Prof. Prof. DK Prof. Dr. med. Marc Possover, MD, PhD

INTRODUCTION

Inguinal hernia, Pelvic organ prolapse and urinary incontinence are common issues affecting many women and men, in women especially after childbirth or with aging. Surgical solutions such as vaginal prolapse repairs, sacropexy/rectopexy, herniorrhaphy/hernioplasty or the insertion of mesh slings (like TOT or TVT) offer relief and restore quality of life for many patients.

But what happens when pain begins - or worsens - after surgery?

If you’re experiencing chronic pelvic, genital, groin or leg pain after prolapse, inguinal hernia or incontinence surgery, you are not alone - and your pain is real. It could be due to pelvic nerve injury or entrapment that occurred during surgery or developed months or even years later.

WHAT IS PELVIC NERVE PAIN?

Pelvic nerve pain (also known as neuropathy or radiculopathy) happens when a nerve is compressed, irritated, or damaged. In pelvic surgeries involving mesh, this can be due to:

• Surgical trauma to the nerve
• Compression from scar tissue or fibrosis
• Mesh shrinkage or incorrect positioning
• Inflammation or infection around the mesh

WHAT ARE THE SYMPTOMS?

Patients often describe their pain as:

• Burning, stabbing, or electric-shock-like sensations
• Numbness or tingling in the vulva, inner thighs, buttocks, or legs
• Difficulty sitting or walking
• Painful intercourse
• Bladder or bowel dysfunction
• A sense of being “misunderstood” or “not believed”

“I had a colporrhaphy for prolapse - now I can’t sit without pain.”
“My vulva is numb, my legs burn - they say it’s psychological, but I know something is wrong.”
“All of this started after surgery - how can it not be connected?”

WHEN DO SYMPTOMS APPEAR?

There are two main types of onsets:

1. Immediate onset - often due to direct surgical injury (neurogenic)
2. Delayed onset (months or years/decades later) - typically caused by surgy- or mesh-related fibrosis compressing the nerves (non-neurogenic)

WHICH NERVES ARE AT RISK?

Different surgeries expose different nerves to risk:

• TOT/TVT (urinary incontinence): Pudendal, genitofemoral, and obturator nerves
• Vaginal prolapse repair: Pudendal nerve, dorsal clitoral nerve, sacral plexus
• Sacrocolpopexy / Rectopexy: Sacral nerve roots (especially S2)
• Inguinal hernia repair (in men and women): Ilioinguinal, genitofemoral, and iliohypogastric nerves

COMMON MISDIAGNOSES

Many patients are misdiagnosed with:

• Interstitial cystitis
• Irritable bowel syndrome (IBS)
• Endometriosis
• Psychosomatic disorders
• Normal healing pain
• Spinal problems like disc herniation or piriformis syndrome

But if the pain started after a pelvic surgery, a neuropelveological evaluation should be considered.

HOW IS IT DIAGNOSED?

Neuropelveology offers a specialized approach to diagnosing pelvic nerve pain. The evaluation takes between 1 and 2 hours and may include:

• A detailed review of surgical and medical/pain history
• Vaginal ultrasound with Doppler to detect vascular compression
• Clinical pelvic nerve mapping
• Selective nerve blocks
• MRI (in some cases)

IS THERE TREATMENT?

Yes - and it’s individualized depending on the type and timing of the nerve injury.

Non-surgical options include:

• Pain medications (Gabapentin, Valproic Acid)
• Osteopathy or physical therapy
• Botulinum toxin A injections (only for nerves outside the pelvic cavity)

Surgical options:

• Mesh removal (only if infected or poorly placed)
• Laparoscopic nerve decompression (releasing the nerve from fibrotic tissue or mesh contact)
• Neuromodulation (LION Procedure) - a minimally invasive method that uses gentle electrical stimulation to modulate nerve function and reduce pain (only when nerve damages!)

KEY MESSAGES FOR PATIENTS

• You are not imagining it - chronic pelvic nerve pain after mesh or prolapse/inguinal hernia surgery is real.
• Surgical mesh is not always the problem - it’s often about how the mesh interacts with nearby nerves.
• Mesh removal is mostly not necessary and does’nt improve pain in majority of patients - nerve decompression can solve the issue.
• There is hope - neuropelveology offers new options for diagnosis and treatment.

FINAL THOUGHTS

If you’re living with persistent pelvic, genital, or leg pain after pelvic surgery, don’t give up. Seek out a neuropelveological consultation with a trained specialist. With accurate diagnosis and a personalized treatment plan, you can reclaim your quality of life.

What you’re feeling is real, and there may be a very real, very treatable cause behind it.

✅ Trust your body.
✅ Ask the right questions.
✅ Seek specialists who understand pelvic nerves and vascular conditions, a Neuropelveologist - not just gynecology or urology.

We’re Here to Help

Possover International Medical Center – Zurich
☎️ +41 44 520 3600
📍 Klausstrasse 4, CH-8002 Zürich
🌐 www.possover.com
📧 mail@possover.com

Let us help you find the cause of your pain - and finally start your journey toward healing.

If you or someone you know is struggling with chronic pelvic pain, pelvic nerve disorders, endometriosis, or consequences of pelvic surgery, please contact us via email at international@possover.com to begin the process. Because we want to avoid the scenario where a patient travels to Zurich, only to discover that we may not be able to offer help for their specific situation, we have Pre-Consultation Zoom process. How does it work?

1. Patients will first receive a Pre-Consultation Form.
2. Based on the information provided, we will assess whether a Zoom consultation is necessary.
3. If indicated, we will schedule a Pre-Consultation Zoom Call to help determine if a full evaluation at our center makes sense for your case.