Sexy Meshes ??
By 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 infections

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 role.  

Normally supported 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.

Like every intervention there are pro's and con's and risks.

Pessaries give 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 ride.

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.

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 pro’s and con’s. No matter how much we would like to have perfect outcomes for everybody, this will not occur. Always weigh the pro’s and con’s 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; “I made it nice and tight.” 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 pro’s and con’s 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".

Central Florida 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 here.