Why Prolapse Surgery May Cause Painful Intercourse (Dyspareunia): Understanding the Causes, Risk Factors, and When Specialized Care Matters

Pelvic organ prolapse surgery is often life-changing for women suffering from pressure, bulge symptoms, urinary problems, or difficulty with daily activities. For many, surgery brings relief and restores function. However, some women experience new or persistent pain during intercourse after prolapse surgery, even when the prolapse itself is corrected.

This can be emotionally devastating—especially when surgery was intended to improve quality of life, not limit intimacy.

Painful intercourse after prolapse surgery is real, medically recognized, and often explainable. In most cases, it is not due to a single issue, but rather a combination of structural changes, scarring, muscle responses, nerve sensitivity, and altered vaginal anatomy.

This article explains:

  • Why prolapse surgery can sometimes lead to painful sex
  • How different prolapse repairs affect the vagina
  • The difference between entry pain and deep pain after prolapse surgery
  • The role of scarring, vaginal narrowing, and pelvic floor muscle spasm
  • How vaginal vault prolapse repair can impact sexual comfort
  • Why expert pelvic reconstructive evaluation is essential in complex cases
  • Why surgeons such as Dr. John Miklos and Dr. Robert Moore are often sought for evaluation and correction of post-prolapse surgery pain

Understanding Prolapse Surgery and Vaginal Anatomy Changes

Pelvic organ prolapse occurs when the bladder, rectum, uterus, or vaginal apex lose support and descend into the vaginal canal. The reason why these organs fall or prolapse is due to the loss tissue integrity of the ligaments, fascia and muscles of the pelvic floor.   Prolapse surgery aims to restore support, but doing so requires altering ligaments, fascia, and vaginal tissue.

While restoring support is critical, any surgery that changes vaginal anatomy can influence sexual function, especially if healing leads to scarring, narrowing, or tension.

Common Types of Prolapse Surgery

Prolapse surgery may involve repair of:

  • Anterior vaginal wall (cystocele / bladder prolapse)
  • Posterior vaginal wall (rectocele)
  • Vaginal vault or apex (after hysterectomy)
  • Uterine prolapse (with or without hysterectomy)
  • Multi-compartment prolapse (more than one area)

Each repair affects the vagina differently—and each carries specific risks related to postoperative pain during intercourse.

Why Painful Intercourse Can Occur After Prolapse Surgery

  1. Vaginal Narrowing or Tightening (Over-Correction)

One of the most common causes of post-prolapse surgery dyspareunia is vaginal narrowing, sometimes referred to as “over-tightening.”

During prolapse repair, excess vaginal tissue may be removed, and underlying fascia tightened. While this improves support, too much tightening can reduce vaginal width or elasticity.

Symptoms of vaginal narrowing

  • Pain immediately upon penetration
  • Feeling like penetration “doesn’t fit”
  • Burning or tearing sensation
  • Pain worse with certain positions or deeper penetration
  • Pain that was not present before surgery

This is more common after:

  • Posterior repairs (rectocele surgery)
  • Perineoplasty (perineal surgery)
  • Multi-compartment repairs
  • Revision surgeries
  • Surgeries in women with already reduced estrogen levels
  1. Scar Tissue Formation (Fibrosis)

All surgery creates scar tissue—but excessive or poorly positioned scar tissue can cause pain.

After prolapse surgery, scar tissue may:

  • Reduce vaginal stretch
  • Create rigid, non-elastic areas
  • Pull on surrounding structures during movement
  • Become tender or hypersensitive

Scar tissue pain is often position-dependent and may worsen with thrusting or deeper penetration.

Scar-related pain may also:

  • Persist despite good lubrication
  • Be associated with a “pulling” or “tugging” sensation
  • Be worse months or even years after surgery as tissue matures
  1. Vaginal Vault or Apex Tension After Prolapse Repair

For women who have had a hysterectomy, prolapse surgery often focuses on supporting the vaginal vault (apex).

While proper apical support is critical, excessive tension or altered vaginal angle can cause deep pain during intercourse.

Common vault-related pain complaints

  • Deep pain with thrusting
  • Feeling like something is being “hit”
  • Pain at the top of the vagina
  • Bleeding after intercourse
  • Pain during pelvic exams

Vault-related pain may result from:

  • Scarred vaginal cuff
  • Shortened vagina
  • Tension on support sutures
  • Altered vaginal axis
  • Nerve irritation near the apex
  1. Pelvic Floor Muscle Spasm and Guarding

After prolapse surgery, the pelvic floor muscles may respond protectively by tightening. Over time, this guarding can become chronic.

Pelvic floor muscle spasm can cause:

  • Entry pain
  • Burning or sharp pain
  • Difficulty tolerating penetration
  • Pain even with gentle touch
  • Pain during exams or tampon insertion

Muscle-related pain is often overlooked because:

  • The vagina may look anatomically “correct”
  • Imaging may appear normal
  • Pain may fluctuate

Without targeted pelvic floor therapy, muscle tension can persist indefinitely.

  1. Nerve Sensitivity or Neuropathic Pain

Prolapse surgery involves working near pelvic nerves. In some women, nerve irritation or sensitization can occur.

