A 54-year-old Auckland mum is looking at a $12,000 bill to try to repair her birth injury if she wants to avoid surgical mesh treatment.
However, if she opts for treatment using mesh it's free because her insurance company covers it.
The mum - who asked not to be named - contacted the Herald after reading stories about women who continue to be harmed by the medical device despite Government officials ordering hospitals to take action to minimise the danger from these operations.
One woman who shared her story with the Herald was 73-year-old Sally Walker. She was forced to have her bladder removed and vagina sewn closed after her insides were so badly damaged from mesh.
The 54-year-old mum said she had a friend who was injured after mesh was implanted into her body and, like Walker, endured years of suffering.
So, when it came to seeking help for her own bladder weakness, she put it off.
"I'm certain I don't want mesh," she said.
Now, she can't play golf or go to a party without wetting herself and needing to change her clothes.
"I have to plan ahead for everything," she said.
Her surgeon told her she could opt for a Bulkamid injection - which was like the gel used for lip fillers but instead was inserted into the wall of the urethra near the bladder. The injection added volume to the wall of the urethra to provide support and better control of urine flow.
While the injection has a lower success rate - about 60 to 70 per cent - than mesh, hospitals deemed it far less risky. The injection also meant a much quicker recovery time, though it may only last five years.
The mum said her choice was to give the injection a go, however, her insurance provider, Southern Cross wouldn't cover it and it wasn't deemed urgent enough to be performed through the public system.
"It means either I come up with $12,000 or I carry on putting up with it."
She said she had been paying Southern Cross premiums for 20 years which was about $1200 a year.
Canterbury urologist Giovanni Losco said in August 2020 he applied for Southern Cross to cover Bulkamid injections but it was declined.
"This is a treatment that we know is good, it works, it's used in the public system, it's funded by ACC and we want patients that have Southern Cross insurance polices to also be able to utilise it," Losco said.
Losco - who is a member of the Urological Society of Australia and New Zealand and clinical director at Christchurch Hospital - said the bulking injections gave women a choice.
"One of the arguments we put to Southern Cross was that by choosing not to fund it, you are actually taking away that choice," Losco said.
"That's why women choose to have health insurance, to give them that choice."
He said he has successfully treated about 30-40 women, who were suffering from stress urinary incontinence, with bulking injections.
"In fact, I had an 80-year-old woman just yesterday, who was very active, she plays golf three times a week and she just said it had totally changed her life, she can get back on the golf course and doesn't need to wear pads."
"It's all about empowering women by giving them a choice."
Southern Cross chief medical officer Stephen Child said the application was declined because the benefit that members would have received from the Bulkamid injections for a $100,000 investment didn't prioritise as well as other treatments they choose to fund.
He said Southern Cross did fund the native tissue procedure which was a major operation with longer recovery but an alternative to mesh, Child said.
The mum said she didn't want the native tissue repair as it meant she would have to take three weeks off work and endure six-week recovery, compared to one day if she got the injection.
Child said he was sorry to hear that some people felt roadblocked from an alternative treatment.
"Our mission statement is to empower members to live healthier lives and therefore we would hope that what we are doing with Southern Cross is giving people access to the best consultations, best surgical options that are out there and physiotherapy as you know we funded, that's an example where the quality of life years gained for the dollars invested is very good."
"We would hope we have funded as many options for women as possible. I'd be sad if that's how women felt and I'm sorry because that's not our intention at all."
Child said his team were always open for reanalysing, reapplication and review.
Southern Cross received about 40 to 60 applications for treatments a year, he said.
Meanwhile, support was growing for a petition, launched by Walker, to pause the use of surgical mesh to treat stress urinary incontinence (SUI).
Organisations including the Consumer Advocacy Alliance (CAA), Cartwright Collective (CC), Auckland Women's Health Council (AWHC), and the Federation of Women's Health Councils (FWHC) have come together to support Walker's petition to suspend these procedures.
CC's Sandra Coney said it was distressing to see such significant harm still occurring.
"Clearly women are not being warned of the risks and the Ministry of Health needs to prohibit the insertion of mesh products in women's bodies. There is still inadequate regulation of medical devices three decades after similar harm to women from certain IUDs."
In 1987, Coney broke a story alleging that women had been experimented on, without their consent, at Auckland's National Women's Hospital in Auckland.
The article, titled 'The Unfortunate Experiment', led to the Cartwright Inquiry, which confirmed the allegations and marked a turning point in healthcare ethics in New Zealand.
Losco, however, said he thought the petition was a shame because stress incontinence was a significant problem and mesh was still a good option, it just needed to be done by the right people who are properly trained.
"If you were to put a pause on it you are actually denying women that choice," he said.
When the Herald asked Losco how harm could be avoided without a pause, he said: "it's about trying to create a system that still gives women access to this surgery but only through properly trained and credentialed surgeons" which was being worked on by the Ministry of Health.
"The main flaw of what we have been doing since 2018 is that every DHB was required to it their own way and now the Ministry of Health is actually centralising that so there's going to be one committee with the same standard," Losco said.
• In Her Head is a Herald campaign for better women's health services. Reporter Emma Russell investigates what's wrong with our current system and talks to wāhine who have been made to feel their serious illness is a figment of their imagination or "just part of being a woman".
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'He was such a nice chap. He had a word for everybody.'