The impact of transvaginal mesh procedures
For those reading this they are words on paper or on an
electronic device, but for those of us living with mesh, and especially those
that have suffered complications, they aren't words, but physical pain,
emotional trauma, fear, embarrassment, ridicule, shame, disbelief, depression,
anxiety, derision, and aloneness.
Throughout this inquiry, the committee has repeatedly been told that the
vast majority of women who have had transvaginal mesh procedures as part of
treatment for stress urinary incontinence (SUI) or pelvic organ prolapse (POP)
have not experienced complications as a result of their surgery and have
experienced improved quality of life.
The committee also heard that the incidence and severity of complications was
less for transvaginal mesh procedures to address SUI using mid-urethral slings
However, the vast majority of women who have written to the committee
have experienced starkly different outcomes. Not only have these outcomes been severely
adverse, but most of these women have experienced great difficulty finding medical
practitioners who would accept that the symptoms they were experiencing were as
severe as they claimed or that they were mesh related. Their struggles to cope
with their symptoms and to find support and treatment have had far reaching and
devastating impacts on their lives and the lives of their families. As the Health Issues Centre (HIC) noted in its submission to the
inquiry,'[m]uch of the debate about the severity of this problem has been
framed in terms of the good outcomes for the many outweighing the unfortunate
experiences of a few.'
The committee seeks to redress this by ensuring the voices of the women
who bravely recounted their deeply personal and frequently traumatic
experiences in submissions and evidence to this inquiry are heard. In this
chapter, the committee considers the physical, social, emotional and financial
impacts of complications associated with transvaginal mesh procedures. At the
same time, the committee notes the accounts provided by women who have had
successful outcomes from transvaginal mesh procedures and views of medical
practitioners who consider there is a place for transvaginal mesh procedures in
the treatment of SUI and POP.
In Chapter 4, the committee considers the advice and support provided to
women prior to transvaginal mesh procedures and to those women who have
experienced complications following their surgery.
The impact of mesh related health problems on women's lives
As noted in Chapter 1, there are a number of different surgical
procedures using urogynaecological mesh to address POP and SUI. The committee
recognises evidence that indicates complications arising from transvaginal mesh
surgery to address POP and SUI can differ in terms of incidence and clinical
For example, RANZCOG submitted that complications that are specific to
the use of MUS for SUI include mesh erosion and pain, particularly groin pain,
while complications unique to transvaginal mesh surgery for POP include:
mesh erosion into the urinary tract;
mesh erosion into the bowel or rectum; and
pain requiring mesh removal.
In this chapter, while the committee has been mindful of this
distinction between devices and procedures and clinical outcomes, the
committee's intention is to provide a broad understanding of the range of complications
that have been reported to the committee in evidence to the inquiry and,
perhaps most importantly, the impact that these complications have had on
The adverse outcomes of mesh procedures reported to the committee cover
the gamut of physical, social, emotional and financial impacts. Ms Stella
Channing, of the Australian Pelvic Mesh Support Group (APMSG), told the
The women have lost their health, and in many cases they have
lost their jobs, their careers, their homes and, in some cases, their husbands.
The pain and complications cause them to be isolated from their friends and
families, and many suffer from depression, anxiety and PTSD. Many women are
shocked and in despair when they realise that they will probably never regain
their health or their life back.
As noted in Chapter 1, the TGA has published an extensive list of
adverse events that may be associated with mesh procedures.
In its submission, The APMSG told the committee that its members suffer with
the effects of mesh erosion, nerve and tissue damage, urethral damage,
perforated organs and debilitating, chronic pain.
The Royal Women's Hospital, Melbourne, (RWH) told the committee that the most
frequent complications seen at that hospital include pain, mesh exposure
through the vagina, infection, urinary problems and recurrence of the prolapse
Many of the women who have provided personal accounts to the inquiry
have experienced, or continue to experience, multiple complications following
transvaginal mesh surgery. As the husband of one woman explained, since her
operation, his wife has experienced extensive and debilitating symptoms that
have impacted greatly on her health, wellbeing and quality of life. These
symptoms, which have persisted even after the removal of the device, include:
extreme hyper-sensitivity bilaterally in the groin area to the
extent that even light pressure over the lower mid-line pubic area is very
'nerve like' pain in both legs, becoming more intense when weight
bearing on the leg and when walking for any period of time;
inflammation and swelling of the lower abdomen;
periodic greenish vaginal discharge with an offensive odor;
extreme vaginal and vulva sensitivity and pain which varies in
intensity, often manifesting as a sudden, sharp shooting pain when walking;
periodic bleeding, especially after walking; and
extreme pain when any attempt is made to examine her vagina, for
example by intra-vaginal ultrasound.
Regrettably, the committee has read and heard many similar catalogues of
symptoms in the personal accounts presented to this inquiry.
Across most of the personal accounts received, a recurring theme is the
chronic and debilitating pain that impacts every aspect of women's lives.
Associate Professor Christopher Maher told the committee that chronic vaginal
pain is the principal and most debilitating complication following transvaginal
mesh for prolapse.
