Is this operation worth the risk?

QI’ve suffered from embarrassing leaks for years, and now have a prolapse. I’ve been referred for surgery but have heard some horror stories about it. What questions should I ask the consultant?

AProlapse, like stress incontinence, is incredibly common. It’s thought that up to half of women who have had a baby have it to some degree. It happens when one or more of the organs in your pelvis, such as the rectum, womb or bladder, drops down into your vagina.

If your symptoms are mild, lifestyle changes – such as avoiding smoking or constipation and losing excess weight – may be enough. Pelvic floor exercises can often help. However, it sounds as if you’ve gone past this stage. Vaginal pessaries can also be very effective, but the only ‘cure’ is surgery.

There are several kinds of surgery: vaginal repair (in which the walls of the vagina are tightened); hitching up your vagina and fixing it to a ligament inside your pelvis or to your sacrum; or a ‘sling’ between your cervix and your sacrum. Most involve using a vaginal mesh. However, there has been a lot of bad publicity about prolapse repair, particularly the use of mesh. In some cases, it has eroded through adjacent structures, including the vagina and bladder, causing severe pain, bleeding and urine leakage.

NICE has just produced updated guidance on the use of mesh in these procedures, which recognises that ‘there are serious but well-recognised complications’ and recommends several precautions. These include: ■ The operation must only be done by doctors who specialise in managing prolapse and incontinence; ■ Doctors must have up-to-date training and perform the surgery regularly; ■ Women must have all the possible risks explained to them; ■ One type of procedure (the sling attached to the sacrum) should only be used in exceptional circumstances.

I advise women to think very carefully, and discuss with their surgeon, whether mesh surgery really is the only suitable option.

QI have a suppressed immune system, and have come back from three months away to find my flu vaccine invitation. Am I too late?

AThe flu vaccine is different every year, because scientists have to predict which strains will be circulating. Sometimes they get it wrong, so the vaccine is less effective. We get a good indication of how well it will work from the Southern hemisphere, which immunises earlier. The current vaccine includes protection against the H3N2 strain, which has caused havoc in Australia. It should reduce your risk of getting influenza by at least 50%, and greatly cut the chance of serious infection.

People with diabetes, liver or kidney problems, heart or lung disease, multiple sclerosis, Parkinson’s, or a suppressed immune system are more likely than the rest of the population to die from flu, so are all offered immunisation. There are often outbreaks in January and February, so yes, I would absolutely suggest you get yourself protected!