Revision Prolapse Surgery: Before-and-After Checklist and Realistic Success Expectations for Patients With Painful Intercourse

If you are considering revision prolapse surgery because sex became painful after a prior repair, having clear expectations is critical. Revision patients are different from first-time surgery patients: the anatomy has already been altered, scar tissue is present, and success depends on precision, not aggressiveness.

This guide is written specifically for women who:

  • Were not in pain before prolapse surgery
  • Developed painful intercourse (dyspareunia) afterward
  • Have had anterior, posterior, vault (apical), or multi-compartment repairs
  • Had mesh for vaginal support and now experience pain
  • Are seeking a second opinion or revision surgery
  • Want to understand what can realistically improve—and what may not

Below you’ll find:

  1. A Before Revision Surgery Checklist (symptoms, history, red flags)
  2. An After Revision Surgery Checklist (what improvement should look like)
  3. Revision success expectations—what good outcomes mean in real life
  4. When revision surgery helps most, and when it may not

PART 1: BEFORE REVISION SURGERY CHECKLIST

(Use This to Confirm You’re a True Revision Candidate)

  1. Pain Characteristics Checklist

Mark all that apply:

Location of Pain

  • ⬜ Pain at vaginal entry (burning, tearing, stinging)
  • ⬜ Deep pain with thrusting
  • ⬜ Pain feels like “hitting a wall”
  • ⬜ Pain is position-dependent
  • ⬜ Pain persists after intercourse

Timing

  • ⬜ Pain began after prolapse surgery
  • ⬜ Pain was not present before surgery
  • ⬜ Pain has lasted longer than 3–6 months
  • ⬜ Pain is worsening over time
  • ⬜ Pain has not improved with lubrication or time

Severity

  • ⬜ Unable to tolerate penetration
  • ⬜ Sex is possible but consistently painful
  • ⬜ Avoiding intimacy due to pain
  • ⬜ Pain affects relationships or emotional well-being
  1. Prolapse Surgery History Checklist

Knowing exactly what was done is essential for revision planning.

  • ⬜ Anterior repair (bladder / cystocele)
  • ⬜ Posterior repair (rectocele)
  • ⬜ Vaginal vault or apical repair
  • ⬜ Hysterectomy at time of prolapse repair
  • ⬜ Multi-compartment repair (more than one area)
  • ⬜ Prior prolapse surgery before the most recent one
  • ⬜ Mesh or prior sling history (if applicable)

Important: Operative reports matter. Please attain your previous operative reports for your new revision surgery to review.  Revision surgeons rely heavily on prior surgical details.

  1. Functional Symptom Checklist (Often Overlooked)

These symptoms frequently coexist with painful intercourse and point to structural causes:

  • ⬜ Vaginal tightness or narrowing sensation
  • ⬜ Difficulty inserting fingers or dilators
  • ⬜ Bleeding after intercourse
  • ⬜ Pelvic pressure or heaviness
  • ⬜ Sensation of pulling or tugging inside
  • ⬜ Urinary urgency or discomfort with sex
  • ⬜ Pain during pelvic exams
  • ⬜ “Everything looks fine” but pain persists
  1. Conservative Treatment Checklist (What You’ve Already Tried)

Revision surgery is usually considered after conservative options fail:

  • ⬜ Vaginal estrogen or tissue therapy (when appropriate)
  • ⬜ Pelvic floor physical therapy
  • ⬜ Lubricants and moisturizers
  • ⬜ Time (6+ months post-op)
  • ⬜ Pain management strategies

If structural narrowing, vault tension, or dense scarring is present, conservative measures alone are often insufficient.

PART 2: AFTER REVISION SURGERY CHECKLIST

(What Improvement Should Look Like)

Revision surgery success is not measured by perfection—it’s measured by meaningful improvement in function and comfort.

  1. Sexual Function Improvements

After adequate healing, many successful revision patients report:

  • ⬜ Penetration is possible without sharp pain
  • ⬜ Significant reduction in entry pain
  • ⬜ Deep thrusting no longer triggers severe pain
  • ⬜ No bleeding after intercourse
  • ⬜ Increased comfort in more positions
  • ⬜ Less fear or muscle guarding during intimacy

Success does not always mean “no sensation”—it means pain is no longer limiting intimacy.

