Women with transvaginal mesh should not ignore new or persistent pelvic, groin or leg pain, pain during sex, abnormal bleeding or discharge, a rough or sharp area in the vagina, recurrent urinary infections or bladder and bowel changes. These can signal mesh exposure, erosion, contraction or nerve irritation. Complications can appear months or years after surgery, and specialist assessment is advised.
What is transvaginal mesh and why was it used?
Transvaginal mesh is a synthetic material, usually woven polypropylene, placed through the vagina to reinforce weakened tissues. It has been used in two main ways: as larger sheets or kits to repair pelvic organ prolapse, and as narrow tapes, called midurethral slings, to treat stress urinary incontinence.
Mesh was adopted widely in the 2000s with the aim of reducing prolapse recurrence. Over time, reports of serious complications grew. The U.S. FDA issued safety communications in 2008 and 2011, reclassified mesh for prolapse as a high-risk device in 2016 and in 2019 ordered manufacturers to stop selling transvaginal mesh for prolapse repair in the United States. Other countries also restricted its use, and the United Kingdom paused vaginal mesh procedures in 2018 pending further safeguards. Midurethral slings remain available in many countries, with careful patient selection and counseling.
Which symptoms may signal a mesh complication?
Symptoms vary depending on where the mesh is and what has gone wrong. Watch for:
- Persistent pelvic pain, or pain in the groin, buttocks, hips or legs
- Pain during intercourse, or a partner feeling scratching or sharp pain
- Vaginal bleeding, especially after sex or after menopause
- Unusual, persistent or foul-smelling vaginal discharge
- A rough, sharp or wire-like area felt in the vagina
- Recurrent urinary tract infections or blood in the urine
- New difficulty emptying the bladder, a weak stream or new urgency
- Bowel symptoms such as pain, bleeding or difficulty emptying
- Fever or swelling suggesting infection
- A recurring bulge, which may indicate prolapse has returned
What are the main types of transvaginal mesh complications?
Mesh exposure
Part of the mesh becomes visible through the vaginal lining. It may cause discharge, bleeding or pain during sex, though some small exposures cause few symptoms. Exposure is among the most frequently reported mesh complications.
Erosion into nearby organs
Less commonly, mesh may work its way into the bladder, urethra or rectum. This can cause blood in urine or stool, recurrent infections, stones forming on the mesh or fistula. It requires specialist management.
Mesh contraction and chronic pain
Scar tissue around mesh can shrink and tighten, producing band-like vaginal pain, a shortened or narrowed vagina and pain with movement or intercourse. Nerve irritation or entrapment may cause pain radiating to the groin, buttocks or legs.
Infection
Mesh infection may occur early or late and can be difficult to clear while the mesh remains in place.
Urinary and bowel dysfunction
Slings or prolapse mesh may lead to voiding difficulty, new urgency or bowel symptoms, sometimes because the mesh is too tight or poorly positioned.
Why can mesh problems appear years later?
Mesh is designed to be permanent. Tissue around it changes over time, especially after menopause, when lower estrogen levels thin the vaginal lining. Scar tissue may contract gradually, and minor exposure may go unnoticed until it causes symptoms. As a result, women may develop complications many years after an apparently successful operation. It is important to tell any doctor treating you that you have vaginal mesh.
How are mesh complications diagnosed?
Evaluation is best done by a urogynecologist or a specialist mesh team. A typical approach includes:
- Obtaining operative records to confirm the type of mesh and where it was placed.
- A detailed history of pain, bleeding, sexual, urinary and bowel symptoms.
- A careful vaginal examination to look and feel for exposure, tight bands and tender areas.
- Cystoscopy if bladder or urethral erosion is suspected.
- Rectal examination or endoscopy if bowel involvement is possible.
- Imaging such as translabial ultrasound or MRI to map the mesh.
- Assessment of pain patterns, sometimes with a pain specialist or physiotherapist.
What treatments are available for mesh complications?
Treatment depends on the type and severity of the complication and the woman's priorities.
- Observation and local estrogen: some small, symptom-free or minimally symptomatic exposures may be managed this way.
- Partial removal: excising the exposed or painful section, often through the vagina.
- Complete or more extensive removal: considered for severe pain, erosion or infection, ideally in specialist centers, as it is complex and carries risks.
- Repair of organ injury: when mesh has eroded into the bladder, urethra or bowel.
- Pelvic floor physiotherapy: for muscle spasm, pain and sexual dysfunction.
- Multidisciplinary pain management: including medications and nerve-focused treatments.
Removing mesh does not always fully relieve pain, and prolapse or incontinence may return after removal. Clear discussion of realistic goals helps women make informed choices.
What should women with mesh do if they have no symptoms?
Women without symptoms do not usually need mesh removed. Routine gynecologic checkups provide an opportunity for examination. Keep a copy of your operative notes, report new symptoms promptly and inform clinicians about your mesh before any pelvic procedure, pregnancy or vaginal treatment.
When are mesh symptoms an emergency?
Most mesh problems develop gradually, but some situations need same-day medical care. These include inability to pass urine, heavy vaginal or rectal bleeding, high fever with pelvic pain, signs of a spreading infection, and passage of urine, gas or stool from the vagina. Sudden severe pain after surgery or a fall should also be assessed promptly. In an emergency, tell the treating team that you have vaginal mesh and, if possible, the type of operation you had, because this affects which tests and specialists are needed. Early recognition can prevent further tissue damage and makes later repair more straightforward.
Frequently asked questions
Is a midurethral sling the same as prolapse mesh?
Both are made of synthetic mesh, but slings are much smaller tapes placed under the urethra for stress incontinence. They have a different risk profile and remain in use in many countries, with informed consent.
Can mesh complications occur ten years after surgery?
Yes. Exposure, pain and erosion have been reported many years after placement, so new symptoms should be evaluated regardless of when surgery occurred.
Will removing mesh cure my pain?
Many women improve after removal, but not all. Pain may involve nerves or muscles that need additional treatment, and outcomes vary.
Can mesh exposure heal on its own?
Very small exposures sometimes heal with local estrogen. Larger or symptomatic exposures usually need surgical treatment.
Should I avoid sex if I suspect a mesh problem?
If intercourse causes pain or bleeding, or a partner feels sharp edges, it is sensible to pause and arrange an examination before resuming.
References
- U.S. Food and Drug Administration. FDA takes action to protect women's health, orders manufacturers of surgical mesh intended for transvaginal repair of pelvic organ prolapse to stop selling all devices. 2019.
- U.S. Food and Drug Administration. Urogynecologic surgical mesh: update on the safety and effectiveness of transvaginal placement for pelvic organ prolapse. 2011.
- Haylen BT, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses and grafts in female pelvic floor surgery. International Urogynecology Journal. 2011.
- Maher C, et al. Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse. Cochrane Database of Systematic Reviews. 2016.
- Independent Medicines and Medical Devices Safety Review. First Do No Harm. United Kingdom. 2020.
This article is for general education and does not replace an examination by a qualified gynecologist. Individual results vary, and every procedure carries risks.
