estrogen suppositories. Talk to your primary care gynecologist and urogynecologist about whether they believe low dose vaginal estrogen therapy would help you.
Keep me posted!

Dr. R

Time to talk to the prescribing physician about side effects and methods to manage the side effects.

Smartmesh – I know nothing specifically about this product, including which company manufactures it. If it’s Prolene-based, it falls under the same scrutiny as the meshes reviewed by Dr. Ostergard. Do you work for said company?

Says Dr, R:
This is an interesting academic critique of my blogpost, accusatory in nature, and bit confused in it’s title that alludes to incontinence while lambasting a blogpost on a scientific study on prolapse. Perhaps the author is drawing unsubstantiated conclusions about data not covered in this study, which did evaluate prolapse but did not evaluate or report on urinary continence or incontinence in this group of women. While incontinence and prolapse often occur in the same woman, they also often occur in isolation. Many women with prolapse suffer no incontinence, and many an horrifically incontinent woman suffers nary a speck of prolapse whatever.

I enjoyed reading this critique, and encourage my blog followers to do likewise. It’s an interesting glimpse into the back-story of how research is scrutinized. Claiming that I misrepresented published medical data, this scientist parses the original manuscript like a seasoned editorial veteran, drawing conclusions about my conclusions that are neither right nor wrong, well-honed though they may be.

Suffice it to say, 5% of women in the “cesarean-no labor” group in this study demonstrated severe, grade 3 prolapse after birthing their first child. Women hoping to completely avoid pelvic support damage need to know that while cesarean reduces the risk, as clearly demonstrated in this paper, it does not guarantee it. The fact that the authors were not 100% certain that the women did not prolapse before or during pregnancy does not detract from the fact that women who underwent cesarean without labor came out of that first pregnancy with horrific prolapse. Cesarean did not guarantee prevention of moderate or severe prolapse for the women evaluated in this study. It did make severe prolapse far less likely, but it did not correlate to an complete absence of prolapse for the women evaluated in this manuscript, regardless the imperfections (and all scientific manuscripts contain imperfections) of the methods.