In its submission to the inquiry, the Women's Health and Research
Institute of Australia (WHRIA) told the committee that many women who are
suffering as a result of transvaginal mesh pain have consulted the WHRIA and
that '[their] suffering is so profound, that often words cannot convey the
degree of human suffering we are seeing.'
Ms Channing described the pain as never ending, debilitating chronic
The following description of living with such pain is typical of the personal
accounts received by the committee:
My life has been impacted in every way. I am in constant
pain, so I cannot do what I used to do, and I must lie down horizontally every
hour or so because the pain becomes unbearable. I have experienced bleeding,
constant bowel and urination pain, and insomnia every night; I cannot sleep
because I am in so much pain. I have always been very active, going to gym, walking,
cycling, but everything is very limited now. Every movement hurts. I used to be
sexually active prior to this, but now I absolutely cannot. It's just pain,
pain, and more pain to merely exist.
For some women the onset of pain was immediate following their surgery
and has not abated:
When I came out of surgery the pain in my left hip was
excruciating. Pain in that area over the years affected my pelvis also. I have
only been painfree in those areas the past year. I have been to a hip professor
who injected needles into my pelvis which has helped me this past year.
At the committee's Sydney hearing, Gai described how she has lived with
constant pain for ten years since surgery to address a prolapsed bladder:
For 10 years—and I don't know how many months, weeks or
minutes that is—I have not had a day without pain. I woke up in agonising pain
from the surgery. No amount of pain medication could help me. They phoned my
implant surgeon who sent his offsider—he didn't even bother to come in....The
pain is indescribably, but it doesn't matter because there's not 100 per cent
of us—and I don't believe those statistics.
In other cases, the pain did not commence until sometime after the
surgery as the following statements indicate:
The surgery was actually successful for quite a few years,
but I started experiencing pain on my left side. I thought it was my Mirena
coil, so I had it taken out. After several months of this intense pain
continuing, I went to two private gynaecologists and through an internal
examination they found out that it was actually my mesh implant causing the
source of the pain.
My mesh was implanted in the UK in 2007 and I experienced no
complications until 2014, seven years later, when I went through menopause. For
nearly two years then I experienced debilitating, life changing complications
which ultimately resulted in me travelling to the USA for mesh removal in May
Many women described the incredible difficulty of going about their
daily lives whilst experiencing constant pain:
I kept working as I had to support my family, I have 3
children of my own, including a daughter living with Down Syndrome, and a step
son from a blended relationship, but I was in constant pain, and by the end of
a working day and often when I was at work, I was so exhausted, to the point of
having to just lay down and not move with extreme pain, tiredness and anxiety.
Drs kept telling me it had nothing to do with my mesh!
Dr Thierry Vancaille, the Director of the WHIRIA told the committee that
the Chronic Pelvic Pain Clinic at the Royal Hospital for Women in Sydney is
seeing patients suffering with chronic pain after mesh surgery with increasing
Nerve pain is horrible; it burns, it stings, it feels like a
ball stuck in the rectum and it does not go away. In 2017 so far, we have seen
54 new patients with nerve pain after mesh surgery and, since the middle of
August, we see six new patients every week.
Joanne, who was implanted with a tension-free vaginal tape-obturator
(TVT-O) sling and posterior and anterior mesh, described for the committee the
limitations that 'the burning chronic pain' that she has been living with place
I was told by my implanting surgeon that I would be back at
the gym within 10 days post implant procedure and that I would be like a
16-year-old virgin after the implants. To this day, I can't sit upright on a
chair for longer than 15 minutes at a time due to the searing pain that travels
across my lower abdomen and deep into my pelvis. I have pudendal nerve
neuralgia that occurred on implant of the two meshes. It took a good 14 weeks,
not 10 days, post implant before I was able to get out of bed and walk again. I
still, to this very day, experience the same burning pain, even after the
removal of both meshes. I describe my pain as being cut open and set alight.
It's a deep, burning, searing ache that intensifies with movement.
Mesh exposure or erosion is also commonly reported in women's personal
Mesh exposure refers to the protrusion of mesh fibres through the vaginal wall.
The committee heard that mesh exposure and scarring of the vagina can lead to
discomfort and pain, including bleeding and pain during intercourse.
Respondents to an on-line survey conducted by HIC reported a range of
complications related to mesh eroding the vaginal wall, including infections,
discharge, adhesions to the bowel and bladder and faecal incontinence.
The committee heard a range of statistics regarding the incidence of
mesh exposure/erosion. Monash Health submitted that 15-20 percent of women
present in the first two years following transvaginal mesh procedures and
between 70 to 80 percent of these will require minor surgery to address mesh
In its submission the Department of Health advised that some studies
estimate the risk of mesh exposure following transvaginal mesh procedures to be
ten percent for POP related procedures, compared to less than two percent for
MUS procedures to address SUI.
Associate Professor Paul Duggan, Head of Obstetrics and Gynaecology at the
University of Adelaide, advised that in a research trial he conducted,
comparing mesh against traditional surgery for vaginal prolapse, nine percent
of participants required further surgery to address complications predominantly
associated with mesh extrusion.
