{'fraction_non_alphanumeric': 0.01582131223825035, 'fraction_numerical': 0.0018613308515588647, 'mean_word_length': 5.17816091954023, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 1, 'zh_pornsignals.json': 0}}
Dyspareunia and mesh erosion after vaginal mesh placement with a kit procedure.

A premenopausal woman underwent a vaginal hysterectomy and anterior and posterior colporrhaphies, performed with a polypropylene mesh kit, for dysfunctional uterine bleeding and stage I uterine and anterior vaginal wall prolapse. Two months postoperatively, she resumed intercourse that was complicated by de novo dyspareunia. The dyspareunia persisted for 30 months without improvement, despite treatment with physical therapy, anti-inflammatory agents, vaginal estrogen, and local injections. On referral to a tertiary care center, her physical examination was remarkable for extreme tenderness bilaterally along the sacrospinous ligament. Light palpation of this area reproduced the dyspareunia. The arms of the posterior wall mesh were clearly palpable as they passed through the midportion of the sacrospinous ligament and were subjectively tight. There was no evidence of mesh erosion. Given failure of other treatment options, we advised resecting the mesh. We used a posterior vaginal wall approach to resect the proximal aspect of the posterior mesh to the level of the sacrospinous ligament bilaterally. We incised the vaginal epithelium in the midline of the posterior vaginal wall down to the mesh. After identifying the mesh, we dissected it off the vaginal epithelium to the point of insertion just in front of the sacrospinous ligament. After we dissected the tissues and rectum underlying the mesh to this same location, we excised this piece of mesh. We did not remove the arms of the mesh in the ischiorectal fossa and left the distal aspect of the posterior vaginal mesh in situ. We left the vaginal epithelium in the area of dissection intact and closed it without tension. This procedure required tedious dissection, patience, and a good understanding of pelvic anatomy. Postoperatively the patient had complete resolution of the dyspareunia, and all compartments of the vagina remain well suspended. Vaginal depth and circumference were not compromised. Figure 1 shows an example of a marketed mesh kit used to treat pelvic organ prolapse. CASE 2