An Exploration of Sexual and Relational Impacts of Vaginal Mesh Injury: A Systematic Review using Thematic Synthesis

Abstract Background Surgical mesh used to treat Pelvic Organ Prolapse and Stress Urinary Incontinence has caused substantial injury to a growing number of women. The impact of mesh injury is far-reaching, significantly disrupting women’s lives. Whilst there is a growing body of literature examining the impacts, there is little research that specifically aims to understand the sexual and relational implications of mesh injury. This study aimed to systematically review evidence regarding the impacts of mesh injury reported by women in relation to sexual and relational functioning. Methods A systematic search of four databases (MEDLINE, CINAHL, PubMed, and ProQuest Dissertations and Theses) and a grey literature search was conducted in July 2025. Studies reporting qualitative data about women’s experiences of mesh injury where sexual and relational impacts were reported were included. The quality of each study was assessed using the qualitative CASP checklist. The data was thematically synthesised. (PROSPERO registration: CRD420251077730). Results A total of eight studies were included, with upwards of 639 participants identified; however, two of the reports included did not specify the number of participants. Of the eight studies included, five were rated high quality with three rated as moderate. Seven overlapping themes were developed from the data: 1) Sexual functioning: changes due to pain, 2) Changes to sexuality, 3) Relational activity: changes due to pain, 4) Changes to relationship satisfaction, 5) Identity: changing sense of self navigating life with mesh injury, 6) Changes in relational roles and a seventh central theme of disrupted embodied sexual-relational self. Conclusion Women with mesh injury experience significant sexual and relational disruption as a result of chronic pain, contributing to psychological distress. Psychological flexibility appears to be a protective mechanism for relational distress. Further research that seeks to understand these impacts is needed, which may inform the development of appropriate psychological interventions.