The Vaginal Mesh Mess
Marja Sprock, M.D.
vaginal mesh mess, sounds cute, however there is a lot
of misunderstanding about mesh, the reason it is
sometimes used in repair of the vagina, and the possible
complications of it. Actually there is a lot of
misunderstanding about vaginas, since mesh is not used
in well supported vaginas with strong healthy tissue,
but in prolapsed vaginas with weak tissue and broken
support systems. A vagina that supports bladder, uterus
or small bowel and rectum well, will not require the
insertion of a mesh. It is the vagina that is coming
down, looking like when you pull a sock inside out,
which possibly requires the insertion of a mesh.
you turn on the radio or TV, you can find ads looking
for people who had certain kinds of meshes placed in the
vagina. The FDA came out with a “vaginal mesh warning’
in 2008. This warning summarizes some of the potential
problems, but at the same time advises to look for an
experienced surgeon. It has been proven by several
studies on numerous different surgical interventions and
procedures: surgeons who perform a certain surgery more
often, “high volume” surgeons, tend to have better
outcomes and fewer complications.
often tell people, “You should not choose to have an
urogynecologist insert your knee replacement”, however
that does not mean the knee implant is defective, it
means choose your surgeon carefully. If your own knee
has worn down to a degree that there is so much damage
that it can not be repaired and it bothers you
tremendously in daily life, replacement may be a good
thing. Will that mean that everything will be 100%
guaranteed fine and your knee will be as good as new?
Obviously not. Naturally with any surgical intervention
there are potential problems, some can be prevented,
not much different when a vagina requires a repair. For
some severely prolapsed vaginas, studies have proven
that the use of a mesh, will lead to less recurrence of
the problem. The chance of a repair of the front of the
vagina, cystocele (bladder coming down), recurring has
been estimated to be close to 30%. That is a high
percentage and with the use of a mesh it has been
brought down. The mesh will be placed to provide extra
support to the weakened tissue, which has a lot of body
weight pushing on it. Also the mesh makes it possible to
put less tension on tissue, and recreate support. Your
own tissue will grow into the mesh and incorporate it.
The softer more open weave meshes which are used more
often nowadays can often only be palpated at the
connection points and only by an experienced surgeon,
not by the patient.
Vaginal prolapse is like a hernia. Surgeons often repair
abdominal hernias with a mesh, since the repair has been
proven to be sturdier. There can be complications, like
non-healing, infection and failure, no surgery is 100%
I showed one of my patients an example of the mesh and
told her which parts of the mesh I probably would trim,
she said: “why would you trim it, I like this, it feels
nice and soft, like the lace I use for sewing”.
the last couple of years, the mesh material used in
vaginal repairs has made significant advances. The risk
of complications depends on the patient, the mesh used,
the procedure and the surgeon. If a patient is older,
has a poor blood supply, has thinning of the vaginal
tissue and systemic diseases like diabetes or obesity,
the chance of complications is higher. The meshes
nowadays have larger pores, are flexible and have
smaller diameters of the fibers used to make the mesh.
mesh, as used in some vaginal prolapse
repairs, reminds some people of lace.
of the use of meshes is erosion or extrusion of the
mesh, meaning a piece of it will be visible in the
vagina. Sometimes not a problem, but a potential sexual
partner will be less enthusiastic. It is however often
easy to fix in the office, and currently almost a
problem of the past. There are people who ended up with
significant pain in the vagina after mesh was used,
which often can be relieved by an experienced vaginal
surgeon. There are also numerous people who end up with
vaginal pain after a repair without mesh. This is often
more difficult to correct since surgeries without a
mesh, often involve removal of a significant amount of
vaginal tissue. Once it is gone, it can not be
recreated. In mesh repairs, the support is recreated and
there is minimal to no removal of tissue. Remember
repairs are done for vaginas that are not well
supported, like the “sock which is turning inside out”,
not a healthy vagina.
risk of infection varies dependent on the type of mesh
used and numerous other factors. If the patient is
obese, has hypertension, a thin non-estrogenized vagina
and diabetes chances of potential problems like
infections and non-healing are significantly increased.
There are other risks to vaginal surgery like possible
injury to organs like bladder and rectum. Not common and
if recognized early often quite easy to repair.
Vaginal meshes often lead to sturdier repairs and in the
right surgeons hands, complications can be kept to a
minimum. A mesh should only be used for significant
prolapse, not for a mild descend of the vagina.
Currently there is a witch hunt going on and it will not
help women if vaginal meshes were abandoned, nor do they
deserve the bad press. I have seen numerous poorly
repaired vaginas with women unable to have intercourse
in vaginal repairs done without mesh, where too much
tissue was removed and it all was pulled too tightly.
meshes have been proven to increase the success rate and
longevity of several vaginal repairs, it is unlikely
they will disappear; neither would it benefit women if
placement was abandoned. It pays to be well informed.
Make sure your surgeon has experience in vaginal mesh
repair and understand your options. Realize that
everything you do in life has a potential risk. If you
get into a car, you can get into an accident and you
accept that risk and try to minimize it. If your vagina
is severely prolapsed and interfering with your quality
of life, you can choose to let it be, have a pessary
inserted or have a surgical intervention. Weighing the
pros and cons this may mean the insertion of a mesh. If
a mesh is placed in your vagina for support it will be
because your natural support is defective and it is
being used as an aid.
make a long story short: the success of a vaginal repair
depends on the patient, the surgeon, the procedure and
the possible mesh product used. Meshes used for repair
of severely prolapsed vaginas have often more advantages
than disadvantages, which should all be discussed and
evaluated carefully. No 100% guarantee can be given, not
for vaginal meshes and not for life. The vaginal mesh
mess may not be as messy after all.
Marja Sprock, MD is a
fellowship trained urogynecologist who will be able to
assist you in the best choice of treatment for your
bladder, bowel or vaginal prolapse problems. Also your
specialist for cosmetic vaginal surgery.
Call our Rockledge office
send us a
note or visit us online at