The experience of women reporting damage from vaginal mesh: a reflexive thematic analysis

doi:10.1016/j.eclinm.2023.101918

. 2023 Mar 23:58:101918.

doi: 10.1016/j.eclinm.2023.101918. eCollection 2023 Apr.

The experience of women reporting damage from vaginal mesh: a reflexive thematic analysis

Francine Toye^{1

2}, Matthew Izett-Kay^{3

4}, Karen L Barker^{1

2}, Abigail McNiven⁵

Affiliations

¹ Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
² Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
³ Department of Urogynaecology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
⁴ Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.
⁵ Medical Sociology and Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.

PMID: 37007734
PMCID: PMC10064426
DOI: 10.1016/j.eclinm.2023.101918

The experience of women reporting damage from vaginal mesh: a reflexive thematic analysis

Francine Toye et al. EClinicalMedicine. 2023.

. 2023 Mar 23:58:101918.

doi: 10.1016/j.eclinm.2023.101918. eCollection 2023 Apr.

Authors

Francine Toye^{1

2}, Matthew Izett-Kay^{3

4}, Karen L Barker^{1

2}, Abigail McNiven⁵

Affiliations

¹ Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
² Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
³ Department of Urogynaecology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
⁴ Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.
⁵ Medical Sociology and Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.

PMID: 37007734
PMCID: PMC10064426
DOI: 10.1016/j.eclinm.2023.101918

Abstract

Background: The UK's 'First do no harm' report highlighted missed opportunities to prevent harm and emphasised the need to incorporate patient voices into healthcare. Due to concerns about, and the subsequent suspension, of vaginal mesh for urinary incontinence thousands of women face the decision about mesh removal surgery. The aim of this study was to explore and understand the experience of living with complications attributed to vaginal mesh surgery so that this knowledge can contribute to improvements in care for those considering mesh, or mesh removal, surgery.

Methods: This study was embedded in the 'PURSUE' study which explored the experiences of 74 people with urogynaecological conditions in the UK (30th April 2021-17th December 2021). Of these 74 people, fifteen women reported complications that they attributed to vaginal mesh surgery. We used the six stages of reflexive thematic analysis to conceptualise these fifteen accounts.

Findings: Our conceptual model anchors eight themes around two dualities: (1) body parts versus body whole, (2) dominant discourse versus marginal discourse. Our themes indicate that trust can be established through: (1) embodied healthcare that focuses on connecting with patients' lived experience, (2) dialectic communication that recognises patient experiences and remains open to alternative perspectives.

Interpretation: This study raises some important issues for education and practice. Our findings can translate to other health settings where treatments aimed to provide care have caused harm.

Funding: NIHR Policy Research Programme (NIHR202450).

Keywords: Qualitative research; Social science; Stress urinary incontinence; Tension-free vaginal Tape; Urogynaecology.

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Conflict of interest statement

FT has received grants or contracts from 10.13039/100004319Pfizer, 10.13039/501100000272NIHR Policy Research Programme and the 10.13039/100007388CSP charitable trust. MK is Chair of International Urogynaecological Association FTECP committee. AM has received grants or contracts from the Oliver Bird Fund, 10.13039/501100000279Nuffield Foundation: OBF/43985 and the 10.13039/501100000664HTA Project: NIHR127489. The other author declares that they have no competing interests beyond their funding source.

Figures

**Fig. 1**
**Conceptual model: (re)negotiating trust.** This figure represents our conceptual model. We see a process anchored around two dualities placed on a lemniscate (body parts/whole person: dominant discourse/marginal discourse). (Re)negotiating trust requires the clinician to negotiate these dualities by (a) treating the patient with dignity as an embodied whole and not focusing solely on body parts, and (b) being open to alternative perspectives rather than remaining fixed on the dominant discourse.

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Cited by

Exploring the experiences of people with urogynaecology conditions in the UK: a reflexive thematic analysis and conceptual model.
Toye F, Dixon S, Izett-Kay M, Keating S, McNiven A. Toye F, et al. BMC Womens Health. 2023 Aug 14;23(1):431. doi: 10.1186/s12905-023-02592-w. BMC Womens Health. 2023. PMID: 37580761 Free PMC article.
Pain and other complications of pelvic mesh: a systematic review of qualitative studies and thematic synthesis of women's accounts.
Williams ACC, Lodato M, McGrigor H. Williams ACC, et al. BMJ Open. 2024 Jun 3;14(6):e085879. doi: 10.1136/bmjopen-2024-085879. BMJ Open. 2024. PMID: 38830733 Free PMC article.

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[1] Greco C. The Poly Implant Prothèse breast prostheses scandal: embodied risk and social suffering. Soc Sci Med. 2015;147:150–157. - PubMed

[2] Greco C. The Poly Implant Prothèse breast prostheses scandal: embodied risk and social suffering. Soc Sci Med. 2015;147:150–157. - PubMed

[3] IMMDSR . Crown copyright; 2020. First Do No Harm – The report of the Independent Medicines and Medical Devices Safety Review.https://www.immdsreview.org.uk/downloads/IMMDSReview_Web.pdf - PubMed

[4] IMMDSR . Crown copyright; 2020. First Do No Harm – The report of the Independent Medicines and Medical Devices Safety Review.https://www.immdsreview.org.uk/downloads/IMMDSReview_Web.pdf - PubMed

[5] Cohen D. How safe are metal-on-metal hip implants? BMJ Br Med J (Clin Res Ed) 2012;344 - PubMed

[6] Cohen D. How safe are metal-on-metal hip implants? BMJ Br Med J (Clin Res Ed) 2012;344 - PubMed

[7] Slieker-ten Hove M.C., Pool-Goudzwaard A.L., Eijkemans M.J., Steegers-Theunissen R.P., Burger C.W., Vierhout M.E. The prevalence of pelvic organ prolapse symptoms and signs and their relation with bladder and bowel disorders in a general female population. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(9):1037–1045. - PMC - PubMed

[8] Slieker-ten Hove M.C., Pool-Goudzwaard A.L., Eijkemans M.J., Steegers-Theunissen R.P., Burger C.W., Vierhout M.E. The prevalence of pelvic organ prolapse symptoms and signs and their relation with bladder and bowel disorders in a general female population. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(9):1037–1045. - PMC - PubMed

[9] Smith F.J., Holman C.D., Moorin R.E., Tsokos N. Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol. 2010;116(5):1096–1100. - PubMed

[10] Smith F.J., Holman C.D., Moorin R.E., Tsokos N. Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol. 2010;116(5):1096–1100. - PubMed

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The experience of women reporting damage from vaginal mesh: a reflexive thematic analysis

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The experience of women reporting damage from vaginal mesh: a reflexive thematic analysis

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