A transvaginal mesh is a net-like sheet of synthetic material that surgeons implant through an incision in the vaginal wall to support pelvic organs that have shifted out of place. It was widely used from the 1990s through the 2010s to treat pelvic organ prolapse and stress urinary incontinence. In 2019, the FDA ordered all remaining transvaginal mesh products for prolapse repair off the U.S. market after manufacturers failed to prove they were safe and effective.
What the Mesh Is Made Of
Most transvaginal mesh implants are made from polypropylene, the same type of plastic used to manufacture lab equipment like test tubes. The material is formed into a flat, flexible sheet with a net-like structure, designed to act as a permanent scaffold that reinforces weakened tissue in the pelvic floor.
These sheets are produced by either knitting or weaving thin plastic fibers together. Knitted versions use a single filament looped with itself, creating a more porous, flexible product. Woven versions cross two separate filaments at right angles, resulting in a stiffer implant. Some less common versions used other plastics or animal-derived tissue, but polypropylene dominated the market for years.
Conditions It Was Designed to Treat
Transvaginal mesh was used for two main conditions. The first is pelvic organ prolapse, where the bladder, uterus, or rectum drops from its normal position and pushes against or through the vaginal wall. This happens when the muscles and connective tissue of the pelvic floor weaken, often after childbirth, menopause, or repeated heavy lifting. Roughly half of all women experience some degree of prolapse in their lifetime.
The second condition is stress urinary incontinence, where urine leaks during coughing, sneezing, laughing, or physical activity. For this use, a narrow strip of mesh called a “sling” is placed under the urethra to provide support. Mesh slings for incontinence remain available and are considered a separate category from the transvaginal prolapse mesh that was pulled from the market.
How the Surgery Worked
The procedure involved making a lengthwise incision along the inside of the vaginal wall, then positioning the mesh sheet between the vaginal tissue and the prolapsed organ. Surgeons anchored the mesh in place using stitches, securing it to structures like the cervix on one end and the tissue near the bladder neck on the other. Additional arms on some mesh designs were threaded through small openings near the pelvis to hold the implant taut.
The approach was developed in the 1990s as a faster alternative to abdominal surgery. Because the surgeon operated entirely through the vagina, patients avoided external incisions and typically had shorter recovery times. Earlier mesh procedures, dating back to the 1970s, required cutting through the abdomen. The appeal of a less invasive route drove rapid adoption of the transvaginal approach.
Transvaginal vs. Abdominal Mesh
The key distinction is the surgical route. Transvaginal mesh goes in through the vagina. Abdominal mesh, used in a procedure called sacrocolpopexy, goes in through small incisions in the abdomen (often with robotic or laparoscopic assistance) and attaches the top of the vagina to a bone at the base of the spine.
The complication rates between the two approaches are strikingly different. A systematic review of nearly 12,000 patients found that mesh erosion occurred in 10.3% of transvaginal prolapse repairs within the first year after surgery, with individual studies reporting rates as high as 29.7%. By comparison, abdominal mesh placement had a median erosion rate of 1.9%. This gap in safety is a major reason why the FDA acted against the transvaginal route specifically, while abdominal mesh for prolapse remains an approved option.
Complications and Warning Signs
Mesh erosion is the most widely reported problem. This happens when the mesh wears through the vaginal tissue and becomes exposed, sometimes protruding into the vagina, bladder, or rectum. Erosion can cause persistent pain, bleeding, discharge, and recurrent urinary tract infections. In some cases, it creates abnormal connections between organs, known as fistulas.
Other complications include chronic pelvic pain, pain during sex, difficulty urinating, and a feeling of tightness or pulling in the vagina. Some women report that symptoms appear months or even years after the original surgery. Vaginal atrophy, which is common after menopause, appears to increase the risk of discomfort and erosion.
If you have an implanted mesh, signs that something may be wrong include new or worsening pelvic pain, pain during intercourse that wasn’t there before, unusual vaginal bleeding or discharge, frequent urinary tract infections, or the sensation of something sharp or rough in the vaginal canal.
FDA Action and Legal Fallout
The FDA reclassified transvaginal mesh for prolapse repair as a high-risk device in 2016, requiring manufacturers to submit formal proof of safety and effectiveness. When Boston Scientific (which made the Uphold LITE and Xenform systems) and Coloplast (which made the Restorelle DirectFix) failed to meet that standard, the FDA ordered them to stop all sales in April 2019. Other companies, including Ethicon (a Johnson & Johnson division) and C.R. Bard, had already pulled their products voluntarily in prior years. There are currently no FDA-approved transvaginal mesh products for prolapse repair on the U.S. market.
Thousands of lawsuits followed, making transvaginal mesh one of the largest mass litigation events in U.S. history. Manufacturers including Johnson & Johnson, Boston Scientific, and C.R. Bard faced claims from women who experienced serious complications. Many of these cases have resulted in settlements, though litigation continues.
Mesh Removal and Revision
For women living with mesh complications, surgical removal or revision is an option, though not a simple one. Polypropylene mesh is designed to integrate permanently with surrounding tissue, so extracting it can be technically difficult and may involve partial rather than complete removal.
A study of 233 patients who underwent mesh revision or removal found that 73% reported their pain improved afterward, 19% said it stayed the same, and 8% said it worsened. Women who had a history of chronic pelvic pain before their original mesh surgery were significantly more likely to have a poor outcome from removal. The type of revision ranged from trimming the exposed portion of mesh to attempting full excision, depending on how deeply the material had incorporated into the tissue.
Current Alternatives for Pelvic Floor Repair
With transvaginal mesh off the market for prolapse, the main surgical options are native tissue repair and abdominal sacrocolpopexy. Native tissue repair uses your own ligaments and tissue to reconstruct pelvic support, without any synthetic implant. Sacrocolpopexy places mesh through the abdomen rather than the vagina.
A clinical trial funded by the NIH compared all three approaches in 360 women. At three years, sacrocolpopexy had a 28% failure rate, transvaginal mesh had a 29% failure rate, and native tissue repair had a 43% failure rate. Despite the higher recurrence rate with native tissue repair, all three groups reported high satisfaction, improved quality of life, and better sexual function. The trade-off is essentially a lower chance of prolapse returning (with mesh) versus a lower chance of mesh-related complications (without it).
For stress urinary incontinence specifically, mesh slings remain widely used and are placed through a small vaginal incision or through tiny abdominal cuts above the pubic bone. These slings use a much smaller piece of mesh than prolapse repairs, and their complication profile is considerably different.