Tag Archives: women

Women in the greatest need are being let down by a lack of local support

Nobody ever turned up to a substance misuse clinic in need of support solely for substance misuse, says Pip Williams, who spent 26 years living with alcohol and drug dependency. At the same time, she grappled with mental health issues, an abusive relationship, homelessness and periods of losing her children to care.

“When you’re a woman with multiple issues you face a choice: we have to deal with what’s killing us first – is it substance misuse or is it domestic violence,” she explains. “Support for those things can only be accessed in silos; there needs to be a place where woman can get holistic help for it all – and before they reach crisis.”

Now in recovery, Williams has gone on to found a support network for pregnant women at risk of having children with foetal alcohol spectrum disorders. She has contributed to Mapping the Maze, a report by Against Violence and Abuse (AVA) and Agenda, the alliance for women and girls at risk. The report highlights the confusing and fragmented nature of provision in local authorities across England and Wales – with some areas having a range of services for women, and others having none at all.

Gathered through FOI requests, here are some of the report’s most troubling findings:

Women are bounced between services

Only 19 out of 173 local authority areas in England and Wales have services for women that address all the following issues: substance misuse, mental health, homelessness, offending and complex needs. Nine areashad no evidence of any of these services for women whatsoever.

The vast majority of services available across England and Wales address single issues – so women are bounced between services, having to repeat their stories multiple times and are often unable to get the help they need.

Support with substance misuse isn’t tailored to women

Women make up around a third of people accessing drug treatment services – with that figure increasing to nearly 40% for alcohol services, according to the National Drug Treatment Monitoring System.

But only just shy of half of all local authority areas in England have support services specifically for women experiencing substance misuse, according to the Mapping the Maze report. In Wales only 22.7% of authorities are home to localised support of this kind.

Substance misuse midwives accounted for more than a third of substance misuse services found, feeding into a wider finding that more than a quarter of all support for women facing multiple disadvantage is for pregnant women or those with a young baby.

Women are commonly invited to join a weekly women’s group, housed within a generic substance misuse service. The report argues that this tends to be an add-on rather than at the core of formal recovery programmes, with one woman interviewed for the report saying she felt these groups were “something to tick a box rather than something [organisations] are committed to”.

The report also notes that it is disappointing that only only ten of the 129 residential rehabilitation services listed on Public Health England’s website are solely for women.

Resistance to providing gender-specific mental health support

The report notes that 104 English local authorities and five Welsh unitary authorities providesupport for women experiencing mental health problems, with the voluntary sector playing a huge role in delivering these services.

More than half (55%) of mental health support identified in the report was aimed at pregnant women and new mothers.

Anecdotally, providing gender specific support for women who don’t fall under maternity or perinatal is met with “notable resistance” from several clinical commissioning groups. A typical response was that “all commissioned services are for men and women equally”.

Donna Covey, director of AVA, would like to see a change in mindset. “We know that delivering the same service for everyone doesn’t deliver equality of outcomes,” she explains. “To be effective, services needs to be trauma-informed and women specific. Central government needs to take the lead in making sure that these women get the support they need to rebuild their lives.”

Mapping the maze

AVA and Agenda have created an interactive map, pinpointing where specialist support is available for women affected by substance use, mental ill-health, homelessness and offending. It will also help to identify gaps in provision, and both organisations are encouraging voluntary organisations, commissioners and public service professionals to use the map as a resource.

Covey says many local authority commissioners have a poor understanding of what women experiencing multiple disadvantage want and need and don’t appreciate the importance of women-specific services.

The report makes a number of recommendations for commissioners and other professionals to address this, including:

  • Speak to women with lived experience and directly involve them in the commissioning process.
  • Promote a trauma-informed culture. Recognise that many women experiencing multiple disadvantage will also have experienced gender-based violence.
  • Be gender aware – specialist services are generally more effective than generic ones – and know that provision of specialist women’s services does not breach the Equality Act 2010.
  • Build longevity and flexibility into tenders. Helping women with complex lives in unlikely to fit neatly within short-term targets.
  • Practice joint commissioning and commission across localities. Commissioners should also ask bidders to demonstrate how they will ensure ease of access to services.

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Medicine treats women as entirely passive – being ‘told’ about HRT is par for the course

Buck up, ladies of a certain vintage! There is marvellous news. “Women told hormone replacement therapy does not lead to early death,” reads the headline in the Times. That’s women “told”, you see. I do not know why any women were worried about the increased risk of breast cancer, heart disease and stroke except that, well, we were told to be. Now scientists more or less agree that the benefits – protection against fracture for lower bone-density, against diabetes and endometrial cancer – cancel out the risks. So pump it up, if that’s your bag.

When I got to the age where I was offered HRT I was completely mystified by the conversations around it. It’s terrible! It’s wonderful! It saves your life and your skin. Suddenly, there was a world of women handing round the names of private doctors like dealers; doctors who offered bioidenticals said to be better than the bog-standard HRT on the NHS.

It wasn’t for me, though now I wonder. What bothered me at the time was the idea that ageing is an illness that must be treated; that our depleted oestrogen has to be restored in order for us to function properly as feminine. Clearly I did not suffer in the way I have seen some women suffer. The insomnia was bad but I quite liked feeling angry all the time, alongside the sense of dropping out of the part of life where one’s drive is seen as inherently about mating.

I wondered what I was becoming, for menopause is a form of transition, an everyday one. Still it’s embarrassing to talk about it all, because age is embarrassing and women’s bodies are frankly weird. We live in a culture where the highest compliments are not “Well done on that Nobel prize”, but, “You’ve lost weight”, and, “You don’t look your age”. This is an unfortunate thing for the middle-aged bon viveur.

But that women’s lives may be put at risk – or that as individuals we may assess those risks, while a medical establishment addresses us as entirely passive – is par for the course. It starts in puberty when girls go to the doctors and are told that the solution to their pain (cysts, fibroids, endometriosis) is either pregnancy or the pill. Thus begins a life on a combination of artificial hormones. Pills for ever until you hit the HRT jackpot.

Along the way, women who do not feel OK may be going to doctors for years complaining of pain before being diagnosed. The new advice on endometriosis is: “Listen to women”. Yes, really. And if you do listen to women you will hear story after story of women not getting the right treatment for years and then women beating themselves up for not giving birth the right way or not finding breast-feeding easy and feeling both that their bodies were all wrong but that nobody was listening to them.

I used to think one of the successes of feminism was in encouraging women to make active choices around contraception and childbirth. My mother, after all, was sterilised against her will while under general anaesthetic, the permission given by her then-husband. He was very much “then” after that, I can tell you.

By the time I had my first child, more than 30 years ago, I still had to fight not to have labour induced, but I had a sense that my generation would demand that the rights of individual women be taken into consideration.

