Transvaginal mesh

What is transvaginal mesh?#

Transvaginal mesh is a synthetic, net-like material used to provide extra support and repair weakened or damaged internal tissue. It is called “transvaginal” because it is implanted in a surgical procedure through the vagina. It may also be called tape, sling, ribbon or hammock.

The mesh has small holes that allow the body’s own tissue to grow into it. It is intended to be permanent and may not be able to be removed if complications arise.

When is transvaginal mesh used?#

Transvaginal mesh may be considered when non-surgical treatment options have been unsuccessful. It is only one of several surgical options.

In many countries, mesh products used solely for repairing most types of pelvic organ prolapse (such as bladder, bowel or uterine prolapse) have been withdrawn because of safety concerns, while mesh continues to be used to treat stress urinary incontinence.

As with all medical procedures, it is important to fully understand what is involved and to weigh up the risks and benefits before you decide. This is part of giving informed consent.

Questions to ask your specialist#

Ask as many questions as you need, such as:

• What are the other treatment options?
• What are the benefits of this procedure for me?
• What are the risks and complication rates?
• What type of mesh will you use?
• Are you trained to perform this procedure, how many have you done, and what were the results?

You may also wish to seek a second opinion.

Possible complications#

Women can experience problems with transvaginal mesh immediately after surgery or years later. Complications can range from mild discomfort to debilitating pain and may include:

• abdominal, buttock or leg pain
• irregular vaginal bleeding or discharge
• pelvic pain or swelling
• discomfort during sex
• bladder and bowel problems, such as infection and incontinence
• a prickling feeling or sharp, stabbing pain in the vagina, which may worsen with exercise

Talking to your doctor about complications#

It can be hard to talk about personal health problems, even with a doctor. These questions may help:

• If I have mesh complications, can you treat them, and how?
• Can the type of mesh I have be removed?
• What are the surgical options, what do you recommend, and why?
• Will my symptoms go away if the mesh is removed?
• What are the alternatives to surgery?
• What will happen if I choose not to have surgery?

Sharing practical information and emotional support with other women who have had similar experiences, for example through a peer support group led by a qualified health professional, can also help. Some hospitals run specialist programs for women with complications from mesh.

Alternatives to transvaginal mesh#

Non-surgical and surgical options that do not use transvaginal mesh are available for women with pelvic organ prolapse and stress urinary incontinence.

Non-surgical treatments include:

• pelvic floor physiotherapy – strengthening the pelvic floor by actively tightening and lifting the muscles at intervals (see a physiotherapist who specialises in pelvic floor training). Electrical stimulation and biofeedback may also help improve pelvic floor muscle function.
• vaginal pessary – a ring-like device that sits in the vagina and helps support the pelvic organs, reducing descent and/or stress urinary incontinence. This can lead to significant improvements in prolapse symptoms and in bladder and bowel function.
• bladder training
• lifestyle changes – including reducing weight, avoiding heavy lifting, and treating constipation and a chronic cough
• absorbent products – these can help manage incontinence for some women
• medication

Alternative surgical treatments include:

• native tissue repair – using the patient’s own tissue to repair the prolapse
• biological graft repair – using a graft from a human or animal source to support a vaginal prolapse
• pubovaginal sling – using the patient’s own tissue
• colposuspension – performed as open or laparoscopic surgery
• bulking agents – injected into the urethra

Your rights#

You have the right to access high-quality and safe healthcare, wherever and whenever care is provided. If you experience a problem, you can report an adverse event to your local medical device or health products regulator.

Anyone can make a complaint about a health service or about anyone who holds their health records. If you are unable to access your health records from your health service or doctor, you may be able to request them through a freedom of information process.

Key points#

• Transvaginal mesh is a permanent synthetic implant used mainly to treat stress urinary incontinence.
• It has been withdrawn in many countries for the treatment of most pelvic organ prolapse.
• Complications can appear soon after surgery or years later and may not be fully reversible, so understand the risks and benefits before deciding.
• Non-surgical and alternative surgical options are available.