The Urogynaecological Society of Australasia (UGSA) provided similar
statistics, noting an incidence of vaginal mesh extrusion of between eight to
ten percent for repair of POP and between one to two percent for treatment of
SUI using MUS. However, UGSA stated that not all cases of vaginal mesh
extrusion required treatment.
Associate Professor Maher provided the committee with the following
breakdown of the incidence of mesh exposure/erosion following transvaginal mesh
procedures for POP:
18 percent of procedures for apical prolapse, with 9.5 percent of
cases requiring surgical intervention; and
11.3 percent of procedures for anterior prolapse, with 7.3
percent of cases requiring surgical intervention.
Associate Professor Maher submitted that mesh exposure or erosion was
more common with larger mesh devices and that early trials with new low weight
mesh suggest significantly lower exposure rates of between one to five percent.
Medical practitioners advised the committee that erosion of mesh into
the vagina can usually be easily addressed. In some cases mesh exposure can be
treated with vaginal oestrogen creams, but some patients require surgery to
remove the exposed mesh.
Dr Jenny King, Chair of UGSA, told the committee:
You can usually trim that really easily. I know that the
husbands hate it, and we try to be sympathetic. That would be a complication we
could fix quite easily...
However, the committee understands that for some women the experience of
mesh exposure or erosion is far from a minor complication and can be painful
and distressing, requiring multiple surgeries,
as the following examples indicate:
Add to this my personal experience of trying to teach full
time with a piece of plastic hanging out of an open wound in my vagina for the
last three months. I can assure you that it was not just an inconvenience or a
trivial or superficial incident.
By 3 months post op I was getting pain in my vagina, bleeding
and there was mesh eroding out through the side of my Vagina, I noticed a smell
that I described as rotting flesh, I went to my GP, who thought I had a fistula
and sent me back to my specialist for review. I saw him and he said it was just
a small hiccup, he would 'snip' the small bit of mesh out in his surgery, and
he did OMG, it hurt so much and I left, with him telling me to take a couple of
Panadol and I would feel ok. This went on for a couple of years, with 4 major
surgeries for mesh erosion and multiple trims in his rooms. I was assured
this was not very common.
Associate Professor Maher told the committee that erosion of mesh into
the bladder or bowel, while reported, is 'incredibly uncommon' and that no case
was reported in the 950 women evaluated as part of the Cochrane anterior mesh
However, submissions to the inquiry indicated the debilitating effects experienced
by women whose mesh implants had either adhered to or penetrated their bowel or
One woman told of the surprise of medical staff when they discovered that the
mesh had perforated her bladder:
After a succession of Urinary Tract Infections, pain when
urinating and excruciating pain after urinating I was finally sent to see a
Urogynaecologist to see if he could determine the cause of my discomfort. He
recommended a Cystoscopy which enables the Doctor to see inside the bladder. I
was fully conscious during this procedure watching with great intent the
workings of my bladder when everyone – doctors, nursing staff and myself – were
surprised to see mesh which had perforated my bladder...it was only after the
surgery [to excise the mesh] that my doctor told me that the mesh was
dangerously close to my urethra.
Another woman told the committee of her experience following surgery to
correct a prolapse of the bowel in 1989. Having experienced a range of symptoms
from 2004 till 2007 she had surgery 'to remove what was assumed to be a partial
obstruction in the bowel.' The 'blockage' was found to have been caused by the
mesh which had become displaced and had pierced her bowel. While the mesh was
removed, this woman now has a permanent colostomy bag.
Many of the women who wrote to the committee reported experiencing
dyspareunia, or painful intercourse, following their mesh surgery.
Monash Health told the committee that between 4.3 to 10 percent of women
who received transvaginal mesh procedures at Monash and Mercy Health between
January 2002 and December 2012 reported painful intercourse following their
However, Associate Professor Maher advised the committee that the
incidence of dyspareunia following transvaginal mesh procedures (9.9 percent) was
similar to that following native tissue or suture repairs (8.8 percent).
While many women reported that sexual intercourse was simply too painful
others told the committee that their husbands had suffered injuries as a result
of mesh which had eroded through the vaginal wall.
One woman described for the committee the impact that her surgery had on her
once 'healthy balanced relationship'.
She described how intimate sensations felt raw and painful and how she dreaded
'constantly failing with every painful attempt'
To add insult to this situation my husband began complaining
that making love to me was like sleeping with a cheese grater. His penis would
be cut when we had intercourse. The pain and embarrassment made me anxious,
sick and depressed.
The impact of this on women's personal relationships and emotional
wellbeing is discussed further below.
Urinary and voiding problems
The most frequent issues reported to the HIC were problems associated
with incontinence and persistent UTIs. Some respondents to the HIC survey
indicated that while the transvaginal mesh procedure had addressed their
incontinence, they were now experiencing difficulty urinating or emptying their
bladder. Some respondents reported needing to self-catheterise.
These responses are consistent with personal accounts provided to the committee.