  1. Vaginal Function Improvements
  • ⬜ Improved vaginal length, width and/orflexibility
  • ⬜ Reduced tightness or resistance
  • ⬜ Improved tolerance of pelvic exams
  • ⬜ Less tenderness at the vaginal apex
  • ⬜ Reduced scar-related pulling sensations
  1. Pelvic Comfort Improvements
  • ⬜ Decreased pelvic floor muscle tension
  • ⬜ Less burning or stabbing sensations
  • ⬜ Reduced post-intercourse pain
  • ⬜ Improved confidence in daily activities

PART 3: REVISION PROLAPSE SURGERY SUCCESS EXPECTATIONS

(What Revision Surgery Can—and Cannot—Do)

What Revision Surgery Can Realistically Do

✔ Reduce vaginal narrowing caused by over-tightened repairs
✔ Improve vaginal elasticity and functional space
✔ Relieve excessive tension at the vaginal vault
✔ Address painful scar tissue or restrictive bands
✔ Improve comfort with penetration
✔ Restore functional anatomy for intimacy
✔ Improve quality of life and confidence

/   Increase vaginal length if needed

For many women, revision surgery changes sex from “not possible” to “possible and comfortable enough to enjoy again.”

What Revision Surgery Cannot Guarantee

✘ Absolute elimination of all pain and sensation
✘ Restoration of “pre-surgery teenage anatomy”
✘ Immediate results (healing takes time)
✘ Cure of pain caused solely by nerve sensitization without a structural component
✘ Improvement if pain is unrelated to anatomy or support

Honest counseling and setting patients expectations are essential—revision surgery is about improvement, not perfection.

PART 4: WHEN REVISION SURGERY HAS THE HIGHEST SUCCESS

Revision outcomes are best when:

  • Pain began after prolapse surgery
  • Pain is mechanical (tightness, resistance, deep pressure)
  • Posterior repair over-tightening is present
  • Vaginal vault tension is identified
  • Structural narrowing limits penetration
  • Pain is reproducible on exam
  • Expectations are realistic and functional
  • Pain is only related to positioning or intercourse and not constant and chronic all day long

WHEN REVISION SURGERY MAY NOT BE THE BEST NEXT STEP

Revision surgery may be less effective if:

  • Pain existed long before surgery
  • Pain is widespread and non-localized
  • Severe nerve pain is the dominant issue
  • No structural restriction is found
  • Pelvic floor muscle spasm is untreated
  • Goals are cosmetic rather than functional
  • Pain is chronic, constant and unrelanting

In these cases, non-surgical strategies or combined approaches may be more appropriate.

Why Expert Revision Evaluation Matters

Revision prolapse surgery is not about tightening more—it is about rebalancing support and function. This requires deep experience with:

  • Scarred tissue
  • Altered anatomy
  • Vaginal dimensions
  • Vault tension dynamics
  • Sexual function preservation

Why Many Revision Patients Seek Miklos & Moore

Miklos & Moore

Dr. John Miklos and Dr. Robert Moore are widely recognized for evaluating and treating complex prolapse revision cases, particularly in women whose primary concern is painful intercourse after prior surgery.

Revision patients often seek them because they:

  • Focus on functional outcomes, not just support
  • Identify subtle causes of dyspareunia
  • Avoid over-correction
  • Have extensive experience with revision anatomy
  • Prioritize vaginal comfort, width, length, and elasticity
  • Have unprecedented experience with mesh removal
  • Listen to their patients
  • They set reasonable post-surgical expectations and do NOT over promise results

They see patients at multiple locations, including:

  • Atlanta, GA
  • Beverly Hills, CA
  • Charleston, SC
  • Miami, FL
  • Dubai

FINAL TAKEAWAY FOR REVISION PATIENTS

Painful intercourse after prolapse surgery is not something you should accept as permanent. For many women, it is the result of:

  • Posterior repair over-tightening
  • Vaginal narrowing
  • Vault tension
  • Scar tissue
  • Muscle guarding layered on top of structural change

With the right diagnosis and realistic expectations, revision prolapse surgery can significantly improve comfort, intimacy, and quality of life.