Pelvic Pain Second Opinion: When Should You See a Urogynecologist?

Persistent pelvic pain can be one of the most difficult and frustrating problems a woman experiences. You may have already seen your OB/GYN, undergone ultrasounds or other testing, tried medications, completed physical therapy, or even had surgery—and still have pain.

Some women are told that everything appears normal despite knowing that something does not feel right.

When pelvic pain continues without a clear explanation, treatment has failed, or surgery is being recommended without confidence in the diagnosis, a second opinion from an experienced urogynecologist may provide another perspective.

At Miklos & Moore Urogynecology in Atlanta, Georgia, Dr. John Miklos and Dr. Robert Moore evaluate women with complex pelvic and vaginal symptoms, including patients seeking second opinions after previous treatment or surgery.

Why Is Pelvic Pain So Difficult to Diagnose?

Pelvic pain is not a single diagnosis.

The pelvis contains multiple organs, muscles, nerves, and supporting structures located close together. Symptoms originating from one structure can sometimes feel remarkably similar to symptoms originating somewhere else.

Potential sources of pelvic pain include the:

• Pelvic floor muscles
• Vagina
• Vulva
• Bladder and urethra
• Uterus and ovaries
• Pelvic nerves
• Perineum
• Scar tissue
• Pelvic support structures

Some women also have more than one condition contributing to their symptoms.

Finding the cause may therefore require looking beyond a single test or diagnosis.

When Should I Get a Second Opinion for Pelvic Pain?

A second opinion may be appropriate when:

• Pelvic pain continues despite treatment
• Your physician cannot determine the cause
• Testing appears normal but you still have symptoms
• Pain during intercourse continues
• Symptoms developed after childbirth
• Pain developed after pelvic or vaginal surgery
• Previous surgery did not correct the problem
• You have significant pelvic pressure or vaginal symptoms
• Surgery has been recommended and you want another opinion
• You have been told there are no additional treatment options

A second opinion does not necessarily mean the original diagnosis was incorrect.

Complex pelvic conditions sometimes require evaluation by a physician who routinely treats pelvic floor and reconstructive problems.

My OB/GYN Says Everything Is Normal, But I Still Have Pelvic Pain

Normal imaging does not necessarily mean that every possible cause of pelvic pain has been excluded.

Some conditions may be identified primarily through a detailed history and specialized pelvic examination rather than routine imaging.

For example, symptoms may sometimes involve:

• Pelvic floor muscle dysfunction
• Vaginal or perineal scar tissue
• Pelvic support abnormalities
• Previous surgical changes
• Vulvar conditions
• Painful vaginal tissues
• Nerve-related symptoms

If pain persists, the next step may be a more specialized evaluation rather than simply repeating the same tests.

Pelvic Floor Dysfunction and Pelvic Pain

The pelvic floor muscles support the bladder, vagina, uterus, and rectum.

These muscles can become weak, excessively tight, painful, injured, or poorly coordinated.

Pelvic floor dysfunction may contribute to:

• Vaginal pain
• Pelvic pressure
• Pain during intercourse
• Urinary symptoms
• Difficulty with bowel movements
• Pain with sitting
• Pain after childbirth

Importantly, not every pelvic floor problem requires strengthening.

Women with excessively tight pelvic floor muscles may actually need relaxation and specialized pelvic floor therapy rather than additional Kegel exercises.

Pelvic Pain During Intercourse

Painful intercourse, or dyspareunia, deserves a careful evaluation because the location of the pain can provide important clues.

Pain near the vaginal opening may be associated with:

• Scar tissue
• Vaginal dryness
• Menopause-related tissue changes
• Pelvic floor muscle tension
• Vulvar conditions
• Previous childbirth injury
• Previous vaginal surgery

Deeper pain during intercourse may have different causes.

Drs. Miklos and Moore evaluate the entire pelvic and vaginal anatomy when determining whether a structural or pelvic floor condition may be contributing.

