Vaginal Pessaries Effective for Many Women With Pelvic Organ Prolapse

By Linda Carroll

February 25, 2021

(Reuters Health) - For many women, especially seniors experiencing pelvic organ prolapse, vaginal pessaries may be an effective long-term treatment, a new study suggests.

An analysis of data from 239 women who were fitted for pessaries revealed that more than three of four were still using the devices after five years.

"We conclude that based on the results of the five-year treatment, the vaginal pessary is an effective treatment in patients with symptomatic POP (pelvic organ prolapse), with a high continuation rate and minor complications," write the researchers, led by Dr. Lan Zhu, deputy director of the department of obstetrics and gynecology at the Peking Union Medical College Hospital in Beijing, China.

"The use of pessaries can significantly reduce pelvic reconstructive surgery application. Among patients who discontinued pessary use, most patients opted for surgery in the first two years. A total vaginal length of less than 7.5 cm, poor improvement in urinary symptoms at three months and incapability of self-care were potential risk factors for discontinuation," they report in Menopause.

To explore whether pessaries could be an effective treatment for POP, Zhu and her colleagues recruited 312 women with a mean age of 68.9 between November 2013 and July 2015 for the prospective study. "Pessaries, which are devices inserted into the vagina, have been used as nonsurgical management for symptomatic POP for thousands of years," the researchers note.

Among the 312 study participants, 265 (84.9%) had a successful pessary fitting. The reasons for the unsuccessful fitting in 47 patients were: discomfort (22 patients); expulsion (15 patients); failure to relieve prolapse symptoms (5 patients); difficulty to start and/or empty bladder in (4 patients); and de novo urinary incontinence (1 patient).

Nearly all the patients (97.5%) were postmenopausal and none had received systemic estrogen or topical vaginal hormone therapy before pessary treatment. Nearly all the patients were classified as having stage III (84.9%) or stage IV (12.1%) prolapse. A total of 202 (84.5%) patients had one or more concomitant urinary symptoms, including incontinence (40.2%), urgency (48.1%) and voiding difficulty (62.8%).

One hundred eighty three patients (76.6%), were fitted with a ring pessary with support while the remaining 56 (23.4%) were fitted with a Gellhorn pessary. Most of the patients chose to remove the pessary themselves, but 54 (22.6%) needed the help of their caregivers.

During the next five years, 26 women were lost to follow-up, including five who died from unrelated causes. The remaining 239 women who completed the study were included in the analysis.

The authors did not respond to a request for comment.

Given that the average age of the women in the study was 69.8, it's likely that most were seniors, said Dr. Jocelyn Fitzgerald, an assistant professor of obstetrics, gynecology and reproductive sciences in the division of reconstructive pelvic surgery at UPMC Magee-Women's Hospital in Pittsburgh.

"Vaginal pessaries are an extremely important tool in female pelvic medicine - they are like orthotics for the vagina and prolapsed pelvic organs," said Dr. Fitzgerald. "These women were almost 70 on average and it's known that pessaries are a better tool in older women who are able bodied."

Younger women are less likely to choose a pessary over surgery, Dr. Fitzgerald said. "They tend to be more active and are less excited about managing a pessary for 30 or more years," she added.

Many women are able to maintain ring pessaries on their own, Dr. Fitzgerald said. "Studies done during COVID-19 suggest we probably bring women with well-managed pessaries into the office too often," she added.

Women do need to be checked periodically "to make sure the vaginal tissue is healthy and that there are no erosions," Dr. Fitzgerald said.

SOURCE: https://bit.ly/3aQQdb9 Menopause, online February 22, 2021.

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