An independent provider in the Merton area

3. Ms G complains a consultant at an Independent London NHS Provider (The Provider) performed a sacrocolpopexy operation in August 2022 without diagnosing her correctly or completing testing and caused a perineal hernia.

4. Ms G says this has left her experiencing daily physical pain and she is now unable to work, causing her ongoing mental, physical, and financial implications.

5. Ms G wants service improvements and financial compensation.

6. In 2019 Ms G had colovaginoplasty surgery abroad.

7. In February 2020, following a severe cough, she described the feeling of something moving down inside her body. She also experienced frequent urination, vaginal bleeding after dilation and left sided vulval swelling so approached her local NHS trust (the Trust).

8. The Trust referred Ms G to The Provider, who diagnosed prolapse of the vaginal vault. She had sacrocolpopexy surgery at The Provider to resolve this in August 2022.

9. In November, Ms G told doctors she was again having a sensation of something coming down. An examination found bulging alongside her neovagina (surgically created vaginal canal), suggestive of a left sided hernia.

10. The Provider operated on Ms G to remove the spermatic cord and excess scar tissue in March 2023. It identified the hernia and following scans and further investigations between then and July, The Provider deemed that Ms G would require a further operation – open hernia surgery.

11. The NHS decided that Ms G’s hernia did not require the same specialist input of The Provider and declined private funding in favour of NHS general surgery. Ms G had hernia repair surgery in April 2025.

16. Ms G complains that The Provider performed surgery to correct a neovaginal prolapse in August 2022 without conducting any investigations or scans, such as an MRI, which would have accurately assessed the problem before surgery.

17. She complains that she received open surgery in place of a laparoscopic camera, which left her in pain, with a long recovery time and a large scar. She had the later hernia repair done using this approach, and questions whether The Provider’s refusal was cost based rather than patient centred.

18. Ms G also complains that NHS staff told her The Provider’s surgery had caused a perineal hernia, not diagnosed until February 2024. She says The Provider then refused to resolve the problem it caused.

19. The Provider said the problems with the hernia did not become apparent until surgeons had addressed the prolapse. It said one problem, or its associated surgery, did not cause the other.

Pre surgery investigations

20. The records show that Ms G had a sacrocolpopexy to treat vaginal vault prolapse in August 2022.

21. We usually consider what happened using national clinical standards and guidance. Our urology adviser explained that the national clinical guidelines for female incontinence apply to vaginal vault prolapse in women, but do not apply to transgender patients, as the anatomy is different. In the absence of applicable guidance, we considered whether what happened was in line with GMC’s Good Medical Practice guidance.

22. GMC Good Medical Practice (January 2024) says doctors must provide treatment that meets a patient’s needs, in their best interests and with the patients’ informed consent.

23. Our urology adviser explained that vaginal vault prolapse is diagnosed solely through examination. They confirmed that there is no requirement for patients to have a scan. Given this, we are satisfied that there is no gap between what happened ahead of surgery, and what should have happened.

Necessity of surgery

24. Our urology adviser noted two possible causes for a vault prolapse, following gender reassignment surgery. They explained that a neovagina is attached to the perineal structures, and if those structures are weak, it can lead to prolapse. Our urology adviser explained the second possibility is that the original surgery may have led to damage of the nerve that controls the pelvic floor.

25. Our urology adviser explained that both of these complications occur gradually and take many years to become apparent. Reviewing the records with this specialist input, we are satisfied that the vault prolapse did exist and that Ms G’s surgery in August 2022 was necessary. We hope she finds this reassuring.

Surgical approach

26. The records show that ahead of the August 2022 surgery, Ms G had asked for a laparoscopic procedure, using a small camera, in favour of open surgery. We can appreciate her rationale, as a smaller entry point means faster recovery. The consultant noted that her previous sigmoid vaginoplasty and its associated scar tissue meant a laparoscopic approach was extremely unlikely to be successful.

27. We can recognise that Ms G did go on to have hernia surgery in April 2025, using a laparoscopic approach, but we cannot say this is evidence The Provider should have done the same, because although staff accessed the same area of her body, the surgery was for a different purpose. It is not possible to consider the appropriateness of surgical approaches when the purpose and associated complications of the surgeries were different.

28. We also have to consider that the records contain a consent form setting out the proposed approach, which Ms G signed, and evidence that the consultant completed the procedure using that plan.

29. Whilst we can recognise that Mrs G did experience a longer recovery time, we have seen clear evidence that The Provider worked within GMC guidance. The records show the consultant discussed the different surgery approaches in line with Ms G’s best interests, before seeking informed written consent from Ms G to perform the procedure. For further reassurance, we have also seen the invoicing communication between The Provider and the commissioning organisation, and there is nothing to suggest this decision was in any way cost driven.

Hernia

30. In November, a consultant examined Ms G and found bulging that suggested a hernia on the left, alongside her neovagina. We considered the connection between the August surgery, and the November findings.

31. Our urology adviser explained that the type of surgery Ms G had in August, can be approached via the abdomen from above, or via the perineum from below. The records show the surgeon approached the site from above.

32. Our urology adviser explained that an abdominal entry point meant that it was not possible to affect the muscles in the pelvic floor. In other words, the surgery in August could not have caused the later diagnosed perineal hernia, and pelvic floor sagging.

33. Whilst we can see that Trust staff were of the opinion the problem originated with The Provider’s 2022 surgery rather than the original 2019 surgery, our urology adviser did not agree. Here we face a difference of clinical opinion. However, we are satisfied that our urology adviser has provided sufficient rationale to outline the reasons why it was not possible and we can see no reason why that information is wrong.

34. We asked our urology adviser whether these problems could have been identified sooner. They explained that it would not have been possible for surgeons to identify the hernia, because the vaginal vault prolapse obscured the area. This became apparent later once the problem was addressed.

35. We asked our urology adviser whether there were any other aspects of Ms G’s complications before and after the surgery in August 2022, that could have been foreseen, prevented, or avoided.

36. Our urology adviser could not see that any of the problems Ms G encountered were caused directly by the vault prolapse surgery. The records show that The Provider considered the requirement for surgery through appropriate examination. With no outstanding actions, we are satisfied that what happened during surgery is what should have happened and if the problem existed in August, surgeons could not have spotted it.

Refusal of revision

37. The records show that The Provider would not provide further service without further NHS funding. The Provider is a private health provider that only provides NHS services through special commissioning, rather than on an ad hoc basis. In Ms G’s case, approval came through the NHS Gender Dysphoria National Referral Support Service (GDNRSS).

38. In March 2023, the records show that The Provider performed an orchidectomy, to remove the spermatic cord and excess scar tissue. In June, The Provider requested funding to resolve an apparent hernia next to the prolapse. GDNRSS declined this funding in favour of general NHS surgery, which placed Ms G back on an NHS surgery waiting list. This means that the GDNRSS declined NHS funding for the surgery, rather than The Provider refusing to provide further care.

39. Ms G’s journey through gender reassignment must have been stressful and our investigation does not take away from that experience. We can recognise the anxiety and anguish she felt, and we hope that our investigation has provided some answers and reassurance. We sincerely wish her all the best going forward.

1. We have carefully considered Ms G’s complaint about an Independent NHS Provider (The Provider). We are sorry to read of her experience, and we recognise the profound effect she describes the complications as having on her quality of life.

2. We have seen evidence that shows Ms G’s surgery in August 2022 was necessary. We have seen no evidence to show that the surgery went on to cause a hernia.