Nerve-related pain may feel:

  • Burning
  • Electric
  • Stabbing
  • Persistent after intercourse
  • Disproportionate to exam findings

This type of pain may coexist with scar tissue or muscle spasm and often requires specialized evaluation.

  1. Low Estrogen and Tissue Fragility After Surgery

Women who are:

  • Postmenopausal
  • Perimenopausal
  • Or who had ovaries removed

may have thinner, drier vaginal tissue at the time of prolapse surgery. Healing tissue under low-estrogen conditions is more prone to:

  • Fragility
  • Micro-tearing
  • Inflammation
  • Pain with penetration

This often causes entry pain but can worsen deeper discomfort when combined with scarring or narrowing.

Entry Pain vs Deep Pain After Prolapse Surgery

Understanding where pain occurs is one of the most important diagnostic clues.

Entry Pain After Prolapse Surgery

Most often associated with:

  • Vaginal narrowing
  • Low estrogen tissue
  • Pelvic floor muscle spasm
  • Scar tissue near the vaginal opening

Symptoms include:

  • Burning
  • Stinging
  • Tearing sensation
  • Pain at initial penetration

Deep Pain After Prolapse Surgery

Most often associated with:

  • Vaginal vault tension
  • Scarred vaginal cuff
  • Adhesions
  • Altered vaginal axis
  • Apical support issues

Symptoms include:

  • Pain with thrusting
  • Pressure or aching deep inside
  • Pain in specific positions
  • Bleeding after intercourse

When Prolapse Surgery Improves Symptoms—but Sex Still Hurts

Many women report:

  • Bulge is gone
  • Pressure is improved
  • Bladder symptoms are better
  • But intercourse is now painful

This disconnect often happens when support is restored, but vaginal function is compromised.

A successful prolapse repair must balance:

  • Support
  • Vaginal length
  • Vaginal width
  • Elasticity
  • Muscle coordination
  • Nerve health

When one of these is overlooked, sexual pain can result.

Why Revision or Specialized Evaluation Is Sometimes Needed

Not all post-prolapse surgery pain resolves with time or conservative measures. Women who may benefit from advanced evaluation include those with:

  • Persistent pain > 6 months
  • Pain that worsens over time
  • Bleeding after intercourse
  • Pain despite pelvic floor therapy
  • Prior failed prolapse repairs
  • Multiple pelvic surgeries
  • Previous surgeries utilizing vaginal mesh ( sacral colpopexy, slings, and anterior and posterior vaginal wall repair.

In these cases, evaluation by surgeons experienced in complex pelvic reconstruction and revision surgery is critical.

Why Dr. John Miklos and Dr. Robert Moore Are Often Consulted for Post-Prolapse Surgery Pain

Miklos & Moore

Dr. John Miklos and Dr. Robert Moore are internationally recognized for their expertise in complex pelvic reconstructive surgery, including evaluation and correction of complications following prolapse surgery.

They frequently see women who:

  • Developed painful intercourse after prolapse repair
  • Were told their pain was “normal” or “expected”
  • Have anatomically successful repairs but poor functional outcomes
  • Require revision surgery focused on comfort and sexual function

What distinguishes their approach

  • Deep understanding of vaginal and pelvic support anatomy
  • Experience identifying subtle causes of dyspareunia
  • Focus on preserving or restoring vaginal function
  • Expertise in revision and corrective surgery
  • Careful balancing of support with elasticity and comfort

Their goal is not simply to correct prolapse—but to restore quality of life, including pain-free intimacy whenever possible.

Locations for Expert Evaluation

Patients travel nationally and internationally to consult with Miklos & Moore, with offices in:

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

Frequently Asked Questions

Is painful intercourse common after prolapse surgery?

Some temporary discomfort can occur during healing, but persistent or worsening pain is not normal and should be evaluated.

Can prolapse surgery permanently damage sexual function?

Most women do well, but when complications occur, they are often treatable, especially with early recognition.

Does vaginal narrowing always require surgery?

Not always. In fact, some women want vaginal narrowing known as vaginal rejuvenation to improve friction during intercourse.  However, when the vagina becomes to narrow and leads to chronic painful intercourse intervention is required to restore ones quality of life.   Pelvic floor therapy, hormonal treatment, and other measures may help—but structural narrowing sometimes requires surgical correction.

Why wasn’t I warned about this risk?

Sexual pain is still under-discussed in surgical counseling. Awareness is improving, but many women are not fully informed beforehand. Many surgeons are just not aware that certain surgical procedures can result in pain and painful intercourse.

Key Takeaway

Prolapse surgery can dramatically improve quality of life—but in some women, it may also lead to painful intercourse due to vaginal narrowing, scarring, muscle spasm, nerve sensitivity, or altered vaginal support.

Pain after prolapse surgery is not something you must accept. With proper evaluation, the underlying cause can often be identified and treated.

When pain is persistent or complex, surgeons experienced in pelvic reconstructive and revision surgery, such as Dr. John Miklos and Dr. Robert Moore, are often sought to help restore comfort, function, and confidence.