Sling The Mesh is deeply concerned to see a global organisation, the International Urogynecological Association (IUGA), publishing a glowing spotlight article featuring an Indian surgeon who continues to use transvaginal mesh for pelvic organ prolapse (POP) – despite its ban in many countries due to serious and well-documented harm.

In a recent IUGA article, Dr Karthik Gunasekaran describes how he not only continues to use transvaginal mesh for prolapse, but also:

• Cuts his own mesh by hand from sheets of polypropylene – a practice that lacks standardisation and has been linked to erosion, chronic pain, and other complications.
• Uses “reusable trocars”, increasing the risk of infection and cross-contamination.
• Admits to off-label use, potentially without fully informed patient consent.
• Shows no mention of disclosing these products are banned in many countries for safety reasons.

This is nothing short of shocking.

Banned – for a reason

Transvaginal mesh for prolapse has been withdrawn or banned across much of the world:

• United States banned by the FDA in 2019
• United Kingdom banned in 2018
• Australia banned in 2017
• New Zealand banned in 2017
• Ireland banned in 2018
• Canada banned in 2019
• Denmark banned in 2019

These decisions were not taken lightly. They came in response to overwhelming evidence of complications – including mesh erosion, nerve damage, mobility problems, autoimmune reactions, chronic infections, inabiity to have sex due to pain.

Why is this still happening?

Mesh manufacturers may have been forced to exit regulated Western markets, but some have shifted focus to countries with different regulatory oversight. This creates a dangerous double standard where women in lower-income or less-protected healthcare systems are exposed to high-risk procedures banned elsewhere.

We are especially alarmed that IUGA, a global body, would platform a surgeon openly admitting to practices that would not be permitted in the US, UK, or Australia. This raises serious ethical and professional questions:

• Why is IUGA showcasing a surgery that has been stopped in many Western countries
• Are patients in India and elsewhere being fully informed that the mesh being used is off-label, manually cut, and banned in much of the developed world?
• What safeguards exist to protect women from these outdated and dangerous practices?

A Call for Global Standards

The same level of caution, regulation, and transparency applied in the UK or US should apply everywhere. It is unethical to continue exposing women – often without their informed consent – to the same risks that triggered widespread bans and legal actions elsewhere.

We call on:

• IUGA to reflect on the messages it is sending on publishing such material in its online magazine
• Regulators and professional bodies to investigate and take action
• Global health leaders to close this double standard and ensure no woman, anywhere in the world, is exposed to harm