Transvaginal mesh is a flat, net-like sheet of synthetic material that was surgically implanted through the vagina to support weakened pelvic tissues. It was primarily used to treat pelvic organ prolapse, a condition where the bladder, uterus, or rectum drops from its normal position and bulges into the vaginal wall. In 2019, the FDA ordered manufacturers to stop selling mesh devices for this purpose in the United States, concluding that the risks outweighed the benefits compared to other surgical options.
What the Mesh Is Made Of
Most transvaginal mesh products were made from polypropylene, a rigid, strong synthetic plastic. The material is nonabsorbable, meaning the body cannot break it down. Once implanted, it stays permanently unless surgically removed.
The mesh itself looks like a thin, flexible piece of netting. Manufacturers produced it by either knitting or weaving polypropylene fibers into a flat sheet. Knitted versions use a single filament looped with itself, creating a more porous and flexible structure. Woven versions cross two different filaments at right angles, producing a stiffer material. Both heavyweight and lightweight polypropylene versions were available, along with less common alternatives made from polyester (sold as Mersilene) and expanded polytetrafluoroethylene (sold as Gore-Tex).
Conditions It Was Designed to Treat
The mesh was intended as a replacement for damaged connective tissue in the pelvic floor. It was used for two main conditions: pelvic organ prolapse (POP) and stress urinary incontinence (SUI), which is urine leakage triggered by coughing, sneezing, or physical activity.
In prolapse repair, the mesh was positioned to act as a bridge between the support structures on either side of the pelvis. Surgeons would make incisions in the vaginal wall, separate the tissue layers, and anchor the mesh arms through surrounding ligaments and fascia to hold the dropped organs in place. The procedure required precise layer separation. Poor technique increased the risk of bleeding and later complications.
Why the FDA Pulled It From the Market
The FDA first issued a safety warning about transvaginal mesh in 2008, noting reports of serious complications. By 2016, the agency reclassified these devices as high-risk (Class III), requiring the most rigorous level of premarket review. When manufacturers failed to demonstrate that the benefits justified the risks, the FDA ordered them to stop selling transvaginal mesh for prolapse repair in 2019.
The agency’s position is that transvaginal mesh for prolapse repair carries additional risks compared to surgery using the patient’s own tissue, particularly mesh exposure (where the material pokes through the vaginal wall) and erosion into surrounding organs. These complications can cause chronic pain, infection, bleeding, and pain during intercourse. Some women required multiple surgeries to address mesh-related problems, and full removal of eroded mesh is technically difficult.
The ban applies specifically to mesh placed through the vagina for prolapse. Mesh used in abdominal prolapse repair (where a surgeon works through the abdomen to suspend the top of the vagina to the lower spine) remains classified as moderate-risk and is still available. Mesh slings for stress urinary incontinence also remain on the market. FDA evaluation found that SUI mini-slings performed comparably to traditional mid-urethral slings over three years, with similar rates of complications and repeat surgery.
Bans Beyond the United States
The FDA’s action was part of a broader international pullback. The UK and Scotland implemented bans on transvaginal mesh in 2014, pending stronger evidence of safety. England, Australia, and New Zealand followed with their own market bans. The UK’s National Institute for Health and Care Excellence issued guidelines in 2017 recommending that transvaginal mesh repairs be limited to clinical studies only. These restrictions led to significant changes in how doctors manage prolapse across multiple countries.
How It Compares to Surgery Without Mesh
One of the key questions driving regulatory decisions was whether mesh actually worked better than traditional surgery using a patient’s own tissue (called native tissue repair). The evidence suggests it does not. In a direct comparison of the two approaches for women with combined front-wall and top-of-vagina prolapse, the recurrence rate at 12 months was 13.1% with mesh and 11.5% with native tissue repair. At three years, the rates were nearly identical: 26.7% for mesh and 27.0% for native tissue. Transvaginal mesh was not superior in either effectiveness or safety, which undermined the central argument for using a permanent synthetic implant.
Recovery After Mesh Surgery
For women who had this procedure before the ban, or who undergo related pelvic surgery, recovery is a slow process. Fatigue and low energy can persist for weeks. Vaginal spotting and discharge may continue for up to six weeks. Activity restrictions typically last 6 to 12 weeks, and surgeons advise against lifting anything heavier than about 20 pounds during that window. That includes grocery bags, small children, full laundry baskets, and heavy cookware.
Most housework is discouraged because pushing, scrubbing, and bending all increase pressure inside the abdomen, which can stress the surgical repair. Walking is encouraged, but other forms of exercise are off-limits during initial healing. Sexual intercourse is restricted for the full 6 to 12 week recovery period because it can disrupt vaginal sutures and raise abdominal pressure. Surgical wounds reach roughly 90% strength by six months, but full wound strength may not develop until two years after the operation.
What’s Available Now
With transvaginal mesh no longer sold for prolapse in the U.S. and several other countries, the primary surgical options are native tissue repair (using the patient’s own ligaments and connective tissue) and abdominal sacrocolpopexy, where mesh is placed through the abdomen rather than the vagina. The abdominal approach, whether performed through open surgery, conventional laparoscopy, or robotic-assisted laparoscopy, suspends the top of the vagina to the sacrum (lower spine) and remains an accepted use of surgical mesh.
For stress urinary incontinence, mid-urethral slings made of mesh are still available and widely used. These are smaller, narrower strips of material placed under the urethra to prevent leakage, and they carry a different risk profile than the larger mesh sheets used for prolapse. The FDA continues to classify SUI slings as moderate-risk devices.