Recurrent urinary tract infections are a common complication noted in
the personal accounts provided to the committee, with many women expressing
concern regarding their continued reliance on antibiotics
Other women have experienced severe incontinence following mesh
In their submissions they described the challenges of going out: the need to
wear incontinence pads, to know where the nearest toilet is; to carry spare
clothes and the embarrassment and indignity when even these precautions are not
It has completely changed my life. I presented with mild
stress incontinence with exercising and 2 years on I have total and
uncontrollable urinary incontinence. I have had multiple hospital admissions,
surgeries, invasive investigations and a total loss of my pride as a woman.
A number of women reported experiencing voiding dysfunction following
their mesh surgery.
Some of these women have been advised that these difficulties are the result of
the mesh obstructing the bowel,
while others have been advised that the dysfunction stems from the mesh being
The Urological Society of Australia and New Zealand (USANZ) noted in its
submission that international studies suggest that the incidence of such
symptoms after transvaginal mesh surgery to treat SUI is low. USANZ noted 11
percent of patients experience new urgency symptoms (an overactive bladder)
after MUS, with 3.9 percent of cases not responding to treatment and 5.3
percent of patients experiencing persistent or recurrent stress urinary
Dr Atherton submitted that the risk of significant voiding disorder and urge
incontinence is much higher following other major surgical procedures for the
treatment of SUI than it is for surgery using MUS. However, Dr Atherton also
noted 'when a complication is severe, whatever the nature of it, the woman's
life is often severely and permanently changed.'
Impact of mesh complications on
quality of life
It is not surprising that alongside physical complications such as those
described above, many women have experienced profound impacts on their quality
of life following mesh procedures. Professor Vancaillie described for the
committee the disastrous impact these symptoms have had on the lives of the
women who have come to the WHRIA:
For some women, things have gotten better, but for quite a
few, problems have gotten worse, resulting in true disaster with substantial
loss of quality of life. They are unable to sit for any length of time, which
means they can't enjoy such basic social interaction as a family dinner. They
can't have intercourse. They have difficulty emptying their bladder or bowel.
They have difficulty with basic physical activity, such as walking or going up
flights of stairs. One patient who just turned 40 summarised it quite
succinctly: "I can't afford feeling like an 80-year-old grandmother. I
have to look after my young children, and I can't."
Many women described how they have withdrawn from social and family
activities, too embarrassed to explain their symptoms to friends and family or
simply unable to engage in normal social activity.
As one woman stated:
I don't make plans anymore, I don't go out much, I live a very
reclusive life because I am embarrassed of my symptoms that I have been left
with from these implants.
Many women described the impact their symptoms had on their once active
lives. Many of the personal accounts recounted a dramatic change in the range
of activities that women could engage in.
One submitter wrote:
It was difficult to return to work, up to the day I had the
operation I was very active, for the past 20 years I have worked at a special
needs high school for behaviour disorders and emotionally disturbed teenagers.
I have always prided myself as being an active team member of our staff. After
the operation I felt I couldn't possibly do the things I used to be able to do
with the kids. Playing basketball, dodgeball, football, netball, cricket etc.
Gradually my weekly workdays diminished from 4 to 3 days to 2 days a week
Another woman told the committee of the difficulty she experienced
trying to live a normal life:
I dragged myself to work each day and on weekends I was
bedridden. I was unable to do normal things like shopping, cooking and
housework without debilitating pain and fatigue. My relationship with my
family, friends suffered as I could not handle social activities. Not being
able to care for my new grandson broke my heart. Surfing was impossible and
walking the dogs or doing other light physical exercise was just too painful.
Many of the personal accounts received by the committee describe the
impact of mesh complications on women's family and personal relationships. As
the accounts referred to above reflect, many women wrote of their inability to
care for their children or interact with their grandchildren.
It has taken its toll on my family life as I am unable to
enjoy many of the activities with my family as I am limited in my movement and
still experience debilitating pain.
Another significant social impact has been the limitations that these
symptoms have placed on women's ability to work. While some women have been
able to modify their working arrangements, by taking regular breaks throughout
the day, modifying their work environment or the work they do,
others have found they are no longer able to work which has created financial
stress for them and their families:
I was unable to work for two years ad (sic) then I made a
very slow return to work because of the fatigue and relapses. Being unable to
work has created financial stress on our family.
Many of the submissions received from women told of the significant
financial burden associated with treatment of complications from mesh surgery.
Most of these women have faced significant out-of-pocket expenses, have taken
significant time off work and have used up their sick leave and long service
Personal accounts received by the committee frequently referred to amounts in
the thousands of dollars for treatment of pain and other symptoms, with few of
these costs covered by private health insurance.
I have to this point spent over $12,000.00 to pay for all of
this and I have ongoing drugs and acupuncture. Money I didn't have and had to
ask friends and family to help.
