As women get older, their pelvic organs tend to sag. That’s a normal part of aging.
But for millions of them, the sagging gets so bad — causing discomfort, urine leakage, or interfering with sex — that they resort to reconstructive surgery.
Synthetic plastic netting was supposed to be a big advance in surgery for what doctors call pelvic organ prolapse.
Instead, “pelvic mesh” has become one of the biggest mass torts in U.S. history. Medical device makers are paying nearly $8 billion to settle the claims of more than 100,000 women who suffered complications including pain, organ damage, infection, and incontinence.
Last month, the U.S. Food and Drug Administration took tough action, ordering the two remaining manufacturers of transvaginal mesh for pelvic organ prolapse to stop all sales.
Here’s the kicker: The FDA’s ban does not apply to all pelvic mesh products, and certain types remain an important option in selected cases, particularly for treating urinary incontinence. Experts say the benefits of using the devices depend on the surgical route, the therapeutic goal, the skill of the surgeon, and other factors that are still being studied.
“Mesh is not just a ‘bad news’ story,” said University of Pennsylvania urogynecologist Lily A. Arya, a specialist in female pelvic medicine and reconstructive surgery. “My ultimate message is one of hope, that ongoing research and clinical trials will help to determine the best treatment for a complex condition.”
How can women (and the men who care about them) sort all this out? Here are some things to consider.
The pelvic floor, the muscular base of the abdomen, supports the vagina, uterus, bladder, bowel, and rectum. When these muscles are weakened by childbirth, chronic coughing, obesity, genetic factors, and inevitable aging, one or more pelvic organs may sink into or against the vagina. The top of the vagina also can drop down into that structure.
The good news is, prolapse is no more troublesome than wrinkles for most women.
“It is very, very common,” Arya said. “The mere presence of prolapse on a pelvic exam doesn’t mean it needs treatment.”
The bad news is, when sagging causes symptoms such as pelvic pressure, a vaginal bulge, lower-back pain, sexual dysfunction, or urine leakage, there are no easy, effective fixes. Conservative remedies include pelvic muscle exercises and a pessary, a removable silicone device that is inserted into the vagina much like a diaphragm or tampon.