Question

I was diagnosed with pelvic organ prolapse. What are the side effects of a vaginal/pelvic mesh treatment?

Answer

Mesh, a class III medical device, is sometimes used during surgery to repair prolapse. Mesh is used as a hammock underneath the organs—such as the bowel, bladder, uterus or rectum-- to hold them up, with the bladder most commonly affected.

The placement and type of mesh varies, depending on the organs affected. It’s usually inserted transvaginally, hence the name transvaginal mesh. In addition to POP, transvaginal mesh is commonly used to treat stress urinary incontinence (SUI), which is when the bladder leaks urine during physical activity or when pressure is exerted on the bladder, such as with a sneeze or cough. The mesh is implanted to support the urethra, and this is the most common type of surgery to correct SUI.

Side effects of transvaginal mesh surgery can range from minor pain, discomfort and bleeding to serious complications. Most women leave the hospital the day of their surgery, and can typically resume activities, including sexual intercourse, within three months.

Yet there are more serious risks. Complications from transvaginal mesh may include nerve damage, vaginal scarring, infection, vaginal shrinkage (via scar tissue), painful sexual intercourse, neuro-muscular problems, mesh erosion, and organ perforation. Studies show that complication rates from transvaginal mesh surgery typically range from 7 to 21 percent, even when performed by experts. Sometimes the complications are so severe, such as organ perforation, that they warrant additional surgery. Since synthetic surgical mesh becomes entrenched in the tissues and blood vessels of the woman’s body, its removal is difficult and sometimes impossible.

More than 100,000 women have filed lawsuits against mesh manufacturers for their injuries, resulting in multimillion dollar verdicts and more than $1 billion in settlements. In 2011, the FDA reported receiving 4,000 adverse event reports caused by transvaginal mesh in the previous six years. In 2016, the FDA changed the classification of transvaginal mesh used to repair POP from a moderate-risk device to a high-risk device. The FDA orders apply only to transvaginal use of surgical mesh to treat POP, and not to the use of transvaginal mesh for SUI.

There are alternatives to using transvaginal mesh for the treatment of POP or SUI. They include: pessaries (a small device placed in the vagina to help support the bladder and other organs), pelvic floor therapy (physical therapy such as Kegel exercises can help strengthen the pelvic floor), and surgery without mesh (where a surgeon can use the patient’s own tissue to treat POP or SUI).

If you have been diagnosed with POP or SUI, ask your doctor about non-surgical methods of treatment before resorting to surgery. If your doctor advises surgery, ask them what type of mesh device they plan to use, then research that specific device for benefits and risks before having it implanted.

If you wish to find more information on transvaginal mesh, the FDA publishes information about transvaginal mesh and its risks on their website, and there are several transvaginal mesh patient advocacy groups as well as publications such as Public Citizen and Mesh Medical News Desk, which serve to educate the public about the risks of mesh and also information about safer alternatives. 

Vaginal mesh and other poorly regulated medical devices are featured in The Bleeding Edge documentary, streaming now on Netflix.

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