Transvaginal Mesh

Transvaginal mesh is a small, net-like implant made of synthetic or biological materials. It is surgically implanted through the vagina to support and reinforce weakened tissues that cause pelvic organ prolapse and stress urinary incontinence. Women may experience these conditions after childbirth or menopause.

Pelvic organ prolapse, or POP, occurs when the bladder, uterus or rectum protrudes into the vaginal wall, causing discomfort and pain. Stress urinary incontinence, or SUI, is the involuntary leakage of urine when a person coughs, sneezes or exercises.

What Is Transvaginal Mesh Used For?

Transvaginal mesh is designed to provide extra support to weakened pelvic tissues and prevent the organs from prolapsing or leaking. This device can reinforce a weakened vaginal wall or support the urethra or bladder neck. The term “transvaginal” refers to the surgical approach doctors use to implant the device through the vagina.

In the 1970s, surgeons started using abdominal mesh to repair pelvic organ prolapse. By the 1990s, gynecologists had adopted mesh to treat stress urinary incontinence. Near the end of the ’90s, reports of serious complications with transvaginal mesh led to a recall and intervention by the U.S. Food and Drug Administration.

The FDA identifies several types of transvaginal mesh, from synthetic to biological. All types of transvaginal mesh implants carry a risk of erosion and other complications.

Surgeons often use nonabsorbable synthetic mesh because it works better with connective tissue to enhance repair strength. Nonabsorbable implants have a lower risk of infection when compared to absorbable implants.

Several manufacturers have produced transvaginal mesh products, including Johnson & Johnson, Boston Scientific and Bard. These companies and others have faced transvaginal mesh lawsuits because of complications associated with their products.

Manufacturers and brands include:

Because of the FDA’s reclassification of pelvic organ prolapse mesh in 2016 as a high-risk device and the agency’s requirement for additional safety studies, several companies have ceased its production.

Treatment for mesh complications includes surgery, pain medication, antibiotics and physical therapy. Some patients consider surgical removal of the mesh implant and replacement with their own natural tissue in the affected area. Surgeons often use a minimally invasive technique to remove the specific portion of mesh that’s causing symptoms and restore proper pelvic function.

The use of transvaginal mesh has been controversial since the late 1990s, and there have been several notable actions taken by the FDA.

The FDA reaffirmed in October 2022 that the risks of using surgical mesh for the transvaginal treatment of pelvic organ prolapse outweigh its benefits.

Several alternatives to transvaginal mesh exist, including physical therapy, pelvic floor exercises, pessaries and traditional surgical repair. These alternatives help strengthen the pelvic floor muscles, alleviate symptoms and provide support to weakened tissues.

Pelvic floor physical therapy, which may include Kegel exercises, can enhance the strength of pelvic muscles and ameliorate mild symptoms of prolapse or stress urinary incontinence.

A pessary is a plastic or silicone device that is inserted into the vagina to provide support to the bladder and organs. Doctors teach women how to properly insert these devices, which are usually made of inert materials such as plastic or silicone.

Traditional surgical repair uses a patient’s own tissue, but the long-term failure rate ranges from approximately 30% to 50%. Potential surgical candidates should discuss the risks and benefits of different surgical options with an expert surgeon.