Sexy Meshes ??
Marja Sprock, M.D.
A sexy mesh sounds
really good, but makes no sense. Mesh is used to support
a severely prolapsed vagina (fallen down, - the inside
out sock idea.) The vagina has lost support to stay
inside and upright, causing it to fall down or even come
out of the body.
Bladder prolapse, almost outside
of the body, making it difficult
to empty and perhaps causing
nighttime voiding and bladder
Currently you hear more
about vaginal meshes from all the lawyer ads than from
the doctors. A lot of people's first comments to
me are "I do not want a mesh" Well most women
visiting the office do not need one, and even though a
mesh may not be sexy, it certainly has a function and
vaginas may be desired to be tighter and vaginal
rejuvenation would be a consideration. This could
enhance sexual pleasure and satisfaction.
Meshes have no role in
vaginal rejuvenation. Slight descend of the
vagina, slight bulges of the vaginal tissue, which may
be bothersome may require surgery, but usually can be
repaired without the use of a mesh. Often well
performed muscle training will get the desired effect or
take the bother away, no other intervention needed.
If you have to get up
several times at night to urinate, you may have a
bladder prolapse. It may even cause recurrent bladder
infections. This prolapse interferes with the quality of
life and can be treated with a pessary or surgery. A
pessary is a small shelf, like a diaphragm, and will
support the bladder which has fallen by gravity.
you have to get up several times
at night to urinate, you may
have a bladder prolapse. It may
even cause recurrent bladder
infections. This prolapse
interferes with the quality of
life and can be treated with a
pessary or surgery.
Like every intervention
there are pro's and con's and risks.
discharges and cannot stay in while having sex. Not a
very sexy solution either in other words, but darn
practical and effective for some people. I have very
happy pessary patients.
Other people have a
bulge of the wall of the vagina and the rectum pushes
in, making it hard to have a bowel movement without
using their fingers to eliminate stool. Also
sometimes there is an accidental loss of stool.
Some people with severe
prolapse desire surgical intervention. Surgery can be
done through the vagina, or through the abdomen with a
laparoscope or robot. Surgery with the laparoscope
or robot always uses a permanent mesh. It has been shown
through several studies to hold better with a permanent
mesh. The surgery even though done through tiny
incisions by laparoscopic or robot assisted instruments
is more intense than a vaginal surgery.
In younger women - up
to early seventies - we often perform this surgery.
According to a report from the FDA on vaginal meshes in
July 2011, there is less chance of mesh complications
with a mesh placed with the laparoscope or robot than
through the vagina. No sexy meshes, however realize that
the surgery itself is more invasive, often takes longer
and if complications occur they are often more serious.
Bowel obstruction or an ileus is basically not seen
event after a vaginal surgery, but is always possible
after the robot or laparoscope. Injury to any other
organ occurs more often laparoscopically/robotically
than vaginally. In other words there is no free sexy
The National Institute
of Health and Clinical Excellence (NICE) stated that the
evidence suggests that vaginal prolapse repair using a
mesh may be more efficacious than a traditional repair
without a mesh.
The New England Journal
as well as some well-regarded review of medical
data/articles groups state that the use of meshes
diminishes the recurrence of prolapse. In other words
not sexy, but do not immediately dismiss it, since it
may be your answer to a repair which will last. And in
all seriousness, most women with a prolapsed vagina feel
less than sexy and do not desire multiple repairs.
Vaginal prolapse, not a sexy
problem, weigh the proís and
conís for your situation
carefully. Remember meshes are
not sexy, but for some people a
So if meshes are not
sexy, but may repair our vagina with a higher overall
success rate, it may be a good decision for some people.
As with everything in life there are proís and conís. No
matter how much we would like to have perfect outcomes
for everybody, this will not occur. Always weigh the
proís and conís for your particular situation.
There is no perfect
repair for everybody. Remember when you need these
surgeries your vaginal tissue/support is far from
perfect; otherwise the vagina would have stayed up and
in place. I do not support surgeries where the vagina is
closed off, because of the high complication rate and I
think we deserve our vagina.
Sex and meshes will be
the subject of another article. If a piece of mesh comes
through the vaginal wall, it will have to be trimmed.
Some people have poor wound healing, however it can
often be corrected in the office.
You may not know the
women whose doctor told them after their vaginal
prolapse repair-often called an AP repair; ďI made it
nice and tight.Ē For a lot of couples that meant no more
sex, since tight here meant pinky finger tight. These
women did not have a mesh, did not have the FDA to
complain to and did not have a lawyer calling them to
join a lawsuit.
Vaginal prolapse is not
a sexy problem. Weigh the proís and conís for your
situation carefully. Remember meshes are not sexy, but
for some people a saving grace.
As I counseled one of
my patients with a large vaginal bladder prolapse about
the use of a mesh and told her about the FDA warning,
lawyers and possible complications as well as that her
neighbors would warn her not to do it. She answered me:
"Dr. Sprock, my neighbor had the mesh inserted by you
and has been doing fabulous, I would like to have that
also done for me and am not scared of it, in fact that
is why I am here".
UroGynecology in Rockledge, your specialist center for
urogynecology, pelvic reconstructive surgery and
cosmetic gynecology. Dr. Sprock has contributed to the
development of several meshes and surgical techniques
and continues to very active in the field.
Call us at 321-806-3929 for an
appointment or leave a note