What to know about transvaginal mesh

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Transvaginal mesh is an implant of natural or synthetic mesh that healthcare professionals use to strengthen a weakened area of the vagina. The insertion of a transvaginal mesh is a surgical procedure.

The Urology Care Foundation notes that people may have a transvaginal mesh implant if they have pelvic organ prolapse (POP) or stress urinary incontinence (SUI).

POP occurs when muscles and ligaments surrounding the pelvic organs weaken and fall out of place.

SUI is a condition where urine leaks out during physical movements, such as when people cough, sneeze, or laugh.

A transvaginal mesh can help support the vaginal wall in people with POP.

Those with SUI may have a mesh sling in place. A surgeon will place a mesh sling through the vagina to support the urethra, the tube that transports urine out of the body from the bladder.

A sling relieves pressure on the bladder, which may help prevent urine from leaking out.

There are different types of vaginal mesh, including:

• Absorbable: Absorbable mesh will degrade and weaken over time, allowing new tissue to grow and provide support instead.
• Nonabsorbable: Nonabsorbable mesh is a permanent implant in the body to provide long-term support.
• Synthetic: Synthetic mesh can come in knitted or nonknitted sheets. Synthetic mesh may be nonabsorbable or absorbable, or a combination of both.
• Animal-derived mesh: Animal-derived mesh is absorbable and may consist of animal intestine or skin, such as from a pig or a cow. The animal tissue undergoes disinfection and processing to be safe inside the body.

A transvaginal mesh may help strengthen a weakened part of the vagina, provide support, and help return any affected organs to their normal position. However, there are risks to be aware of.

Potential risks of vaginal mesh include:

• persistent vaginal bleeding
• irregular vaginal discharge
• recurrent urinary tract infections

Other possible complications may include:

• pain or swelling in the pelvic area
• discomfort during sex
• infection of the bladder or bowel
• incontinence
• stabbing pain or a prickling sensation in the vagina, which exercise may worsen
• pain in the abdomen, buttocks, or legs

There is some controversy around transvaginal mesh and whether it is a safe treatment method for POP or SUI.

In 2019, the Food and Drug Administration (FDA) issued a press release to ban the continued manufacturing, selling, and distribution of surgical vaginal mesh to treat POP.

The FDA stated that Boston Scientific and Coloplast, two manufacturers of vaginal mesh, had not shown enough safety or effectiveness in their products.

The FDA felt this action was necessary after increasing reports of negative side effects from using transvaginal mesh to treat POP.

The American Urogynecologic Society (AUGS) states that they support the use of transvaginal mesh in some situations, where it is the most appropriate treatment option.

Alternative treatment options to transvaginal mesh include:

Pessaries

A pessary is a silicone device that inserts into the vagina to support organs that have dropped out of place. A pessary may also place pressure on the urethra to prevent urine leakage.

Around 50–80% of females can successfully use a pessary, regardless of age, medical history, or the severity of their condition.

People may choose to have a pessary to treat POP or SUI, and it may be suitable for those who:

• want a temporary or long-term solution to urine leakage during physical activity
• want a nonsurgical solution
• have time to regularly remove and clean the pessary as necessary

Pessaries may not be suitable for people with:

• a widened vaginal opening
• a narrow or shorter vagina due to surgery
• vaginal scarring
• vaginal dryness
• weak pelvic floor muscles

Learn more about the different types of pessary here.

Pelvic floor therapy

Another alternative treatment to vaginal mesh is pelvic floor therapy. Pelvic floor therapy involves specific exercises that strengthen the pelvic floor muscles.

People may want to work alongside a physiotherapist who offers pelvic floor training.

Other options

Techniques such as biofeedback and electrical stimulation may also help improve the function of pelvic floor muscles and treat POP and SUI.

Other treatments may include:

• bladder training and absorbent products for SUI
• medications
• lifestyle changes, such as maintaining and achieving a healthy body mass index, avoiding heavy lifting, and treating constipation or chronic coughing

There are also surgical alternatives, such as:

• native tissue repair or pubovaginal sling, which uses the person’s own tissue to treat POP
• biological graft repair, which uses human or animal tissue to support a prolapse
• bulking agents, which a doctor injects into the urethra as a treatment for SUI

If people have any symptoms of complications from vaginal mesh, they will need to speak with a healthcare professional.

A doctor may carry out examinations, such as imaging tests, to check for any issues with the transvaginal mesh.

In people who have concerns about the safety of their mesh but no adverse symptoms, there is no need to remove the mesh.

Surgery to remove the mesh may cause unwanted symptoms and is unnecessary unless there is a medical problem.

Transvaginal mesh is a synthetic or natural implant of mesh into the vagina to treat POP or SUI. Transvaginal mesh can help support dropped organs, strengthen a weakened vagina wall, or prevent urine leakage.

There has been some controversy surrounding the use of transvaginal mesh, and the FDA banned two manufacturers from selling surgical mesh devices due to concerns about their safety and effectiveness.

Other organizations, such as AUGS, have stated that vaginal mesh may be a suitable treatment option in some circumstances.

People can discuss the potential benefits and risks of vaginal mesh surgery and other treatment options with a healthcare professional.