Pelvic Pain After Childbirth

Pregnancy and childbirth can place substantial stress on the pelvic floor and vaginal tissues.

Women may develop symptoms related to:

• Significant vaginal tearing
• Episiotomy
• Perineal scar tissue
• Pelvic floor injury
• Changes in vaginal support
• Pelvic organ prolapse
• A widened vaginal opening
• Painful intercourse

Some women continue experiencing symptoms years after childbirth.

Persistent pain should not automatically be dismissed simply because the delivery occurred long ago.

Pelvic Pain From an Episiotomy or Perineal Tear

Most episiotomies and childbirth tears heal without long-term problems.

However, some women develop painful or restrictive scar tissue.

Symptoms may include:

• Pulling
• Burning
• Tenderness
• Pain during penetration
• A tearing sensation
• Pain around the vaginal opening

An examination can help determine whether scar tissue, pelvic floor muscle tension, structural perineal changes, or several factors are contributing.

Pelvic Pain After Previous Vaginal or Pelvic Surgery

Miklos & Moore frequently evaluate women seeking second opinions after previous pelvic or vaginal surgery.

Persistent or new symptoms after surgery may sometimes involve:

• Scar tissue
• Changes in vaginal support
• Excessive tightening
• Persistent prolapse
• Recurrent prolapse
• Pelvic floor dysfunction
• Mesh-related concerns
• Previous sling procedures
• Structural changes

The existence of pain after surgery does not automatically identify the cause.

Reviewing the previous operation and evaluating the current anatomy are important before recommending another procedure.

Pelvic Pain After a Bladder Sling or Mesh Procedure

Women who develop pain following a previous urinary incontinence or pelvic reconstruction procedure may need specialized evaluation.

Symptoms can vary considerably and may include pelvic pain, vaginal pain, painful intercourse, urinary symptoms, or a combination.

The evaluation may include reviewing previous operative reports and determining the type and location of any implanted material.

Additional surgery should not be recommended until the likely source of the symptoms is understood as clearly as possible.

Can Pelvic Organ Prolapse Cause Pelvic Pain?

Pelvic organ prolapse more commonly causes pressure, heaviness, or a vaginal bulge than severe pain.

Women may describe:

• Pelvic pressure
• Vaginal heaviness
• A sensation that something is falling
• Difficulty emptying the bladder
• Difficulty with bowel movements
• Vaginal bulging

If significant pain is present, other possible causes should also be considered rather than assuming prolapse explains every symptom.

Can Scar Tissue Cause Pelvic or Vaginal Pain?

Yes.

Scar tissue following childbirth or surgery can sometimes become tight, sensitive, or painful.

Women may experience:

• Burning
• Pulling
• Localized tenderness
• Pain with penetration
• Pain during certain movements

Treatment depends on the location and severity of the scar and whether surrounding pelvic floor muscles are also involved.

What Happens During a Pelvic Pain Second Opinion at Miklos & Moore?

A second-opinion evaluation begins by understanding the entire history of the problem.

Drs. Miklos and Moore may review:

• When the pain began
• Exact location of symptoms
• Childbirth history
• Previous pelvic surgery
• Previous vaginal surgery
• Previous prolapse repairs
• Bladder sling or mesh procedures
• Urinary symptoms
• Bowel symptoms
• Sexual symptoms
• Treatments already attempted
• Previous imaging and testing

A detailed examination can then help determine whether a pelvic floor, vaginal, vulvar, reconstructive, or support-related problem may be contributing.

Bring Your Previous Surgical Records

Women who have undergone previous surgery should bring available medical records to their second-opinion consultation.

Helpful records may include:

• Operative reports
• Previous imaging
• Ultrasound reports
• MRI or CT reports
• Pathology reports
• Previous treatment records
• Information about implanted mesh or sling materials

Knowing exactly what was performed previously can be particularly important when evaluating postoperative pain.