This was because the body was firmly at the centre of feminist debate and many women benefitted from that debate whether they considered themselves feminist or not. The proverbial birthplan did not come about by accident.

But what has gone on in the meantime? Sure, progress has been made, but I do not know a woman who hasn’t been patronised by a doctor or been made to feel that she should not complain.

At the same time I was being offered HRT or antidepressants, I was in A&E with one of my daughters, then 19 and in terrible pain. My entire reproductive life flashed before me as she was having an internal scan and the consultant said: “Mummy, come behind the curtain and see your daughter’s lovely eggs. Don’t worry, you will be a grandma after all.” Yes, my daughter gave me permission to tell you this story as we were both mortified by it. Her value was that she could reproduce; mine was that I had done so.

This is still the way much of the medical establishment addresses us; the reality of having a female body with its periods and malfunctions and fluctuating hormones, its hair and its blood and its pain.

From young women brushed off in doctors’ surgeries to women in their 50s being “told” whether we can have HRT or not, it never stops. Listen to women: such a simple thing to do. I can’t wait for it to start.

Medicine treats women as entirely passive – being ‘told’ about HRT is par for the course

Buck up, ladies of a certain vintage! There is marvellous news. “Women told hormone replacement therapy does not lead to early death,” reads the headline in the Times. That’s women “told”, you see. I do not know why any women were worried about the increased risk of breast cancer, heart disease and stroke except that, well, we were told to be. Now scientists more or less agree that the benefits – protection against fracture for lower bone-density, against diabetes and endometrial cancer – cancel out the risks. So pump it up, if that’s your bag.

When I got to the age where I was offered HRT I was completely mystified by the conversations around it. It’s terrible! It’s wonderful! It saves your life and your skin. Suddenly, there was a world of women handing round the names of private doctors like dealers; doctors who offered bioidenticals said to be better than the bog-standard HRT on the NHS.

It wasn’t for me, though now I wonder. What bothered me at the time was the idea that ageing is an illness that must be treated; that our depleted oestrogen has to be restored in order for us to function properly as feminine. Clearly I did not suffer in the way I have seen some women suffer. The insomnia was bad but I quite liked feeling angry all the time, alongside the sense of dropping out of the part of life where one’s drive is seen as inherently about mating.

I wondered what I was becoming, for menopause is a form of transition, an everyday one. Still it’s embarrassing to talk about it all, because age is embarrassing and women’s bodies are frankly weird. We live in a culture where the highest compliments are not “Well done on that Nobel prize”, but, “You’ve lost weight”, and, “You don’t look your age”. This is an unfortunate thing for the middle-aged bon viveur.

But that women’s lives may be put at risk – or that as individuals we may assess those risks, while a medical establishment addresses us as entirely passive – is par for the course. It starts in puberty when girls go to the doctors and are told that the solution to their pain (cysts, fibroids, endometriosis) is either pregnancy or the pill. Thus begins a life on a combination of artificial hormones. Pills for ever until you hit the HRT jackpot.

Along the way, women who do not feel OK may be going to doctors for years complaining of pain before being diagnosed. The new advice on endometriosis is: “Listen to women”. Yes, really. And if you do listen to women you will hear story after story of women not getting the right treatment for years and then women beating themselves up for not giving birth the right way or not finding breast-feeding easy and feeling both that their bodies were all wrong but that nobody was listening to them.

I used to think one of the successes of feminism was in encouraging women to make active choices around contraception and childbirth. My mother, after all, was sterilised against her will while under general anaesthetic, the permission given by her then-husband. He was very much “then” after that, I can tell you.

By the time I had my first child, more than 30 years ago, I still had to fight not to have labour induced, but I had a sense that my generation would demand that the rights of individual women be taken into consideration.

This was because the body was firmly at the centre of feminist debate and many women benefitted from that debate whether they considered themselves feminist or not. The proverbial birthplan did not come about by accident.

But what has gone on in the meantime? Sure, progress has been made, but I do not know a woman who hasn’t been patronised by a doctor or been made to feel that she should not complain.

At the same time I was being offered HRT or antidepressants, I was in A&E with one of my daughters, then 19 and in terrible pain. My entire reproductive life flashed before me as she was having an internal scan and the consultant said: “Mummy, come behind the curtain and see your daughter’s lovely eggs. Don’t worry, you will be a grandma after all.” Yes, my daughter gave me permission to tell you this story as we were both mortified by it. Her value was that she could reproduce; mine was that I had done so.

This is still the way much of the medical establishment addresses us; the reality of having a female body with its periods and malfunctions and fluctuating hormones, its hair and its blood and its pain.

From young women brushed off in doctors’ surgeries to women in their 50s being “told” whether we can have HRT or not, it never stops. Listen to women: such a simple thing to do. I can’t wait for it to start.

Endometriosis left me in agony. Now doctors must take women seriously | Brydie Lee-Kennedy

I am writing this while lying in a semi-foetal position with a cold cloth on my forehead and a heat pack on my abdomen. This is not an ideal position from which to do any type of work, but for me and the other 176 million endometriosis sufferers worldwide, it’s often all we can manage. This is why the updated guidelines from the National Institute for Health and Care Excellence (Nice), released today, are to be commended.

These guidelines emphasise the importance of doctors believing their patients when they tell them about their menstrual pain and other attendant symptoms. This seems like obvious advice, but the average time it takes to diagnose endometriosis is seven to eight years. That’s seven to eight years of mind-numbing pain, clotting, diarrhoea, chronic bloating, self-medicating and, often, extremely low moods and anxiety. It’s seven to eight years of potential damage to your chances of conceiving.

It’s estimated that endometriosis affects one in 10 people with uteruses worldwide and yet when I was diagnosed a decade ago, I knew no one else with the disease. I was 20 and had been in chronic pain since the age of 13. While the pain would reach its peak during menstruation, leading to me vomiting and passing out, it affected me all the time. There was sharp, stabbing ovulation pain, dragging, relentless back pain, stinging rushes of pain through my legs and arms. I medicated, then medicated some more, then went to bed for days with nausea and misery, wondering why my body had betrayed me.

Despite all this, I was comparatively lucky because my parents and my GP took my pain seriously. By the age of 20, I had tried every non-surgical treatment available and all that was left was a laparoscopy, an invasive procedure that remains the only effective way of treating endometriosis. I went under for four hours and when I woke up I was shown pictures of my insides, which had been scraped and lasered and prodded about.

