Objective To describe the patient cohort accessing a quaternary pelvic mesh referral service, identify their requirements and ensure services can meet their needs. To determine areas of future research. Design Retrospective and prospective observational study. Setting Quaternary pelvic mesh complications service in the U.K Population Women accessing a pelvic mesh complications service over 5 years. Methods All women attending the mesh complication service between 2018 and 2023 were included. Data was collected on referral rates, demographics, mesh complications experienced, management options selected, and post operative complications suffered. Mesh complications were compared against mesh devices and management options chosen. Results 785 women were managed in the mesh service over 5 years. Of 765 women with confirmed mesh devices, 92% (n=707/765) were referred with a painful mesh complication and 54% (n=416/765) reported pain alone. Fifty eight percent requested surgical management (n=403/692). Of 288 who received surgery, 52% (n=150/288) requested complete mesh excision. The recurrent Stress Urinary Incontinence (SUI) and Pelvic Organ Prolapse (POP) rate was 66% (n=141/215) and 23% (3/13) respectively. Eighteen percent (n=51/288) experienced a surgical complication however only 0.7% (2/288) were considered serious . Conclusions This study has identified patients reporting ‘pain alone’ as the commonest patient cohort attending a UK pelvic mesh centre between 2018 and-2023, suggesting that mesh associated pain exerts considerable burden on affected individuals and maybe more prevalent than once thought. This group has the greatest variation in treatment. Further research is required to understand the pathophysiology of mesh related pain to inform effective treatment options.