Should I Get a Second Opinion Before Pelvic Surgery?

If significant surgery has been recommended, obtaining another opinion can provide additional information before making a decision.

This can be especially valuable when:

• The diagnosis remains uncertain
• Previous surgery failed
• Revision surgery is being recommended
• Mesh removal is being considered
• Hysterectomy has been recommended
• Major prolapse reconstruction is proposed

The purpose is not necessarily to avoid surgery.

It is to make sure the proposed procedure addresses the condition actually causing the symptoms.

Why Experience Matters in Complex Pelvic Pain

Pelvic pain involving previous childbirth injury, prolapse, urinary procedures, vaginal surgery, or reconstructive surgery can be particularly complicated.

Dr. John Miklos and Dr. Robert Moore are double board-certified in Obstetrics and Gynecology and Female Pelvic Medicine and Reconstructive Surgery.

They have extensive experience evaluating complex pelvic floor conditions, reconstructive problems, previous surgical complications, and women seeking second opinions after unsuccessful treatment.

Miklos & Moore also serves as a referral center for women with complex pelvic and vaginal conditions, including patients traveling from throughout Georgia, the Southeast, and across the United States.

You Do Not Have to Accept “Everything Looks Normal” as the Final Answer

Sometimes testing truly does show that there is no structural abnormality requiring surgery.

But persistent pain still deserves an explanation and an appropriate treatment plan.

A second opinion may confirm the original diagnosis, identify another possible source of symptoms, or determine that a different specialist or non-surgical treatment would be more appropriate.

The goal is not simply to find something to operate on.

The goal is to understand the problem as accurately as possible before deciding what should happen next.

Schedule a Pelvic Pain Second Opinion With Miklos & Moore

If you continue to experience pelvic pain despite previous evaluation or treatment, Dr. John Miklos and Dr. Robert Moore can provide a comprehensive second-opinion evaluation.

Miklos & Moore Urogynecology evaluates women with complex pelvic pain, painful intercourse, pelvic floor dysfunction, prolapse, previous surgical complications, vaginal scar tissue, bladder sling and mesh concerns, and other difficult pelvic conditions.

Patients travel to Miklos & Moore from Atlanta, Alpharetta, throughout Georgia, the Southeast, and across the United States for specialized urogynecologic and reconstructive care.

Frequently Asked Questions About Pelvic Pain Second Opinions

When should I get a second opinion for pelvic pain?

Consider a second opinion when pain persists despite treatment, the diagnosis remains unclear, previous surgery has not helped, or significant surgery is being recommended.

Can I still have pelvic pain if my ultrasound and MRI are normal?

Yes. Some causes of pelvic pain are not easily identified through routine imaging and may require specialized examination.

Should I see a urogynecologist for pelvic pain?

A urogynecologist may be particularly appropriate when pain is associated with pelvic floor dysfunction, prolapse, urinary symptoms, childbirth injury, vaginal symptoms, or previous pelvic surgery.

Can childbirth cause pelvic pain years later?

Previous childbirth injuries, scar tissue, pelvic floor dysfunction, and changes in pelvic support can sometimes contribute to symptoms long after delivery.

Can previous pelvic surgery cause chronic pain?

Persistent pain after surgery may have several possible causes, including scar tissue, pelvic floor dysfunction, structural changes, or complications related to previous procedures.

Can a bladder sling cause pelvic pain?

Some women experience pain or other symptoms following sling procedures. A specialist can evaluate whether the sling, scar tissue, pelvic floor, or another condition may be contributing.

Should I get another opinion before revision pelvic surgery?

A second opinion can be especially valuable before revision surgery because previous operations may have altered the anatomy and made subsequent treatment more complex.

Do Miklos & Moore see patients from outside Atlanta?

Yes. Miklos & Moore evaluates patients from throughout Georgia, the Southeast, and across the United States who are seeking specialized urogynecologic care and second opinions.

Schedule a Pelvic Pain Second Opinion →