It was not a pretty sight. My endometrium – the stuff that’s supposed to stay in your uterus until it exits your body – had spent seven years attaching itself to my bladder, fallopian tubes and bowel. It had scarred my right ovary. If left unchecked, this could have rendered me infertile, not to mention further destroyed my quality of life. I spent a difficult month recovering, during which I suffered from a severe bout of depression (a common side-effect of the surgery) and needed help walking until I could rebuild my abdominal strength.


There are days when I am physically unable to get out of bed (or, even worse, off the bathroom floor)

I experienced around 18 months of reduced symptoms before they began to build up again. I have had surgery once since then and now have a piece of mesh behind my right ovary to prevent it from being trapped against my pelvic floor. When I decide to have a child, there is a strong possibility that I’ll need a third surgery if I hope to conceive naturally.

I have structured my life and my career around this disease. I’ve missed more social events than I can count and recently went to a wedding so medicated that I had to ask the friend next to me to keep me upright during the ceremony. I am the only person I know who doesn’t own a pair of jeans, but what seems like a kooky style choice is actually a result of my near-constant painful abdominal swelling, rendering anything with a tight waistband unwearable. I work as a freelance writer and editor partly because I need a job that I can do from home as there are days when I am physically unable to get out of bed (or, even worse, off the bathroom floor).

I spent my early 20s working minimum-wage jobs in bars, theatres and shops and the only way I got through shifts was by taking double the recommended painkiller dose and secretly throwing up in the staff toilets. Most sufferers are not as fortunate as me. They’re still doubling their doses and throwing up in your workplace because they don’t have any other options. They may not even know what’s causing their pain because the last doctor they saw recommended ibuprofen and sent them on their way.

This move from Nice is so welcome because endometriosis sufferers need to be believed. Treatment is a long road and it only gets harder the longer the disease is left unchecked. From my foetal position on the floor, I hope fervently that these guidelines make a difference.

Brydie Lee-Kennedy is an Australian-born, London-based columnist and writer for TV and theatre

Endometriosis left me in agony. Now doctors must take women seriously | Brydie Lee-Kennedy

I am writing this while lying in a semi-foetal position with a cold cloth on my forehead and a heat pack on my abdomen. This is not an ideal position from which to do any type of work, but for me and the other 176 million endometriosis sufferers worldwide, it’s often all we can manage. This is why the updated guidelines from the National Institute for Health and Care Excellence (Nice), released today, are to be commended.

These guidelines emphasise the importance of doctors believing their patients when they tell them about their menstrual pain and other attendant symptoms. This seems like obvious advice, but the average time it takes to diagnose endometriosis is seven to eight years. That’s seven to eight years of mind-numbing pain, clotting, diarrhoea, chronic bloating, self-medicating and, often, extremely low moods and anxiety. It’s seven to eight years of potential damage to your chances of conceiving.

It’s estimated that endometriosis affects one in 10 people with uteruses worldwide and yet when I was diagnosed a decade ago, I knew no one else with the disease. I was 20 and had been in chronic pain since the age of 13. While the pain would reach its peak during menstruation, leading to me vomiting and passing out, it affected me all the time. There was sharp, stabbing ovulation pain, dragging, relentless back pain, stinging rushes of pain through my legs and arms. I medicated, then medicated some more, then went to bed for days with nausea and misery, wondering why my body had betrayed me.

Despite all this, I was comparatively lucky because my parents and my GP took my pain seriously. By the age of 20, I had tried every non-surgical treatment available and all that was left was a laparoscopy, an invasive procedure that remains the only effective way of treating endometriosis. I went under for four hours and when I woke up I was shown pictures of my insides, which had been scraped and lasered and prodded about.

It was not a pretty sight. My endometrium – the stuff that’s supposed to stay in your uterus until it exits your body – had spent seven years attaching itself to my bladder, fallopian tubes and bowel. It had scarred my right ovary. If left unchecked, this could have rendered me infertile, not to mention further destroyed my quality of life. I spent a difficult month recovering, during which I suffered from a severe bout of depression (a common side-effect of the surgery) and needed help walking until I could rebuild my abdominal strength.


There are days when I am physically unable to get out of bed (or, even worse, off the bathroom floor)

I experienced around 18 months of reduced symptoms before they began to build up again. I have had surgery once since then and now have a piece of mesh behind my right ovary to prevent it from being trapped against my pelvic floor. When I decide to have a child, there is a strong possibility that I’ll need a third surgery if I hope to conceive naturally.

I have structured my life and my career around this disease. I’ve missed more social events than I can count and recently went to a wedding so medicated that I had to ask the friend next to me to keep me upright during the ceremony. I am the only person I know who doesn’t own a pair of jeans, but what seems like a kooky style choice is actually a result of my near-constant painful abdominal swelling, rendering anything with a tight waistband unwearable. I work as a freelance writer and editor partly because I need a job that I can do from home as there are days when I am physically unable to get out of bed (or, even worse, off the bathroom floor).

I spent my early 20s working minimum-wage jobs in bars, theatres and shops and the only way I got through shifts was by taking double the recommended painkiller dose and secretly throwing up in the staff toilets. Most sufferers are not as fortunate as me. They’re still doubling their doses and throwing up in your workplace because they don’t have any other options. They may not even know what’s causing their pain because the last doctor they saw recommended ibuprofen and sent them on their way.

This move from Nice is so welcome because endometriosis sufferers need to be believed. Treatment is a long road and it only gets harder the longer the disease is left unchecked. From my foetal position on the floor, I hope fervently that these guidelines make a difference.

Brydie Lee-Kennedy is an Australian-born, London-based columnist and writer for TV and theatre

Anal sex is not the only option for women suffering painful vaginal intercourse | Nina Booysen

Women around the world reacted with disgust to doctors who suggested women experiencing painful sex as a side-effect of vaginal mesh implants try anal intercourse instead. Sadly, this kind of dismissive attitude from the medical profession is not surprising. However, as a sexologist who mainly works with women who have trouble enjoying sexual intercourse, I can tell you there are other options.

Research shows that doctors respond differently to patients who complain of pain based on gender. Typically, people do not question the experience of pain of a cancer patient, or indeed a man. A woman tends to be met with scepticism, especially when it comes to her reproductive organs or nether regions. Often, woman will be met with: “I’m sure it’s not that bad” or “that really shouldn’t hurt” or even, “you’re being a little hysterical”.

It’s not just women suffering pain from vaginal mesh implants who are dismissed. It is also the reason conditions such as endometriosis, vulvodynia (unspecified pain or burning in vulva region) and vaginusmus (involuntary contraction of the pelvic floor muscles) have not been adequately researched and treated. Endometriosis typically goes undiagnosed for seven to 10 years. The statistics show one in 10 women of reproductive age suffer from endometriosis – that’s 176 million women worldwide. Yet, so many women suffer silently and are afraid to be a “nuisance”.

