Safe or Not-So-Safe? The Truth Behind the Vaginal Mesh Controversy

Tune into daytime television and you’re likely to see commercials taking aim at vaginal mesh implants. The goal of these ads is to enlist women to join a class-action lawsuit against device manufacturers. But they also strike fear into many women with a long list of scary side effects flashing across the screen: Pain, infection, mesh tearing into the vagina — yikes.

But are the ads true? Are women suffering from painful side effects after having a procedure they believed was safe? The truth is, most women don't experience complications. But some do. Also true: There’s more to the story. Let’s start from the beginning.

What Is Vaginal Mesh?

Surgeons began using vaginal mesh in the 1990s to treat pelvic organ prolapse (POP). This common condition happens when the vagina walls weaken and nearby organs — like the bladder or uterus — fall or drop down into the vagina. All kinds of things can cause this:

• Having children
• Hormonal changes during menopause
• Obesity

The vaginal mesh acts like a sling or brace to hold up those falling organs. Vaginal mesh or pelvic mesh looks like a piece of woven fabric, but it's made of polypropylene. This material has been used for many years to treat hernias.

This procedure offers relief from pain, pressure, and a range of embarrassing symptoms like urinary leakage.

Why Vaginal Mesh Procedures Got Messy 

Problems with the vaginal mesh procedure arose when surgeons began inserting the mesh through the vagina (transvaginally). They used an incision inside of the vagina instead of inserting it through the skin and abdomen. 

Their intention was good. This procedure had a quicker recovery time. It appeared to be effective. Yet, because this surgery was less invasive, doctors without proper training began performing it. Some of their patients experienced complications. Women began reporting painful side effects after the transvaginal mesh procedure. 

This led the U.S. Food and Drug Administration to restrict the use of this surgery in 2019. 

Is Vaginal Mesh Safe?

Researchers now have a better understanding of what went wrong.

“A recent study published in 2021 found that the percentage of patients who had problems with the mesh implant rubbing into the vagina was about 8%,” says UVA Health urogynecologist Monique Vaughan, MD. “In that study, fellowship-trained urogynecologists did all procedures. This is a low rate of complication. This was a big study, the best study we have with the longest follow-up.”

You may have heard that you should avoid any procedure using vaginal mesh. But that’s not the case, Vaughan assures. “The controversy relates to a very specific procedure where surgeons placed the mesh transvaginally to repair prolapse,” she says. “We still use mesh often. But these are very different surgeries.”

Surgeons may use vaginal mesh in a few different procedures:

Sacral Colpopexy for Prolapse

This procedure uses vaginal mesh to treat pelvic organ prolapse. However, surgeons insert the mesh through an incision in the abdomen. 

Vaughan recommends this treatment for women who are: 

• Younger 
• Very active 
• In need of long-term, lasting repair

“This is usually suggested for women who are at high risk of prolapse coming back,” says Vaughan. “It is widely considered to be safe and is the gold standard of surgery to repair vaginal prolapse.”

Sling Surgery for Stress Urinary Incontinence

With stress incontinence, you leak urine when coughing, sneezing, laughing, or exercising. It can be treated with a mesh sling to support the small tube from the bladder (urethra). “The mesh is about the width of Scotch tape, smaller than the mesh used to treat prolapse,” says Vaughan. “It’s placed through an incision in the vagina. It’s a very safe, effective surgery.”

If your doctor recommends a vaginal mesh surgery, talk to them about the risks and any concerns you may have.

I Had the Transvaginal Mesh Surgery — Should I Worry?

Once you’ve heard the horror stories, it’s easy to get consumed by the what ifs. But keep in mind that most women who had transvaginal mesh surgery had a positive outcome. There’s no need to worry or have the mesh removed if you’re not having any problems. 

Signs of vaginal mesh complications include:

• Pain
• Pain during intercourse
• Partner pain with intercourse
• Abnormal bleeding
• Abnormal vaginal discharge
• Worsening bladder symptoms, such as incontinence
• Blood in urine or stool

“If you’re not having any symptoms, then just be sure you’re following up with your gynecologist,” says Vaughan. “The American Urogynecologic Society recommends annual pelvic exams even after menopause or hysterectomy.”

If you are experiencing any of the symptoms above, talk to your gynecologist right away.

Treat Pelvic Organ Prolapse Without Surgery

Pelvic organ prolapse is a common condition. Half of all women will get it by the time they reach their 80s. But not all women need surgery to treat POP.

“The great thing about seeing a urogynecologist, especially our group at UVA Health, is that we have broad training. We can provide a lot of different options, both nonsurgical and surgical,” says Vaughan. “We can tailor the treatment to the individual patient and her particular situation and goals.” 

Pessaries 

These removable devices come in different shapes and sizes. You can insert them into your vagina to support pelvic organs. Our specialists can help determine the right one for your body.

Pelvic Floor Physical Therapy 

Pelvic physical therapy strengthens your pelvic floor muscles. Therapists with special training do a vaginal exam to check your pelvic health. They teach exercises and other ways to help improve symptoms of POP. These includes kegels, stretches, and lifestyle modifications.

“These options are not a cure," says Vaughan. "But they can help women with mild or moderate prolapse manage their symptoms.”