One woman told the committee that she had been prescribed a course of
six injections of Hyaluronic acid to address nerve pain. She said:
I have currently had six of these injections with no
desirable affect or improvement. The 'direct' cost for these injections has
amounted to $6,000, a fraction of the indirect cost on my business and loss of
Another woman told the committee that out of pocket costs associated
with her treatment have run into tens of thousands of dollars:
I cannot work because of my medical issues, which has caused
financial problems. The costs for treatment for my pain and other symptoms is
ongoing. I have spent tens of thousands of dollars out of pocket for treatment,
after private health insurance claims. My last surgery cost $8000+ out of
Some women described the difficulties they have experienced accessing
financial support through Centrelink.
Women have found it difficult to explain their symptoms and the impact this has
on their ability to work. One woman described how after her surgery, she found
she was only able to manage working 15 hours a week, 'and even then it is
difficult to maintain these hours.' However, she has been advised by Centrelink
that she is capable of working at least 23 to 27 hours a week. Her attempts to
explain her condition, even with the help of medical records and letters from
her legal advisers have so far been unsuccessful. She said:
It makes me very angry and depress[ed] just because the outside
looks fine doesn't mean I am.
Another woman explained to the committee how low her experience of continually
trying to explain her condition had brought her:
In the end, it drove me to the point where I had had enough
and I was still in a lot of pain at that stage. About a year ago, I just
thought: 'I'm ready to check out. I've had enough.' I had $200 left in the
bank. I had spent all my money that I had saved. I had nothing left.
I got onto a social worker who, ultimately, processed the
application for me. But I spoke to, I would say, about 50 different people
during that process and wrote so many letters, spent hours on hold. Every time
I spoke to a different person in Centrelink, I'd have to tell the story again.
It was just a nightmare.
The committee heard that women have mortgaged or sold their homes, while
others have come close to losing theirs as they struggle to meet spiralling
Others have experienced difficulties trying to access their
As the following examples indicate, for some women, the delays and difficulties
associated with this have caused them an additional layer of stress:
I am assisted by my husband who has had to take time off
work. I am still on leave from work myself. Forced to serve the 395 day waiting
period for my super to pay me 70% of my wage, the addition of $50,000 to our
mortgage means we struggle to make ends meet.
I wrote to my superannuation fund but was denied being able
to waive the waiting period regardless of all the evidence my doctors are able
to give them going back 5 years. Disgusting really, my family is suffering from
this and why should they? My option now is to write to the Superannuation
Ombudsman...The government knows the difficulties women are having with this
tragic medical outcome yet why am I made to pay the price for something I did
not ask to happen – unsure how I will cope financially, mentally, emotionally.
A number of women who are waiting for surgery to remove their mesh told
the committee of the lengths they have needed to go to in an attempt to raise
the thousands of dollars required. Some have turned to friends and family for
The surgery cost is $9,600 which I haven't got yet but have
pawned my wedding rings, jewel[le]ry, set up a crowdfunding page and asked my
children for money to help as I am determined to have it as I need this product
out of me before it causes more damage. My three children live in the United
States so going through all this on my own has been very stressful.
Some women have drawn on every source of funds available to them,
leaving them concerned for their future financial security and their ability to
enjoy the quality of life many people might take for granted:
Removal costs will be approx. $50000. I have not worked since
this mesh was implanted in me in March 2011. The death of my father and an
inheritance sum of money paid [off] the remainder of my mortgage and is funding
my surgery...I live [off] income protection from my superannuation and have income
streamed my super. Mesh has robbed me of a future, a career and my health. It
robbed me of being able to provide family holidays for my children and me. It
has taken away my social life and friends. They do not understand what a daily
battle I have and it is just getting worse.
Another woman observed: 'There is one thing I can say that the mesh does
hold my pelvic floor up but at what cost now and in the future.'
The emotional toll
To sum it up mesh has
ruined my life.
So many of the submissions received from individual women related the
emotional toll that mesh related complications have had on their lives. The
APMSG told the committee:
Many women in the APMSG have pain that is so debilitating,
they have given up work, they can no longer have sexual intercourse with their
husbands/partners, they are in pain every day, they are on a cocktail of pain
medications, many have urinary tract infections and are on antibiotics. They
are suffering from depression and anxiety, many have post traumatic stress disorder.
Some women have suicidal thoughts because they can find no way out of their crippling
While some women spoke of the incredible support and understanding
provided by their families,
most women who wrote to the committee about mesh related complications were all
too keenly aware of the toll that living with their symptoms has had on their
relationships with their families. For some women it is a daily struggle to
push through the physical and emotional pain they feel:
On the receiving end are my husband, children and friends. I
have attempted to keep my physical and emotional pain from the ones that I
love, and I've pushed on through so hard so I always get back on track, back to
being the mum that I always was and the hardworking woman I strive to be.
Others cannot believe I'd end up broken, but I am. I suffer with post-traumatic
stress, huge anxiety and I have recently accepted that, yes, depression is
real. I now rely on medication so I can smile at my children, look at my
husband and remind him of why he married me. I can't attend work anymore. I am
no longer able to pretend that I am okay. The pain slowly kills your soul.
For others, the deterioration of their relationships with family and
friends, has left them isolated and lonely:
My life is broken, my children no longer see me as the person
I once was, with the exception of my eldest who is older and more able to
understand, therefore is able to tolerate me. The two younger rarely if ever
see me. They cannot relate to me and now see me as an old confused lady. I try
at times to revive my communication with them but they do not want this, see me
as an embarrassment...