Painful sexual intercourse is a common side effect of all these conditions. When we are young and learning, if you put your hand on a hot stove, your brain screams at you to never, ever do that again! Well, painful sex can have the same effect. The difference being we don’t need to have our hands on hot stoves to lead fulfilling lives. We do however seek relationships, which survive because of intimacy, connection and sex. This is where the work of a relationship therapist or sex therapist can help. We essentially help woman reconnect with their bodies and rewire their brains to have a renewed relationship with themselves. It’s about finding what’s “good enough” and what works for each individual woman based on her history, medical diagnoses, sexual experiences and values.

Even when woman are managing their condition well, they may be left with psychological and emotional issues in relation to body image, intimacy and self-esteem. It is important to note that the onset of endometriosis occurs during the crucial years of sexual development. Women struggle between the often debilitating symptoms of endo, making sex difficult, and the pressure of knowing it is a social expectation, especially if you want to be in a relationship, not to mention if you want children. This inhibits the development of an identity as a sexual being. Sex is something you have to endure.

It is important for women experiencing any sexual dysfunction to grieve and surrender. Grieve the loss of what they feel being “normal” is, the loss of relationships, the loss of fertility, the loss of their own hopes for their sex lives. In doing so, women are able to surrender. We can then look at what parts of yourself you want to keep, what parts you want to give away and, in doing so, what you are making space for. What can be different? Because all we really want is quality of life.

Can we make space in our brains for the possibility that our bodies can bring us pleasure? Can we make space for the possibility that not all affectionate touch has to lead to sex and not all satisfying sex has to involve penetration? Do we understand what it feels like to be a sexual being, not a sexual object? Is it possible that the thought of a partner’s touch won’t trigger a fear response? I believe it is, and many women have benefitted from seeking assistance in these matters.

As a couples therapist and sexologist I know that any sexual issue is a couple’s issue and needs to be addressed as a couple, therefore making the experiences of partners quite valid. In understanding our partner’s experience, we can gain understanding, not just guilt. Suggestions made by the medical fraternity can be simplistic and insensitive. There seems to be a repeated narrow focus on what can make it work for the partner, not necessarily what can help the woman. Suggesting anal sex is extremely narrow-minded and offensive to some, even though it might be an option for others.

So what can we do? I would suggest to clients that they seek help where they can be given ownership of their disease or issue and empowered to manage it. I would encourage them to go back to basics in being self aware and understanding how they identify as sexual beings, not sexual objects. Experiment and think outside the box at the accessories and sexual aids available to help make sex more comfortable. Furniture wedges or fake vaginas have proven very successful for some couples.

These options allow the woman to be more comfortable and less tense. Partner penetration of a fake vagina, strategically placed, can also be stimulating for a woman at the same time. I emphasise the need for open communication and for the woman to reconnect with her body in a pleasurable way, not necessarily sexual in nature, but to reconnect in ways that are pleasant – such as the great taste of a square of chocolate.

At the same time, we must continue to talk about and study women’s experiences of endometriosis and other chronic diseases and conditions of the female reproductive system. As sufferers, we can grieve the life we thought we would have and surrender to the necessary steps for managing the disease. This doesn’t mean it owns us. We experiment psychologically and physically, challenging our pre-conceived ideas about sex, pleasure and intimacy.

We can continue to encourage women to “never give up”. We can ask them to push professionals to look for new options and be mindful of their approach. We can celebrate the ability to adapt. We can feel validated as human beings, women and lovers.

Nina Booysen will be speaking at the EndoActive endometriosis conference on Saturday 9 September in Sydney. Get your tickets here.

Anal sex is not the only option for women suffering painful vaginal intercourse | Nina Booysen

Women around the world reacted with disgust to doctors who suggested women experiencing painful sex as a side-effect of vaginal mesh implants try anal intercourse instead. Sadly, this kind of dismissive attitude from the medical profession is not surprising. However, as a sexologist who mainly works with women who have trouble enjoying sexual intercourse, I can tell you there are other options.

Research shows that doctors respond differently to patients who complain of pain based on gender. Typically, people do not question the experience of pain of a cancer patient, or indeed a man. A woman tends to be met with scepticism, especially when it comes to her reproductive organs or nether regions. Often, woman will be met with: “I’m sure it’s not that bad” or “that really shouldn’t hurt” or even, “you’re being a little hysterical”.

It’s not just women suffering pain from vaginal mesh implants who are dismissed. It is also the reason conditions such as endometriosis, vulvodynia (unspecified pain or burning in vulva region) and vaginusmus (involuntary contraction of the pelvic floor muscles) have not been adequately researched and treated. Endometriosis typically goes undiagnosed for seven to 10 years. The statistics show one in 10 women of reproductive age suffer from endometriosis – that’s 176 million women worldwide. Yet, so many women suffer silently and are afraid to be a “nuisance”.

Painful sexual intercourse is a common side effect of all these conditions. When we are young and learning, if you put your hand on a hot stove, your brain screams at you to never, ever do that again! Well, painful sex can have the same effect. The difference being we don’t need to have our hands on hot stoves to lead fulfilling lives. We do however seek relationships, which survive because of intimacy, connection and sex. This is where the work of a relationship therapist or sex therapist can help. We essentially help woman reconnect with their bodies and rewire their brains to have a renewed relationship with themselves. It’s about finding what’s “good enough” and what works for each individual woman based on her history, medical diagnoses, sexual experiences and values.

Even when woman are managing their condition well, they may be left with psychological and emotional issues in relation to body image, intimacy and self-esteem. It is important to note that the onset of endometriosis occurs during the crucial years of sexual development. Women struggle between the often debilitating symptoms of endo, making sex difficult, and the pressure of knowing it is a social expectation, especially if you want to be in a relationship, not to mention if you want children. This inhibits the development of an identity as a sexual being. Sex is something you have to endure.

It is important for women experiencing any sexual dysfunction to grieve and surrender. Grieve the loss of what they feel being “normal” is, the loss of relationships, the loss of fertility, the loss of their own hopes for their sex lives. In doing so, women are able to surrender. We can then look at what parts of yourself you want to keep, what parts you want to give away and, in doing so, what you are making space for. What can be different? Because all we really want is quality of life.

Can we make space in our brains for the possibility that our bodies can bring us pleasure? Can we make space for the possibility that not all affectionate touch has to lead to sex and not all satisfying sex has to involve penetration? Do we understand what it feels like to be a sexual being, not a sexual object? Is it possible that the thought of a partner’s touch won’t trigger a fear response? I believe it is, and many women have benefitted from seeking assistance in these matters.

