Why Dr. John Miklos and Robert Moore are Leading Expert in TVT Sling Removal—and How He Understands the True Pathways of Sling-Related Pain

For millions of women, the tension-free vaginal tape (TVT) sling was meant to be a solution for stress urinary incontinence. But for a small but significant subset of patients, the mesh sling that once promised confidence becomes the source of debilitating pain, sexual dysfunction, burning sensations, and a profound decline in quality of life. When complications arise, choosing the right surgeon is everything—and no names are more trusted worldwide than Drs John Miklos and Robert Moore  of Miklos & Moore Uroygnecology internationally recognized urogynecologists and two of the  most experienced TVT sling removal specialists in the world.

Drs. Miklos & Moore  have dedicated over 30 years to understanding the biomechanics, anatomy, and long-term complications of mesh slings. Their unparalleled expertise has drawn women from all 50 U.S. states and over 60 countries who seek answers, relief, and a way to reclaim their lives. What truly separates them from other surgeons is their deep, nuanced understanding of how and why TVT slings cause pain, particularly pain that radiates into the lower abdomen, pubic bone, vagina  and urethra—pain that often becomes excruciating during intercourse and may persists even when sexually inactive.

Understanding the Pain Pathways of TVT Slings: Why the Location of the Sling Matters

A TVT sling is placed under the urethra and passed behind the pubic bone. While this placement effectively supports urinary control during rises of abdominal pressure,  it also sets the stage for a well-documented pattern of injury:

  1. Pain Following the Pathway of the Sling

One of the hallmark characteristics of TVT sling complications is that pain does not remain localized in the vagina or at the urethra, but it travels along the exact anatomical route of the sling. Patients frequently describe:

  • Pubic pain on one or both sides
  • Lower abdominal pain
  • Burning or searing discomfort in the pubic region
  • Pain that shoots toward the urethra
  • A tight, tearing, or “wired-in” feeling deep in the pelvis
  • Vaginal pain
  • Stabbing pain during intercourse

Dr. Miklos explains this phenomenon by identifying the underlying contributors: mesh contraction, nerve entrapment, scar tissue along the sling arms, and chronic tension radiating outward from the mesh attachment points.

  1. Pubic Bone Pressure and Pain

The TVT sling sits in the retropubic space, immediately behind the pubic bone. When mesh is introduced into the pelvis, the human body identifies the mesh and creates a cascade of event known as healing.  The very first step of this healing process is inflammation followed by collagen formation which ultimately becomes scar tissue resulting in contraction of the mesh.  This contraction of the mesh pulls upon its anchoring points at the vagina and the abdominal wall just above the pubic bone.  This can results in tension between the anchoring structures causing the patient symptoms such as:

  • Vaginal pain or pain with intercourse
  • Constant or intermittent pain at the pubic bone or lower abdomen
  • Enhanced pain with sitting, bending over or upon standing
  • Sharp pain during intercourse or leg movement

Dr. Miklos’ and Moore’s clinical evaluation allows  identification of  whether the mesh is causing life altering symptoms and ultimately tailor a specific plan of action of mesh removal to address the patients specific symptoms.

This leads to the distinctive groin pain pattern so many patients describe. Dr. Miklos recognizes this instantly because he has seen thousands of similar cases—and because he understands the sling’s three-dimensional relationship with nerves, fascia, and muscle.

  1. Urethral Burning and Searing Pain

Mesh placed directly under the urethra can induce:

  • Urethral hypersensitivity
  • Chronic inflammation
  • Referred burning pain
  • Painful urination
  • Post-coital urethral pain
  • Recurrent urinary tract infections.

Many women describe “burning” or a  “fire-like” or “razor blade” sensation. Dr. Miklos explains that this comes from nerve irritation around the periurethral tissues or from direct compression where the mesh lies.

Why Pain Intensifies During Sexual Intercourse

One of the most devastating complications of TVT slings is severe dyspareunia—pain during sex. Dr. Miklos has studied this extensively and explains that intercourse applies multidirectional forces to the pelvic floor, which:

  • Stretches the vaginal walls
  • Pulls on scarred or contracted mesh
  • Compresses nerves
  • Increases friction against the vaginal portion of the mesh sling
  • Tightens inflamed pelvic floor muscles

Because TVT mesh becomes integrated with surrounding tissue via inflammation and scar formation, it does not simply sit still—it moves when you move, especially during deep penetration or thrusting motions.