As noted earlier, many women told the committee that following their
surgery it was either extremely painful or impossible for them to sustain an
intimate relationship and spoke of the emotional pain and grief that this had
So many of the women who wrote to the committee spoke of the pain, both
physical and emotional, that this had caused them and their partners.
One woman told the committee:
The first time we tried to have intercourse it felt like
barbed wire inside me. My husband could also feel the mesh. This [came] as a
massive shock as my professor had told me I would be like a new woman after
childbirth everything would be tighter. I grieved for my sex life for a long
time as my husband and I had only been married 6 months.
The committee heard that the inability to sustain intimate relationships
has had far reaching impacts on women's emotional well-being. As a woman from
the Tiwi Islands explained to the committee:
If you look at women in remote Indigenous communities...and at
the impact of isolation on Indigenous women, you will find that if they have
this mesh, they will be totally ostracised. When our women talk about sex, sex
is not just sex; it encompasses a whole community and involves love, intimacy,
For many women, the breakdown of their intimate relationships, together
with the financial and other stresses associated with their complications, has
led to the breakdown of their marriages and their family unit.
I just became non-sexual. I ended up sleeping on the couch
for two years and we tried so hard to stay together as a couple and a family
but we just couldn't keep going. So 6 weeks ago, I moved in with my parents at
the age of 52. I have no money, nothing of value (and neither does he). I left
behind everything...we made the decision it would be best for our children to
live in our rental home with my husband. I have lost the love of my life, my
best friend and we hardly even talk anymore. I hardly see my children and I am
The committee was struck by the number of women who reported the breakdown
of their marriage.
The responses to the WHRIA's Pelvic Pain Impact Questionnaire suggest that of
124 women surveyed, 72 percent reported that pelvic pain had affected their
levels of intimacy or sexual relationships.
The Health Issues Centre told the committee that of the respondents to
its survey of women's experiences following transvaginal mesh surgery, 88
reported a negative impact on their intimate relationships, including avoidance
of sexual activity due to their own pain or that of their partner. 110
respondents reported relationship issues both as a result of their physical
symptoms and the financial strain caused by the cost of treatment and multiple
surgeries and often an inability to work.
Ms Elizabeth Howard, from the WHRIA, told the committee that in the
WHRIA's experience perhaps as many as 50 percent of marriages breakdown
following complications associated with transvaginal mesh implants.
Some women have experienced nervous breakdowns that they attribute to
the pain and anxiety their symptoms have produced,
while others spoke of suicidal ideations:
I feel isolated and alone. I feel angry and violated. I live
in fear of not knowing which way to turn. My self-esteem is low. I am consumed
with negative thoughts and require ongoing counselling.
Its actually destroyed my life to the point that I thought I
couldn't go on any further and suicide was an option.
Many women have suffered these devastating symptoms unaware that other
women have had similar experiences.
As one woman told the committee:
I have had my own history of mesh problems and it was only
this year that I discovered that there are literally thousands of women in
Australia and hundreds of thousands around the world who have had complications
and side effects. For ten years I have thought that I was just about the only
one who continued to suffer, that there was no help for me, nothing that could
be done so I gave up...
One woman told the committee of the relief she experienced once she
discovered that she was not alone:
I have honestly thought of ending it all on several occasions
as I often feel as if I'm so alone with it all and can't bear it any longer.
Until recently I have found a group of ladies with the same issues because of
mesh implants, they have helped me feel as though I'm not mad and I'm not
alone, there are so many of us out there suffering in silence, like me. Until
now we have not had a voice. It has been too embarrassing and personal.
The evidence provided to the inquiry by individual women demonstrates
that complications following transvaginal mesh procedures have far reaching
and, in many cases, devastating impacts on women's lives. In the words of one
submitter, '[w]hen it goes wrong, it goes catastrophically wrong.'
So many of the women who wrote to the committee or appeared at public
hearings live with constant pain and a range of other debilitating
complications that undermine their quality of life.
The committee acknowledges the impact of complications from transvaginal
mesh procedures which encompass every aspect of women's lives. In many cases,
women have become isolated from their families and friends and have had to
endure their symptoms with limited practical and emotional support. In so many
cases, the committee heard how women have been robbed of so much: their
interests; their ability to parent; to work and to sustain close and loving
relationships. At the same time they have lost their dignity and self-esteem
and many have struggled with depression.
The committee notes the significant costs associated with managing the
complications following transvaginal mesh surgery. In addition to significant
out of pocket costs associated with pain management, scans and incontinence and
mobility aids, women have used up their leave, drawn upon their superannuation,
sold valuables and, in some cases sold or mortgaged houses and drawn on the
generosity of friends and family to fund their treatment.