As a couples therapist and sexologist I know that any sexual issue is a couple’s issue and needs to be addressed as a couple, therefore making the experiences of partners quite valid. In understanding our partner’s experience, we can gain understanding, not just guilt. Suggestions made by the medical fraternity can be simplistic and insensitive. There seems to be a repeated narrow focus on what can make it work for the partner, not necessarily what can help the woman. Suggesting anal sex is extremely narrow-minded and offensive to some, even though it might be an option for others.

So what can we do? I would suggest to clients that they seek help where they can be given ownership of their disease or issue and empowered to manage it. I would encourage them to go back to basics in being self aware and understanding how they identify as sexual beings, not sexual objects. Experiment and think outside the box at the accessories and sexual aids available to help make sex more comfortable. Furniture wedges or fake vaginas have proven very successful for some couples.

These options allow the woman to be more comfortable and less tense. Partner penetration of a fake vagina, strategically placed, can also be stimulating for a woman at the same time. I emphasise the need for open communication and for the woman to reconnect with her body in a pleasurable way, not necessarily sexual in nature, but to reconnect in ways that are pleasant – such as the great taste of a square of chocolate.

At the same time, we must continue to talk about and study women’s experiences of endometriosis and other chronic diseases and conditions of the female reproductive system. As sufferers, we can grieve the life we thought we would have and surrender to the necessary steps for managing the disease. This doesn’t mean it owns us. We experiment psychologically and physically, challenging our pre-conceived ideas about sex, pleasure and intimacy.

We can continue to encourage women to “never give up”. We can ask them to push professionals to look for new options and be mindful of their approach. We can celebrate the ability to adapt. We can feel validated as human beings, women and lovers.

Nina Booysen will be speaking at the EndoActive endometriosis conference on Saturday 9 September in Sydney. Get your tickets here.

What does pelvic mesh do and why are women suing over it? – explainer

What is a transvaginal mesh implant?

Urogynaecological meshes (sometimes known as transvaginal meshes) are used to treat stress incontinence, a condition that can lead to women leaking from their bladder when doing impact activities such as running and jumping, or when sneezing or coughing. The condition is very common in women after childbirth and at the menopause – around 20% of women are affected sufficiently for it to be a problem in their daily lives. Mesh surgery has a low complication rate for incontinence.

The meshes are also sometimes offered as a treatment for women suffering from pelvic organ prolapse. Pelvic organ prolapse affects up to half of women who have had children, and occurs when a pelvic organ – such as the bladder, rectum or uterus – “sags” and moves out of place. This can happen when the pelvic floor muscles, ligaments and tissue that hold the organs in place are weak or damaged.

Surgical mesh graphic

Childbirth is a main source of trauma to the muscles and ligaments, and hormonal changes during the menopause also lead to muscles weakening and becoming less elastic. Heavy lifting can also cause damage to the pelvic organs and lead to prolapse. The condition also tends to run in families and is more common in women who are overweight.

While some women have no symptoms, pelvic organ prolapse can be debilitating and make it hard to go to the toilet, can cause painful or heavy sensations in the vagina, and can make sex difficult, all of which require treatment. It can also cause a loss of sensation and make it harder to “push”, for example when urinating. For women with these symptoms reconstructive surgery using vaginal mesh is sometimes recommended.

How does it work?

The mesh is a net-like implant. It comes in a number of forms including a “sling”, “tape”, “ribbon”, “mesh” and “hammock”. There are different brands and manufacturers.

The aim of the mesh is to give permanent support to the weakened organs and to repair damaged tissue.

Surgery can be done through the abdomen (transabdominal) or through the vagina (transvaginal). A small incision is made in the vaginal or abdominal wall, and the surgical mesh is implanted and held in place by sutures or tissue fixation devices. The idea is that tissue will grow into the pores of the mesh to create a wall of support.

When were they introduced?

The most common form of implant, called a transvaginal tape (or TVT), has been widely used to treat stress incontinence across Europe, the US and Australia since the early 2000s.

Early clinical trials suggested excellent efficacy and many surgeons saw advantages over traditional open-surgery procedures, which took longer to perform, involved a longer recovery for patients and were associated with their own range of complications. By contrast, a TVT procedure typically takes 3o minutes, is performed using keyhole surgery and patients often go home the same day.

Meanwhile, the traditional treatments for pelvic organ prolapse, which included suturing to reconstruct and repair the affected organs and surrounding tissue, were proving less successful, with reports of up to 29% of women suffering another prolapse after treatment. Hysterectomy is another treatment option, which some women wish to avoid.

“Because outcomes of using the mesh for incontinence and hernia were so good people were enthusiastic and confident it would also be good for prolapse,” said Christopher Maher, a urogynaecologist and associate professor at the University of Queensland. “That’s what the mindset was when it was introduced for prolapse around 2002.”

But he said regulators around the world should have demanded more testing to ensure the mesh was as effective for treating prolapse as it was for other conditions.

There have also been reports that pharmaceutical companies who make the meshes began heavily promoting them to doctors for treating pelvic organ prolapse. By 2010, transvaginal mesh operations accounted for nearly 25% of prolapse interventions in some countries.

What is the current controversy surrounding vaginal mesh?

Most short-term clinical trials have found high efficacy and low complication rates for the most common mesh implants (TVT) used for incontinence, but there is a growing body of evidence that efficacy is lower and complication rates are higher for pelvic organ prolapse.

There is also little robust information on the success of the procedures in the long term and when carried out in the wider population. However, there are indications that complication rates could be significantly higher than those typically reported in trials – in the UK, NHS data suggests that one in 15 women later has to have their implant surgically removed.

Fitting & removal rates graphic

In a survey of 2,220 women who had undergone pelvic mesh implants to treat stress urinary incontinence and pelvic organ prolapse, 59% said the procedure did not resolve their original issue, and 58% said they were left experiencing pain during intercourse. However, this was a consumer survey, carried out by the consumer advocacy group, the Health Issues Centre, rather than being a scientific study.

As the mesh became more widely used, women came forward suffering complications and class actions have been brought against manufacturers around the world. In 2012 the United States Food and Drug Administration reclassified transvaginal mesh as a high-risk device.

What can go wrong?

“In most cases, the complications are relatively minor,” said Peta Higgs, a Royal Australian and New Zealand College of Obstetricians and Gynaecologists spokeswoman and a urogynaecologist. “However, in a small number of cases the complications have been very serious.”

These include mesh exposure and erosion – when the mesh pokes through the vaginal wall or cuts through internal tissue – vaginal scarring, fistula formation, painful sex, and pelvic, back and leg pains. Some of these complications may occur years after surgery and can be difficult to treat. And although serious complications appear to be rare, given the thousands of women who have had the implants, the numbers of women suffering adverse reactions is high.

