Considerable aspects of transvaginal mesh healthcare practice, technology evolution, and regulatory procedure have been addressed within the United States (U.S.), calming previously occurring high anxiety among patients in need of pelvic organ prolapse repair. Multiple areas of the globe continue to struggle with transvaginal mesh navigation. Patient voice was examined in consideration of providing insights to address sentiment regarding mesh procedures occurring in countries outside  of the U.S., where considerable transvaginal mesh complication media exposure, class-action activity, and high patient anxiety are currently occurring.

A 24 hour open-response single question quick-poll was shared on March 20, 2018, within a closed Facebook online POP support forum. Patient members responded to the question, “How do you feel about mesh surgery? If you don’t see a category that fits, add one sentence responses.”  A total of 172 POP forum members responded within the allotted 24 hour window.

Patient responses regarding mesh were extremely variable.  172 women replied to the survey: 28.5% of women indicated they had not had surgery, and would prefer to avoid it altogether as long as possible; 23.8% would prefer native tissue repair related to mesh complication concerns; 10.5% would opt for mesh surgery if it was the best option for normalcy, but would seek a highly skilled pelvic organ prolapse specialist, 10.5% indicated if mesh was their only option for normalcy, they would agree to its use; 9.9% consider their mesh procedure successful; 6% had native tissue repair, but would choose mesh for next procedure if native tissue repair failed, 4.6% with mesh repair were satisfied because they feel their chances of surgical success are higher; 2.3% experiencing Ehlers Danlos tissue integrity issues would consider a mesh repair if the specialist was versed in the comorbid concerns, 2.3% experienced non-mesh complications or bowel issues; 1.8% experienced mesh complications and do not feel their procedure was successful; 1.2% had mesh complications and felt their issues were addressed and they were satisfied with end result.

A relatively common topic in online patient support forums is the safety of mesh procedures for pelvic organ prolapse repair. Open public hostility prevents patients outside of secure patient support forums from engaging in conversation regarding transvaginal mesh. Mesh fear factor remains high in women routinely encountering mesh complication litigious documentation exposure, or one-sided journalism without balanced access to scientific evidence for mesh success. A controlled environment that prevents patient bashing and disables litigation based fear-factor journalism is pivotal to reduce patient fear, and enable open mesh dialogue regarding issues and value. Given similarities in media exposure which occurred within the U.S. from 2011-2013 regarding transvaginal mesh complications and those currently occurring within Australia, New Zealand, and the U.K, additional efforts to expose patients to balanced mesh information and patient support may reduce patient anxiety and enable valuable navigation toward best practices within other countries.

Patient voice can and should play a pivotal role in all aspects of healthcare progression. The evolution of best practices rests on recognition of the significance of patient input to analyze missteps and to evaluate next steps, regarding both the benefits and detriments of transvaginal mesh.