Women often report:

  • Burning in the urethra
  • Tearing sensations in the vagina
  • Sharp pubic bone pressure or pain
  • Immediate or delayed pelvic spasms

Even more heartbreaking is that many women begin to avoid intimacy, experience relationship stress, and suffer silently because they think the pain is “just in their head.” Dr. Miklos reassures patients that this pain is real, mechanical, and more often than not treatable through expert surgical removal.

Pain Even When Not Having Sex: Why It Happens

Not all mesh-related pain is triggered by intercourse. Many women continue to experience daily, life-altering symptoms such as:

  • Aching in the pelvic floor
  • Burning in the urethra while walking
  • Pubic bone pain when sitting or standing
  • Groin pain radiating down the legs
  • Constant pulling or tugging sensations

Dr. Miklos attributes this to several causes:

Chronic Inflammation

Mesh can induce a long-term inflammatory reaction that results in scar formation, bridging over the mesh and a type of contraction of the mesh due to scar tissue which can  irritates nerves and tissues around the sling.

Mesh Contraction

Over time the sling can shrink by up to 30–50%, creating constant tension on the pelvic muscles and nerves.

Nerve Entrapment

As scar tissue forms around the mesh, nerves can either become compressed or irritated due to the pulling of nerve laden muscles, leading to unpredictable, ongoing pain.

Pelvic Floor Hypertonicity

When the body protects itself from mesh-related injury, pelvic muscles can spasm continuously, creating a cycle of pain.

Drs. Miklos and Moore are two of the few surgeons who fully understands that sling-related pain is not only physical but can have severe emotional consequences —because chronic pelvic pain affects sleep, mood, self-image, and intimacy. His compassionate, patient-centered approach allows women to finally feel understood.

Why Dr. John Miklos and Robert Moore are considered Top Surgeons for TVT Sling Removal

  1. Unparalleled Experience

Drs. Miklos & Moore are two of the world’s most experienced surgeons in TVT, TOT, and single incisions sling removals, having performed hundreds of complex revision surgeries. Because they were two of the early adopters of mesh-based incontinence procedures, he uniquely understands how their placement, design, and complications evolve over time.

  1. Minimally Invasive Surgical Expertise

He performs most removals through minimally invasive approaches—vaginal or s laparoscopic—depending on the patient’s anatomy and the extent of mesh involvement. His precision reduces recovery time while maximizing outcomes.

  1. Ability to Remove the Entire Sling (When Necessary)

Many surgeons only remove a small, central portion of the sling. Drs. Miklos & Moore can remove partial or full TVT slings, including the retropubic arms, when indicated. Removing only the middle may leave painful arms behind—he understands that complete symptom relief often requires more comprehensive surgery.

  1. Expert Diagnosis of Sling-Induced Pain

They spend extensive time listening to a patient’s pain pattern and mapping symptoms to anatomical pathways. This advanced diagnostic skill helps him predict exactly which parts of the sling are causing pain—something few surgeons are trained to do.

  1. Thousands of Women Seek Miklos & Moore Urogynecology When Other Surgeons Turn Them Away

Patients commonly say:

  • “No one believed my pain until I saw Dr. Miklos.”
  • “Other doctors told me the mesh wasn’t the problem.”
  • “my surgeon said it cant be the mesh because it is where it is supposed to be and not eroding into the vagina,.
  • “Dr. Moore was the only surgeon who understood exactly what I was describing.”

Their commitment to validating women’s experiences sets them apart.

  1. International Teaching and Research

They have lectured globally on mesh complications, pain pathways, and reconstruction of damaged pelvic tissues. Their research has shaped modern urogynecologic surgical standards.

A Path to Relief, Healing, and a Pain-Free Future

For women suffering from groin pain, pubic bone pain, urethral burning, searing sensations during intercourse, or chronic pelvic pain that follows the path of the sling, Drs. John Miklos  and Robert Moore offer what so many are searching for:

  • Answers
  • Validation
  • Expertise
  • And most importantly—relief

Their unmatched knowledge of TVT mesh anatomy and surgical skills make them a leading voice in the world of mesh removal. Women trust him because they listens, they understands, and they know that mesh-related pain is real.

If you or someone you love is living with TVT sling complications, Drs. Miklos & Moore represents a path toward healing—toward reclaiming comfort, confidence, and quality of life.