Three Johnson & Johnson group companies are now fighting a major class action from 700 Australian women, who allege faulty pelvic mesh implants caused them debilitating pain. Similar class actions involving thousands of women are also under way in the UK and US. More than 100,000 transvaginal mesh lawsuits have been filed in the US, with the manufacturer of the most commonly used meshes, Johnson & Johnson, facing the most lawsuits.

In many of the cases, issues have been raised around informed consent. Shine Lawyers is leading the Australian class action and alleges Johnson & Johnson failed to properly test the devices and played down their risk to both surgeons and patients.

The Australian government is also holding a Senate inquiry into the use of transvaginal mesh examining any financial or other incentives provided to medical practitioners to use or promote transvaginal mesh implants, the lack of data available on how many procedures were performed, and the type and incidence of health problems women have experienced. The next round of public hearings will be held in Sydney on 18 September.

How many women have mesh implants?

In the UK, a 2014 government report estimated the procedure was performed on about about 17,000 women per year suffering stress incontinence and that these numbers had remained stable for a few years. The number of vaginal mesh implants used for prolapse peaked around 2009 with 3,200 implants sold to hospitals, but had dropped gradually to about 2,000 per year, the report found.

In the US, the Food and Drug Administration [FDA] issued safety warnings to doctors and consumers in 2011 about an increase in adverse event reports related to mesh. The latest available FDA figures show approximately 300,000 women in the US undergo surgical procedures for prolapse each year and approximately 260,000 underwent surgical procedures to repair stress incontinence. According to industry estimates, approximately one out of three prolapse surgeries used mesh, and of the incontinence surgeries, over 80% were done transvaginally with mesh.

There is no accurate data available to track the number of women who have had a mesh implant for the treatment of prolapse or incontinence in Australia, Higgs says.

According to Maher, this is because surgeries for prolapse have been recorded under “vaginal repair”, which can involve numerous procedures that do not involve mesh. It also makes it hard to determine complication rates related to mesh unless women are signed up to clinical trials. However, Australia’s Therapeutic Goods Administration believes there have been “many thousands” of mesh devices implanted in Australian patients.

Brands of mesh have been pulled from the market around the world by manufacturers, and brands and types that have been studied have been replaced by newer versions that doctors have less evidence about. This makes it difficult to understand if some have higher complication rates or are more effective than others.

Is the surgery reversible?

The mesh implants are designed to be permanent and during the first weeks after surgery become embedded in the surrounding tissue to provide better pelvic support. If the implant becomes exposed in the vagina, doctors normally cut away the mesh and put in some stitches, which can sometimes be done under local anaesthetic. However, if the patient is suffering from more permanent complications, such as pain, full removal can require hours of surgery and doctors have to also weigh up the risk of damage to nerves and nearby organs, including the bladder and bowel.

Should women be worried?

Higgs said women who had undergone a mesh procedure in the past and who are well are unlikely to suffer any adverse effects or complications.

“However, some women might experience a late vaginal mesh exposure or erosion,” she said. “If women are concerned, or experience any abnormal vaginal bleeding or pain, we encourage you to see your doctor.”

The complications seem to be much more common in women who had the surgery to treat prolapse.

While new treatments are sometimes trialled on patients when other options have proven ineffective, patients should always be informed that the treatment is new and that little data exists for its efficacy, so that they can give informed consent. Women should feel comfortable asking their specialist about complication rates, the evidence that the surgery will work, and about surgeon training.

What does pelvic mesh do and why are women suing over it? – explainer

What is a transvaginal mesh implant?

Urogynaecological meshes (sometimes known as transvaginal meshes) are used to treat stress incontinence, a condition that can lead to women leaking from their bladder when doing impact activities such as running and jumping, or when sneezing or coughing. The condition is very common in women after childbirth and at the menopause – around 20% of women are affected sufficiently for it to be a problem in their daily lives. Mesh surgery has a low complication rate for incontinence.

The meshes are also sometimes offered as a treatment for women suffering from pelvic organ prolapse. Pelvic organ prolapse affects up to half of women who have had children, and occurs when a pelvic organ – such as the bladder, rectum or uterus – “sags” and moves out of place. This can happen when the pelvic floor muscles, ligaments and tissue that hold the organs in place are weak or damaged.

Surgical mesh graphic

Childbirth is a main source of trauma to the muscles and ligaments, and hormonal changes during the menopause also lead to muscles weakening and becoming less elastic. Heavy lifting can also cause damage to the pelvic organs and lead to prolapse. The condition also tends to run in families and is more common in women who are overweight.

While some women have no symptoms, pelvic organ prolapse can be debilitating and make it hard to go to the toilet, can cause painful or heavy sensations in the vagina, and can make sex difficult, all of which require treatment. It can also cause a loss of sensation and make it harder to “push”, for example when urinating. For women with these symptoms reconstructive surgery using vaginal mesh is sometimes recommended.

How does it work?

The mesh is a net-like implant. It comes in a number of forms including a “sling”, “tape”, “ribbon”, “mesh” and “hammock”. There are different brands and manufacturers.

The aim of the mesh is to give permanent support to the weakened organs and to repair damaged tissue.

Surgery can be done through the abdomen (transabdominal) or through the vagina (transvaginal). A small incision is made in the vaginal or abdominal wall, and the surgical mesh is implanted and held in place by sutures or tissue fixation devices. The idea is that tissue will grow into the pores of the mesh to create a wall of support.

When were they introduced?

The most common form of implant, called a transvaginal tape (or TVT), has been widely used to treat stress incontinence across Europe, the US and Australia since the early 2000s.

Early clinical trials suggested excellent efficacy and many surgeons saw advantages over traditional open-surgery procedures, which took longer to perform, involved a longer recovery for patients and were associated with their own range of complications. By contrast, a TVT procedure typically takes 3o minutes, is performed using keyhole surgery and patients often go home the same day.

Meanwhile, the traditional treatments for pelvic organ prolapse, which included suturing to reconstruct and repair the affected organs and surrounding tissue, were proving less successful, with reports of up to 29% of women suffering another prolapse after treatment. Hysterectomy is another treatment option, which some women wish to avoid.

“Because outcomes of using the mesh for incontinence and hernia were so good people were enthusiastic and confident it would also be good for prolapse,” said Christopher Maher, a urogynaecologist and associate professor at the University of Queensland. “That’s what the mindset was when it was introduced for prolapse around 2002.”

But he said regulators around the world should have demanded more testing to ensure the mesh was as effective for treating prolapse as it was for other conditions.

There have also been reports that pharmaceutical companies who make the meshes began heavily promoting them to doctors for treating pelvic organ prolapse. By 2010, transvaginal mesh operations accounted for nearly 25% of prolapse interventions in some countries.

What is the current controversy surrounding vaginal mesh?

