TVT & TOT Sling Pain: How Scar Tissue, Inflammation, and Nerve Irritation Cause Debilitating Symptoms—And Why Dr. John Miklos and Robert Moore are Global Leaders in Sling Removal Surgery

Tension-free vaginal tape (TVT) and transobturator tape (TOT) slings were designed to treat stress urinary incontinence by supporting the urethra. While many women experience relief, others develop life-altering complications months—or even years—after surgery. The pain associated with TVT and TOT slings is often misunderstood by non-specialists, leaving patients feeling dismissed, confused, and trapped in their symptoms.

But the truth is clear: TVT and TOT sling pain is real, mechanical, and rooted in scar tissue formation, chronic inflammation, nerve irritation, and mesh contraction. These reactions can create predictable yet intensely painful patterns that affect the vagina, groin, pelvis, pubic bone, lower abdomen and inner thighs. For some women, the pain becomes so severe that spreading their legs, walking, sitting, or sexual intercourse becomes nearly impossible.

Few surgeons understands these symptoms and pain patterns—or how to remove slings safely and thoroughly—better than Drs. John Miklos and Robert Moore, internationally recognized urogynecologist, lecturer, researcher, and pioneer in complex mesh removal surgery.

How Scar Tissue and Inflammation Cause Sling Pain

Mesh slings are foreign bodies. The moment they are implanted, the body enters a permanent inflammatory state intended to heal the implanted mesh. Over time, this leads to dense, fibrotic scar tissue that binds the mesh and incorporating adjacent muscle and fascia causing tension on associated nerves, and pelvic structures.

For many women, this process becomes painful for several key reasons:

  1. Scar Tissue Contracts and Pulls on Surrounding Structures

Scar tissue is not static. It tightens as it matures. As mesh becomes encased in this contracting scar tissue:

  • It pulls on muscles
  • It tugs on ligaments
  • It compresses nerves
  • It increases tension on pelvic structures
  • It distorts the mesh’s original position

This tightening effect can spread outward like a web, creating pain in multiple locations far from the original surgical site.

Women often report:

  • A constant pulling or “tethered” sensation
  • Sharp pain with movement
  • Pain shooting into the vagina, groin, inner thighs and lower abdomen
  • Difficulty sitting or walking
  • Painful intercourse

This is not random; it reflects the biological process of mesh encapsulation and contraction.

  1. Chronic Inflammation Irritates Nerves

The mesh and the surrounding scar tissue can both trigger chronic inflammation, which sensitizes nerve fibers and magnifies pain signals.

Inflammation also causes:

  • Local swelling
  • Tissue pressure
  • Increased friction with movement
  • Hypersensitivity of the urethra, vagina, or pelvic muscles

Many women describe symptoms similar to:

  • Burning
  • Searing sensations
  • Electrical or shock-like pain
  • Radiating discomfort into the legs or groin

These are classic signs of nerve irritation, not psychological symptoms—a distinction Dr. Miklos & Moore make clear to every patient.

  1. Mesh Arms Pass Near Major Nerve Pathways

Both TVT and TOT slings can interact closely with pelvic nerves:

  • TVT mesh arms pass behind the pubic bone, near the ilioinguinal and genitofemoral nerves.
  • TOT mesh arms pass through the obturator region, near the obturator nerve and branches of the pudendal nerve.

When scar tissue tightens around the mesh there is either direct pressure on the nerves or the contracting scar pulls on neighboring muscle, fascia and nerves  – that results in a predictable pain distribution. That pain distribution is usually along the pathway of the implanted mesh sling.

Common TOT mesh sling symptoms include:

  • Vaginal pain
  • Painful intercourse
  • Inner-thigh pain
  • Groin pain radiating down the inner thigh
  • Pain when opening or spreading the legs
  • Sharp pain when walking, climbing stairs, or standing from a seated position

When the obturator nerve is affected, women often feel pain deep in the groin and all along the inner thigh. This is one of the signature complications of TOT slings, and one of the reasons why there have been so many lawsuits regarding mesh slings.

Common TVT mesh sling symptoms include:

  • Vaginal pain
  • Painful intercourse
  • Lower abdominal pain
  • Pubic pain
  • Tension and pulling in these areas
  • Pain with bending over, walking, climbing stairs or standing from a seated position

When scar tissue encases the sling, it  tightens between two points of attachment, the vagina and the lower abdominal wall.  This can lead to tension, like a tug-of-war between the two stabilizing points of attachment resulting in tension, a pulling sensation and ultimately pain.