The committee considers that it is of no consolation to women who have
lost so much to be told that they are part of a very small minority. The
committee notes the observation of Mrs Elaine Holmes, from the Scottish Mesh
We are told that, for the majority of women, mesh is
successful. We sincerely wish them continued good health, and hope they never
suffer the hell that we do. Every transvaginal mesh survivor knows only too
well what it is like to suffer from stress urinary incontinence and/or pelvic
organ prolapse. Yes, it is uncomfortable, painful at times, unpleasant and
embarrassing. However, neither is a life-threatening condition.
Successful outcomes using mesh
As mentioned earlier, the committee received evidence emphasising the
many women who have experienced positive outcomes following transvaginal mesh
procedures. The committee heard that vaginal mesh implants have provided 'excellent
anatomical and quality of life results for the silent majority of women who
have undergone surgery.'
Submitters expressed concern that insufficient attention was being focussed on
the positive, life changing impacts of transvaginal mesh implants,
and that women deserve the right to choose procedures most suitable to their
The committee also received submissions from women who were concerned at
what they described as 'the Media furore' over the use of vaginal mesh for the
treatment of SUI and POP. Many of these women were anxious that the committee
should 'not take this knee jerk reaction too seriously.'
The committee heard that in many cases women have suffered terribly for
years before having surgery. A number of women described their experience of
living with both bladder and bowel incontinence:
I was completely bladder incontinent, bowel incontinent; I
couldn't have sexual intercourse. I continuously had bladder infections. I
developed chronic thrush because of it. I was sick for years. My life revolved
around having extra clothes, pads, being close to a toilet and hoping to God
that when I had a shower my bowels wouldn't release themselves on me. That was
Another woman recounted similar experienced:
To be clear, my day revolved around timing my bladder and
bowels, I had to make sure that I was close to a bathroom at all times, I had
to carry spare clothes and underwear in case I soiled myself, I had to wear
pads, If I wanted to have sexual intercourse I had to empty my bladder before,
during and afterwards and at times my bowels as well. Sometimes I didn't make
it to the bathroom on time. I cannot convey enough to you how humiliating this
was for me.
This surgery has changed my life, I have not a single urinary
infection since, I don't look for the bathrooms wherever I go, I can hold on if
I need to, I don't have [to] carry a spare set of cloths with me, I can enjoy
an intimate relationship with my husband.
Another woman, who underwent major repair surgery for POP using mesh,
described for the committee the distress caused by severe prolapse:
Whilst waiting to see [the surgeon]. I was extremely
uncomfortable & distressed by the severity of my symptoms. Vaginal Prolapse
is a very disturbing issue, one that I found very debilitating; it's a hard
thing to put up with and the fact that there is so much discomfort, in my case
made me feel unwell.
This woman went on to say:
Whilst the initial recovery immediately after the surgery,
was harrowing to say the least. I went home after 3 days in hospital, &
spent a full 6-8 weeks following my specialists advice to take it extremely
easy, no lifting, driving, housework, work etc. As this was my second time with
this condition I followed her advice to the letter.
It is nearly 3 years since this operation, and for me it
appears to be an ongoing success, I am not saying that I don't have issues that
could be associated with the operation, but thus far I have no ongoing major
complications associated with the actual Mesh.
Another woman simply stated that '[g]oing from a severe prolapse to
normality was a greater relief than I can explain to anyone who has not
experienced this difficult problem.'
This evidence was underscored by photographic evidence provided to the
committee that highlighted the realities of living with severe prolapse.
A number of submitters and witnesses expressed concern that a restriction
on the use of transvaginal mesh would deny many women access to treatment
appropriate to their particular circumstances.
Ms Sunny Hutson, expressed concern that the discussion about
urogynaecological mesh is 'focusing on only the material itself and not the
crucial differences between the procedures that use it, the principles they're
based on and their dramatically different outcomes.'
Ms Hutson explained to the committee that she had lived with the effects of
severe pelvic organ prolapse for 30 years as a result of being disembowelled by
a swimming-pool filter at the age of two. In her submission, Ms Hutson
described her feelings of desperation prior to her surgery and the dramatic and
life changing impact that a procedure using urogynaecological mesh has had in
The complexity of treating pelvic
Medical practitioners stressed that pelvic floor disorders can be very
complex to treat and that surgeons who manage advanced and/or recurrent
prolapse must be able to offer patients a complete range of non-surgical
surgical and surgical options.
UGSA submitted that '[n]o one procedure is appropriate for all patients
and for some women a transvaginal mesh procedure may be the most effective and
UGSA went on to explain that clinicians must try to balance the benefits of a
treatment against the possibility of uncommon events:
Even without mesh, pelvic floor reconstructive procedures can
be complicated by pain, vaginal scarring, bladder symptoms and difficulties
with intercourse. For example, a recent large randomised trial demonstrated no
significant difference in serious adverse events including dyspareunia between
those with native tissue and those with mesh repair (15). And the rate of all
intra and post-operative complications is increased if repeat surgery is
required due to failure. So for some women, for example those with significant
comorbidities or at high risk of recurrence, the smaller risk of a mesh
complication may outweigh the risks of redo surgery which is them more likely
to need mesh implants.