Most short-term clinical trials have found high efficacy and low complication rates for the most common mesh implants (TVT) used for incontinence, but there is a growing body of evidence that efficacy is lower and complication rates are higher for pelvic organ prolapse.

There is also little robust information on the success of the procedures in the long term and when carried out in the wider population. However, there are indications that complication rates could be significantly higher than those typically reported in trials – in the UK, NHS data suggests that one in 15 women later has to have their implant surgically removed.

Fitting & removal rates graphic

In a survey of 2,220 women who had undergone pelvic mesh implants to treat stress urinary incontinence and pelvic organ prolapse, 59% said the procedure did not resolve their original issue, and 58% said they were left experiencing pain during intercourse. However, this was a consumer survey, carried out by the consumer advocacy group, the Health Issues Centre, rather than being a scientific study.

As the mesh became more widely used, women came forward suffering complications and class actions have been brought against manufacturers around the world. In 2012 the United States Food and Drug Administration reclassified transvaginal mesh as a high-risk device.

What can go wrong?

“In most cases, the complications are relatively minor,” said Peta Higgs, a Royal Australian and New Zealand College of Obstetricians and Gynaecologists spokeswoman and a urogynaecologist. “However, in a small number of cases the complications have been very serious.”

These include mesh exposure and erosion – when the mesh pokes through the vaginal wall or cuts through internal tissue – vaginal scarring, fistula formation, painful sex, and pelvic, back and leg pains. Some of these complications may occur years after surgery and can be difficult to treat. And although serious complications appear to be rare, given the thousands of women who have had the implants, the numbers of women suffering adverse reactions is high.

Three Johnson & Johnson group companies are now fighting a major class action from 700 Australian women, who allege faulty pelvic mesh implants caused them debilitating pain. Similar class actions involving thousands of women are also under way in the UK and US. More than 100,000 transvaginal mesh lawsuits have been filed in the US, with the manufacturer of the most commonly used meshes, Johnson & Johnson, facing the most lawsuits.

In many of the cases, issues have been raised around informed consent. Shine Lawyers is leading the Australian class action and alleges Johnson & Johnson failed to properly test the devices and played down their risk to both surgeons and patients.

The Australian government is also holding a Senate inquiry into the use of transvaginal mesh examining any financial or other incentives provided to medical practitioners to use or promote transvaginal mesh implants, the lack of data available on how many procedures were performed, and the type and incidence of health problems women have experienced. The next round of public hearings will be held in Sydney on 18 September.

How many women have mesh implants?

In the UK, a 2014 government report estimated the procedure was performed on about about 17,000 women per year suffering stress incontinence and that these numbers had remained stable for a few years. The number of vaginal mesh implants used for prolapse peaked around 2009 with 3,200 implants sold to hospitals, but had dropped gradually to about 2,000 per year, the report found.

In the US, the Food and Drug Administration [FDA] issued safety warnings to doctors and consumers in 2011 about an increase in adverse event reports related to mesh. The latest available FDA figures show approximately 300,000 women in the US undergo surgical procedures for prolapse each year and approximately 260,000 underwent surgical procedures to repair stress incontinence. According to industry estimates, approximately one out of three prolapse surgeries used mesh, and of the incontinence surgeries, over 80% were done transvaginally with mesh.

There is no accurate data available to track the number of women who have had a mesh implant for the treatment of prolapse or incontinence in Australia, Higgs says.

According to Maher, this is because surgeries for prolapse have been recorded under “vaginal repair”, which can involve numerous procedures that do not involve mesh. It also makes it hard to determine complication rates related to mesh unless women are signed up to clinical trials. However, Australia’s Therapeutic Goods Administration believes there have been “many thousands” of mesh devices implanted in Australian patients.

Brands of mesh have been pulled from the market around the world by manufacturers, and brands and types that have been studied have been replaced by newer versions that doctors have less evidence about. This makes it difficult to understand if some have higher complication rates or are more effective than others.

Is the surgery reversible?

The mesh implants are designed to be permanent and during the first weeks after surgery become embedded in the surrounding tissue to provide better pelvic support. If the implant becomes exposed in the vagina, doctors normally cut away the mesh and put in some stitches, which can sometimes be done under local anaesthetic. However, if the patient is suffering from more permanent complications, such as pain, full removal can require hours of surgery and doctors have to also weigh up the risk of damage to nerves and nearby organs, including the bladder and bowel.

Should women be worried?

Higgs said women who had undergone a mesh procedure in the past and who are well are unlikely to suffer any adverse effects or complications.

“However, some women might experience a late vaginal mesh exposure or erosion,” she said. “If women are concerned, or experience any abnormal vaginal bleeding or pain, we encourage you to see your doctor.”

The complications seem to be much more common in women who had the surgery to treat prolapse.

While new treatments are sometimes trialled on patients when other options have proven ineffective, patients should always be informed that the treatment is new and that little data exists for its efficacy, so that they can give informed consent. Women should feel comfortable asking their specialist about complication rates, the evidence that the surgery will work, and about surgeon training.

What does pelvic mesh do and why are women suing over it? – explainer

What is a transvaginal mesh implant?

Urogynaecological meshes (sometimes known as transvaginal meshes) are used to treat stress incontinence, a condition that can lead to women leaking from their bladder when doing impact activities such as running and jumping, or when sneezing or coughing. The condition is very common in women after childbirth and at the menopause – around 20% of women are affected sufficiently for it to be a problem in their daily lives. Mesh surgery has a low complication rate for incontinence.

The meshes are also sometimes offered as a treatment for women suffering from pelvic organ prolapse. Pelvic organ prolapse affects up to half of women who have had children, and occurs when a pelvic organ – such as the bladder, rectum or uterus – “sags” and moves out of place. This can happen when the pelvic floor muscles, ligaments and tissue that hold the organs in place are weak or damaged.

Surgical mesh graphic

Childbirth is a main source of trauma to the muscles and ligaments, and hormonal changes during the menopause also lead to muscles weakening and becoming less elastic. Heavy lifting can also cause damage to the pelvic organs and lead to prolapse. The condition also tends to run in families and is more common in women who are overweight.

While some women have no symptoms, pelvic organ prolapse can be debilitating and make it hard to go to the toilet, can cause painful or heavy sensations in the vagina, and can make sex difficult, all of which require treatment. It can also cause a loss of sensation and make it harder to “push”, for example when urinating. For women with these symptoms reconstructive surgery using vaginal mesh is sometimes recommended.

How does it work?

The mesh is a net-like implant. It comes in a number of forms including a “sling”, “tape”, “ribbon”, “mesh” and “hammock”. There are different brands and manufacturers.

The aim of the mesh is to give permanent support to the weakened organs and to repair damaged tissue.