Why Some Women Cannot Spread Their Legs

A TOT sling passes through the obturator foramen—the opening in the pelvis connecting to the inner thigh. After the sling is placed:

  • Scar tissue forms along both mesh arms
  • The obturator muscles can become inflamed or hyper-contracted
  • The obturator nerve can become compressed

Because the obturator nerve controls leg adduction (bringing the legs together) and supplies sensation to the inner thigh, compression or irritation leads to:

  • Pain when abducting the legs (spreading them apart)
  • Difficulty with gynecologic exams
  • Severe pain during intercourse
  • Sharp pulling sensations in the groin
  • Inability to perform exercises such as squats or lunges

Some women describe the feeling as:

  • “A knife in my groin when I move my leg.”
  • “My thighs feel locked in place.”
  • “I can’t spread my legs without searing pain.”

These symptoms are direct mechanical consequences of mesh placement, not psychological issues. Drs. Miklos and Moore are two of the few surgeons who understands the exact anatomical pathway of this pain and how to relieve it through specialized removal techniques.

Why Drs. John Miklos and Robert Moore are the World’s Leading Surgeon for TVT and TOT Sling Removal

While many pelvic surgeons can implant a sling, very few have the training, experience, and precision required to remove them safely—especially when the arms extend deep into the retropubic or obturator regions. Mesh removal is one of the most technically challenging procedures in urology and urogynecology, and most surgeons avoid it entirely.

Drs. John Miklos and Robert Moore are considered the global authority in this field for several reasons:

  1. Unmatched Surgical Experience

Dr. Miklos and Moore have performed hundreds of sling removal surgeries, including:

  • TVT (retropubic) sling removals
  • TOT (transobturator) sling removals
  • Mini-sling removals
  • Partial and full sling excisions
  • Reconstructive pelvic surgery following mesh removal

Their extensive experience gives him the ability to anticipate complication patterns and tailor solutions to each patient’s anatomy and symptoms.

  1. Mastery of Minimally Invasive Techniques

Many surgeons remove only a small piece of mesh because they lack experience retrieving the deeply embedded arms. However, leaving the arms behind often means:

  • Persistent groin pain
  • Ongoing nerve irritation
  • Continued pelvic floor dysfunction

Dr. Miklos is one of the few surgeons capable of removing entire retropubic or obturator arms, often through minimally invasive approaches such as:

  • Vaginal removal
  • Laparoscopic removal
  • Robotic-assisted removal

His skill reduces recovery time and improves the likelihood of meaningful pain relief.

  1. Deep Understanding of Pain Pathways

During consultations, patients are often amazed by how accurately they predict pain patterns—even before examining, imaging or surgical records. The patients often will tell stories of seeing numerous other surgeons only to be told that the mesh is not eroding through the vagina therefore it is not causing pain.  Miklos and Moore know you don’t need to have vaginal mesh erosion to have pain. Dr. Miklos & Moore has spent more than two decades mapping and understanding:

  • Mesh contraction patterns
  • Scar tissue distribution
  • Nerve involvement
  • Variations in pelvic anatomy

They do not dismiss symptom, they explain why these symptoms occur and this validates thepatient’s perception of pain.

This is why so many women say:

  • “He was the first doctor who understood my pain.”
  • “Every symptom finally made sense.”
  • “He knew exactly where the sling was causing problems.”
  1. Global Reputation for Complex Revision Surgeries

Women travel from across the United States and around the world to see Drs. Miklos and Moore because:

  • Most surgeons do not perform full mesh removal
  • Many dismiss pain as unrelated
  • Most surgeons claim removal is impossible or unnecessary

Drs Miklos and Moore has restored quality of life for hundreds of women who spent years being told “nothing is wrong.”

They have lectured physicians and surgeons

internationally and continues to lecture on the evolving understanding of mesh complications and pain mechanisms.

  1. Compassionate, Patient-Centered Care

Mesh pain affects far more than the body. It impacts:

  • Intimacy
  • Relationships
  • Mobility
  • Mental health
  • Self-confidence

Drs. Miklos and Moore treat patients with empathy and respect, acknowledging the emotional toll that chronic pelvic pain creates. Their patients consistently describe them as:

  • Reassuring
  • Thorough
  • Honest
  • Gentle
  • Highly skilled

A Path Toward Relief and Healing

TVT and TOT sling pain is not in your head. It is not normal. And it is not something you must live with forever.

Pain from these slings is the result of:

  • Scar tissue
  • Inflammation
  • Mesh contraction
  • Nerve compression
  • Muscle irritation
  • Mechanical distortion of pelvic structures

For women suffering from lower abdominal, pubic, groin, and inner thigh pain, painful intercourse, difficulty spreading their legs, or chronic pelvic discomfort, Dr. John Miklos and Dr. Robert Moore offer hope—and real solutions.

With unparalleled experience, advanced surgical skill, and a deep understanding of the nerves, tissues, and biomechanics of mesh, Drs. Miklos and Moore remain the world’s most trusted expert in TVT and TOT sling removal.