Gynaecology isn't often covered on the nightly news. Women's reproductive health can be such a secret domain.
Even when the covers come off an issue such as vaginal mesh complications, getting a clear explanation of the problem can be difficult. Most media reports that I have read seem to be at least a little confused and a bit heavy on medical mumbo jumbo.
So here's Dr Pat's 5 minutes on vaginal mesh.
Prolapse is a VERY common condition affecting women. It's where the vaginal walls (and sometimes the uterus) bulge towards the vaginal opening. Not surprisingly, this can be very uncomfortable. In many cases it is associated with bladder or bowel problems as those organs share the pelvis with the reproductive system. Prolapse is caused primarily by stretching from pregnancy and childbirth. Other common risk factors for prolapse include chronic cough, heavy lifting and obesity.
Gynaes have developed many treatments for prolapse over the years. Surgery for prolapse is very common and consists of a procedure called a vaginal repair. This operation "repairs" the stretched vaginal tissues and attempts to replace the vaginal walls back near their original location. It sometimes includes a hysterectomy if the uterus itself is involved in the prolapse.
The major problem with prolapse surgery has always been the risk of recurrence. Gynaes will try to reduce recurrence rates by encouraging weight loss, pelvic floor physiotherapy (such as our inhouse Physiotherapist, Belinda Matthews) and quitting smoking to avoid chronic cough. Still, recurrence remains an ongoing risk after prolapse surgery. As I always say to my patients, "gravity does not stop applying to your body on the day I do the repair".
In the 1990s and 2000s, a number of gynaes turned to mesh products to try and make vaginal repairs perform better and last longer. Sheets of special plastic were cut to shape and laid in the tissue under the vaginal skin during a vaginal prolapse operation. These were intended to "bolster" the repair, just like general surgeons had been doing for some years to improve hernia repairs.
It is important to remember many, many mesh vaginal repairs have been performed expertly and improved symptoms for women without any complications.
Unfortunately, many women have developed complications from the use of the mesh. The most common problem is called a "mesh erosion". This is where small areas of the vaginal skin can break down and expose the underlying mesh, leading to discharge and sexual difficulties. More complex mesh complications can lead to damage to the bladder or bowel. Some women have experienced the mesh causing a rigidity in the vagina that has resulted in chronic pain and sexual dysfunction. These are the problems being discussed in the media and by Senator Derryn Hinch at present.
Many gynaes now feel that the risks of mesh repairs outweigh the benefits for most women. Specialist bodies such as the Royal Australian And New Zealand College of Obstetricians and Gynaecologists caution again the routine use of mesh for prolapse. There will always be some women with special problems who may still be advised to have a mesh repair and those women need very careful advice from dedicated, experienced pelvic floor surgeons.
Media reports commonly confuse mesh used for prolapse repairs with other products used for the treatment of urinary incontinence. Incontinence "slings", as they are commonly called, have been used to treat bladder leakage for almost 20 years. They are highly effective in treating the type of incontinence where a woman leaks if she coughs, sneezes or exercises. In experienced hands complication rates are very low. When complications do occur, they are usually relatively straightforward to correct. The confusion arises because incontinence slings are made of similar materials to vaginal mesh sheets. When the synthetic material is used near the bladder opening, to correct incontinence, it is much safer than the large sheets of mesh used in the upper vagina for prolapse.
I don't use vaginal mesh for routine prolapse repairs, instead I opt for a 'native tissue' repair. I do perform many incontinence sling procedures and anyone experiencing incontinence should check out my post I wees when I sneeze. I want all my patients to feel safe and well-informed and I encourage anyone with concerns or questions to contact me.