Surgery can be done through the abdomen (transabdominal) or through the vagina (transvaginal). A small incision is made in the vaginal or abdominal wall, and the surgical mesh is implanted and held in place by sutures or tissue fixation devices. The idea is that tissue will grow into the pores of the mesh to create a wall of support.

When were they introduced?

The most common form of implant, called a transvaginal tape (or TVT), has been widely used to treat stress incontinence across Europe, the US and Australia since the early 2000s.

Early clinical trials suggested excellent efficacy and many surgeons saw advantages over traditional open-surgery procedures, which took longer to perform, involved a longer recovery for patients and were associated with their own range of complications. By contrast, a TVT procedure typically takes 3o minutes, is performed using keyhole surgery and patients often go home the same day.

Meanwhile, the traditional treatments for pelvic organ prolapse, which included suturing to reconstruct and repair the affected organs and surrounding tissue, were proving less successful, with reports of up to 29% of women suffering another prolapse after treatment. Hysterectomy is another treatment option, which some women wish to avoid.

“Because outcomes of using the mesh for incontinence and hernia were so good people were enthusiastic and confident it would also be good for prolapse,” said Christopher Maher, a urogynaecologist and associate professor at the University of Queensland. “That’s what the mindset was when it was introduced for prolapse around 2002.”

But he said regulators around the world should have demanded more testing to ensure the mesh was as effective for treating prolapse as it was for other conditions.

There have also been reports that pharmaceutical companies who make the meshes began heavily promoting them to doctors for treating pelvic organ prolapse. By 2010, transvaginal mesh operations accounted for nearly 25% of prolapse interventions in some countries.

What is the current controversy surrounding vaginal mesh?

Most short-term clinical trials have found high efficacy and low complication rates for the most common mesh implants (TVT) used for incontinence, but there is a growing body of evidence that efficacy is lower and complication rates are higher for pelvic organ prolapse.

There is also little robust information on the success of the procedures in the long term and when carried out in the wider population. However, there are indications that complication rates could be significantly higher than those typically reported in trials – in the UK, NHS data suggests that one in 15 women later has to have their implant surgically removed.

Fitting & removal rates graphic

In a survey of 2,220 women who had undergone pelvic mesh implants to treat stress urinary incontinence and pelvic organ prolapse, 59% said the procedure did not resolve their original issue, and 58% said they were left experiencing pain during intercourse. However, this was a consumer survey, carried out by the consumer advocacy group, the Health Issues Centre, rather than being a scientific study.

As the mesh became more widely used, women came forward suffering complications and class actions have been brought against manufacturers around the world. In 2012 the United States Food and Drug Administration reclassified transvaginal mesh as a high-risk device.

What can go wrong?

“In most cases, the complications are relatively minor,” said Peta Higgs, a Royal Australian and New Zealand College of Obstetricians and Gynaecologists spokeswoman and a urogynaecologist. “However, in a small number of cases the complications have been very serious.”

These include mesh exposure and erosion – when the mesh pokes through the vaginal wall or cuts through internal tissue – vaginal scarring, fistula formation, painful sex, and pelvic, back and leg pains. Some of these complications may occur years after surgery and can be difficult to treat. And although serious complications appear to be rare, given the thousands of women who have had the implants, the numbers of women suffering adverse reactions is high.

Three Johnson & Johnson group companies are now fighting a major class action from 700 Australian women, who allege faulty pelvic mesh implants caused them debilitating pain. Similar class actions involving thousands of women are also under way in the UK and US. More than 100,000 transvaginal mesh lawsuits have been filed in the US, with the manufacturer of the most commonly used meshes, Johnson & Johnson, facing the most lawsuits.

In many of the cases, issues have been raised around informed consent. Shine Lawyers is leading the Australian class action and alleges Johnson & Johnson failed to properly test the devices and played down their risk to both surgeons and patients.

The Australian government is also holding a Senate inquiry into the use of transvaginal mesh examining any financial or other incentives provided to medical practitioners to use or promote transvaginal mesh implants, the lack of data available on how many procedures were performed, and the type and incidence of health problems women have experienced. The next round of public hearings will be held in Sydney on 18 September.

How many women have mesh implants?

In the UK, a 2014 government report estimated the procedure was performed on about about 17,000 women per year suffering stress incontinence and that these numbers had remained stable for a few years. The number of vaginal mesh implants used for prolapse peaked around 2009 with 3,200 implants sold to hospitals, but had dropped gradually to about 2,000 per year, the report found.

In the US, the Food and Drug Administration [FDA] issued safety warnings to doctors and consumers in 2011 about an increase in adverse event reports related to mesh. The latest available FDA figures show approximately 300,000 women in the US undergo surgical procedures for prolapse each year and approximately 260,000 underwent surgical procedures to repair stress incontinence. According to industry estimates, approximately one out of three prolapse surgeries used mesh, and of the incontinence surgeries, over 80% were done transvaginally with mesh.

There is no accurate data available to track the number of women who have had a mesh implant for the treatment of prolapse or incontinence in Australia, Higgs says.

According to Maher, this is because surgeries for prolapse have been recorded under “vaginal repair”, which can involve numerous procedures that do not involve mesh. It also makes it hard to determine complication rates related to mesh unless women are signed up to clinical trials. However, Australia’s Therapeutic Goods Administration believes there have been “many thousands” of mesh devices implanted in Australian patients.

Brands of mesh have been pulled from the market around the world by manufacturers, and brands and types that have been studied have been replaced by newer versions that doctors have less evidence about. This makes it difficult to understand if some have higher complication rates or are more effective than others.

Is the surgery reversible?

The mesh implants are designed to be permanent and during the first weeks after surgery become embedded in the surrounding tissue to provide better pelvic support. If the implant becomes exposed in the vagina, doctors normally cut away the mesh and put in some stitches, which can sometimes be done under local anaesthetic. However, if the patient is suffering from more permanent complications, such as pain, full removal can require hours of surgery and doctors have to also weigh up the risk of damage to nerves and nearby organs, including the bladder and bowel.

Should women be worried?

Higgs said women who had undergone a mesh procedure in the past and who are well are unlikely to suffer any adverse effects or complications.

“However, some women might experience a late vaginal mesh exposure or erosion,” she said. “If women are concerned, or experience any abnormal vaginal bleeding or pain, we encourage you to see your doctor.”

The complications seem to be much more common in women who had the surgery to treat prolapse.

While new treatments are sometimes trialled on patients when other options have proven ineffective, patients should always be informed that the treatment is new and that little data exists for its efficacy, so that they can give informed consent. Women should feel comfortable asking their specialist about complication rates, the evidence that the surgery will work, and about surgeon training.