Gender, surgery and silencing women: why the ‘mesh scandal’ is depressingly familiar

On 12 March, BBC News reported on the case of Lucinda Methuen Campbell, a woman who had been treated in 2014 with a mesh implant. Campbell had consulted the surgeon privately, ‘desperate for a solution to the pain’ she was experiencing, linked to ‘complex’ problems with her bowel and womb. She wanted to avoid having a hysterectomy, and a surgical mesh promised a solution.

Campbell’s surgeon, Tony Dixon, was one of the pioneers of the use of a surgical mesh to fix prolapses of the bowel. A mesh is a woven sheet that is used as a permanent or temporary support for internal organs and tissues. Since the 1990s, meshes have been used in a range of reconstruction and repair surgeries, especially for pelvic and vaginal wall reconstructions in women.

Some meshes are intended to degrade in the body and others are more permanent. All are increasingly controversial. Polypropelene meshes in particular have been associated with severe discomfort and internal problems. More than one woman has died from complications linked to the use of vaginal mesh treatment.

Chrissy Brajac, just 42 years old, died of sepsis after repeated, antibiotic resistant infections linked to a mesh that she received. In her case, as in that of thousands of other women, this extreme and dangerous treatment was presented as a solution to minor stress incontinence after childbirth: the kind of condition that can be treated by a course of physiotherapy.  

Because of cases like Brajac’s, the vaginal mesh scandal, also referred to as the 'new thalidomide scandal’ (thalidomide being the anti-sickness medication once given to pregnant women with catastrophic effects) has attracted considerable attention. There are class action suits being brought around the world. An estimated 10,000 women every year in Britain alone receive a mesh implant for prolapse, hernias or incontinence, and despite fears over its safety, the operation is still being performed.

Somewhere between 10 and 40 per cent of women are believed to have experienced problems with mesh implants: not just chronic pain and loss of sex life, but also, as a recent article in The Independent noted, ‘organ erosion, perforation, implants slicing into vaginal walls, debilitating infections’ and more. Women report being dismissed and ignored or treated as hysterical when they draw attention to their suffering; surgeons defending the treatment maintain that no device is perfect, and that they offer patients a 'choice'.

In 2017, Parliament rejected cross-party calls for a suspension to mesh treatment. After a tremendous campaigning effort, the government finally agreed in January 2018 to review all cases of mesh implants (more than 100,000 cases), dating back to 2005.

This story is depressingly familiar. In the 1950s, when silicone implants were developed, they were announced as a saviour for women with breasts that were too small. Indeed, the condition of ‘hypomastia’ or pathologically small breasts was invented by psychiatrists at the same time as male cosmetic surgeons and silicone manufacturers came up with a solution: silicone implants, that could look and feel like the ‘real thing’.

The first woman to receive silicone breast implants, Tammie Jean Lindsey, agreed to be a guinea pig after she went to see cosmetic surgeons about her sticking out ears. The surgeons who were working on the silicone implants – and had successfully implanted them into a dog – offered to pin her ears back for free, provided they could pop in some silicone implants at the same time. Lindsey hadn’t realised her breasts needed enlarging until the surgeons pointed it out to her. She agreed and spent the next few decades  in agony.

Since that time, there have been multiple questions raised about the ethics and safety of implants, including a moratorium on silicone implants in the US, and the PIP scandal in Europe. In the latter case, thousands of women reported psychological and physical problems linked to the implants, which were not made of medical-grade silicone, but the same material used to stuff mattresses. Nevertheless, silicone breast implants continue to be in demand, along with a wide range of cosmetic interventions.

It is not unusual for women’s complaints of ill-health to be rejected. There is a long tradition in medical history of hystericizing women’s experience, or reducing it to psychological causes. The term ‘hysterical’ itself comes the Greek word hysterika, meaning womb. The Ancient Greeks believed that a wandering womb that moved around the body caused a variety of mental disturbances. How often is the term ‘hysterical’ used today to dismiss a woman’s experience? There is more than one book on the history of women’s voices being ignored within medicine.

What the mesh scandal tells us is that yet again women’s health is being risked by a medical procedure that is demonstrably flawed. Women’s stories have been denied and not heard by professionals invested in the continued use of the mesh. It is only now that NHS records acknowledge a 'shocking' rate of failure that the mesh is under scrutiny. A similar neglect for women’s voices has been seen historically in the dismissal of conditions like endometriosis and the over-use of hysterectomies to treat a wide range of ailments.

Time and again in history, women’s bodies have been treated as a series of parts; in the case of urinary and gynaecological complaints, organ removal is often seen as an easy or convenient solution that requires less investment of time, and arguably money, on the part of healthcare providers. Since women are principally viewed through the lens of reproduction, why keep parts that are no longer functional?

There is no better illustration of this, than in the treatment meted out to Lucinda Methuen Campbell. Unbelievably, Dixon is said to have removed Campbell’s ovaries during her operation. He did so without her permission, and apparently without remorse. When she asked why, his justification was simple: she didn’t need them, and they were ‘in the way’. When Campbell expressed shock, the surgeon apparently said he had done her ‘a favour… I thought you know, a woman of your age [she was 54] wouldn’t really need ovaries’.

Ovaries are not merely designed to produce the eggs that lead to babies and women’s function is not entirely to reproduce. Ovaries perform a complex hormonal regulation of the body, and their removal has serious side effects that range from depression and anxiety and a decreased sex drive to premature death. 

How shocking that a surgeon’s convenience should be seen as more important than a patient’s systemic health, as well as her rights over her own body. And how familiar this is to other aspects of invasive medical treatment without consent – including, for instance, the little known but widely practised policy of giving anaesthetised women pelvic examinations for student training purposes.

‘My life is absolutely ruined’, Campbell reported after receiving the mesh. Sadly, she died at home in Swansea on 22 January, leaving two children, according to the South Wales Evening Post. The cause of her death is still being investigated. Dixon has been suspended by the NHS from performing this and related surgeries, and he has been referred to the General Medical Council for investigation.

The mesh scandal reflects an international crisis in confidence around medicine, surgery and women's health. Importantly, this is not a story about the universal indifference of surgeons to the suffering or rights of patients. Many surgeons care deeply about the impact of their work, and about the broader socio-political context in which they engage with women’s health. Which is why we need to hear more from and about these surgeons, especially those who speak out about invasive treatments that are ethically questionable, of unproven efficacy, and potentially damaging to health.