As noted earlier, while submitters generally acknowledged a higher level
of risk associated with transvaginal mesh procedures for the treatment of POP, a
number of specialist medical practitioners emphasised the positive outcomes
associated with the use of MUS in the treatment of SUI. Dr Alison De Souza, a
Urogynaecologist with the Mercy Hospital for Women told the committee
The mid-urethral sling has been life-changing for many
thousands of Australian women by correcting their urinary leakage. We feel that
the silent majority of women who are happy with the outcome of their mesh
procedure also need to be heard and taken into account.
UGSA submitted that there is extensive data, including data from
multiple, high quality randomised controlled trials and long term follow up
over 17 years, to support the 'excellent safety and efficacy' of MUS. UGSA
stated that procedures using MUS have been performed up to 20 times more frequently
than previous abdominal procedures with immense quality of life benefits for
women of all ages.
USANZ, submitted that the results of an Australian study on the
frequency of side effects from MUS had demonstrated that health related quality
of life improvement at three months after retropubic MUS predicts persistence
of improvement at four years. USANZ stated '[a]lthough patient numbers are
modest, these data contribute to the scarce longer term HRQL [Health-Related
Quality of Life] data on the MUS, which is a safe and durable procedure with a
minimal complication profile.'
USANZ provided the following breakdown of the incidence of complications
associated with MUS requiring surgery:
a 3.2% rate for slings that obstruct (too tight), 2% for mesh
erosion or exposure, 0.3% for fistulas (connection between one organ system and
another) and 0.1% for bowel injury. Further analysis of complications that were
defined as life altering, demonstrated chronic pain in 4.3% of which 0.5% was
refractory [resistant] to treatment, 11% of patients had new urgency symptoms
(over active bladder) and 3.9% of these were refractory to treatment and 5.3%
of patients had persistent or recurrent stress urinary incontinence.
The committee notes evidence that suggests further research is required to
validate claims regarding the high rate of successful outcomes for transvaginal
procedures using MUS for SUI.
Information provided by the APMG indicates that of 101 incidences of
complications reported by its members, involving 176 mesh devices, 70 involved
mesh for the treatment of SUI using either TVT or TVT-O compared to 43
involving mesh for the treatment of POP. 27 instances were reported by women
who had transvaginal mesh surgery to address both SUI and POP.
The evolution of mesh products
As noted earlier, a number of practitioners drew a distinction between
the use of devices constructed of large sheets of urogynaecological mesh and devices
using tape. Dr Darren Gold told the committee that sheets of mesh positioned to
hold up organs have never been shown to improve POP symptoms.
The International Society for Pelviperineology (ISP) submitted that the rate of
complication associated with mesh sheets as compared to tape is much greater
and that mesh sheets tend to shrink creating tension in the tissues which in
turn contributes to nerve pain.
The ISP stated that complications, including pain, are less with MUS and that
most involve 'surfacing of a small segment of mesh which can be dealt with by
snipping, usually as an outpatient.'
The committee heard that overtime mesh devices have evolved. Dr Gary
Swift, President of the National Association of Specialist Obstetricians and
Gynaecologists, told the committee:
In the very early days of mesh usage we knew that there were
design flaws in the very early meshes. They became obvious when the rates of
erosions were much higher...There has certainly been an evolution. In the early
meshes, no-one will deny that mesh erosions were much higher in the earlier
generations. We have certainly seen those. Those products, I understand, were
voluntarily recalled once there was clear evidence that there was potentially a
design flaw in the product itself.
Dr Caroline Dowling, from the Urological Society of Australia and New
Zealand, told the committee
There is absolutely no contention that the meshes that
predated polypropylene were high risk, and they were withdrawn from the market.
There has not been a polypropylene mesh product withdrawn from the market that
I am aware of apart from a mini-sling called TVT-Secur.
At the same time, the evidence base for transvaginal mesh has been
evolving. Professor John Skerritt, representing the Therapeutic Goods
Association, noted that the evidence base for transvaginal mesh has evolved:
We are all older and wiser and as medical experience with
surgery and with particular products evolves you know more at a particular
point of time than you would have two, five, 10, 12 or 15 years ago. And this
is particularly true with mesh devices. The evidence base for meshes has
However, the committee notes that, while many of the personal accounts
received from individual women during the inquiry relate to transvaginal mesh
surgery performed more than five years ago, a number of the accounts relate to
surgery performed in the last two years. Information provided by the APMSG
indicates that of the 101 women who have reported complications to the APMSG,
16 of these women have had transvaginal mesh surgery in the last two years and
52 have had transvaginal mesh surgery in the last five years.
The committee does not discount the successful outcomes experienced by
many women. Nor does the committee underestimate the complexity of treating SUI
and POP. However, the committee is concerned that the plight of those women who
have experienced devastating impacts on their health and quality of life not be
downplayed, simply because they are in the minority. Rather the committee
intends that greater focus be placed on understanding why some women experience
positive life changing outcomes and other experience catastrophe.
In the next two chapters, the committee will consider the extent of
usage of transvaginal mesh implants in Australia and the provision of
information, clinical care and support to women who present with symptoms of
SUI and POP.
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