Rates of Pessary Self-Care and the Characteristics of Patients Who Perform it

Abstract

Objective The aims of this study were to determine the percentage of patients who opt to undergo pessary self-care versus those who return to the office for care and to identify any differences in the characteristics between the 2 groups. Methods This study is a retrospective chart review conducted at a tertiary care center. Demographic data; details regarding pessary use; body weight; pelvic organ prolapse stage; and medical, surgical, and obstetrical histories were evaluated. Variables were compared between groups of patients using the t test, Wilcoxon rank sum test, χ2 test, and Fisher exact test. Results The rate of patients choosing to perform pessary self-care was 31%. The patients in the self-care group were significantly younger (65.0 vs 75.0 years, P < 0.001). Those who were performing self-care were more likely to be premenopausal (6.9% vs 1.5%, P = 0.003), have a lower stage of pelvic organ prolapse (61.3% vs 42.1%, P < 0.001), and more likely to be sexually active (40.5% vs 9.6%, P < 0.001). Those not performing self-care had higher rates of vaginal bleeding (26.0% vs 16.4%, P = 0.012) and erosion (23.5% vs 9.9%, P < 0.001). Self-care patients predominantly used the ring with support pessary, whereas those in the non–self-care group were mostly using the Gellhorn. Conclusions Only one third of patients who use a pessary chose to perform self-care. Patients who use self-care are younger, premenopausal, sexually active, and have lower degrees of prolapse. These data can help educate patients on the characteristics more often seen in those choosing self-care. This study highlights the importance of further exploring pessary care preferences and using this information for counseling.

What is known from the existing literature about self-management of pessaries for pelvic organ prolapse? A scoping review

“…Several characteristics were associated with women being more likely to self-manage, including being younger,16–23 being premenopausal,23 being sexually active,18 19 21 having a higher level of education,18 prolonged pessary use,24 having fewer comorbidities,17–19 22 23 a lower stage of prolapse (one or two),19 23 a smaller genital hiatus22 and being diagnosed with atrophy 21…”

“…These work by providing both structural support and filling the vaginal cavity to prevent vaginal descent 25. Women using space occupying pessaries are less likely to perform self-management than those using support pessaries 19 23. Moreover, Clemons et al 36 state gell-horn pessaries are too difficult to self-manage, a perception shared by many pessary practitioners 12 14.…”

“…Self-management reduces complications when compared with clinician-led care, with an overall complication rate for self-managing women of 10%–16%,35 37 44 compared with complication rates of 62% for women receiving clinician-led care 35. Studies report a lower rate of vaginal erosions for self-managing women 19 23. However, no difference was reported between women self-managing or receiving clinician-led care regarding vaginal pain, discharge or irritation 21.…”

“…Several characteristics were associated with women being more likely to self-manage, including being younger, [16][17][18][19][20][21][22][23] being premenopausal, 23 being sexually active, 18 19 21 having a higher level of education, 18 prolonged pessary use, 24 having fewer comorbidities, 17-19 22 23 a lower stage of prolapse (one or two), 19 23 a smaller genital hiatus 22 and being diagnosed with atrophy. 21 Age differences between women who self-manage or receive clinician-led care may be due to generational attitudes to pessary use or touching one's genitals, or the value associated with perceiving a clinic appointment as a social event with associated psychological and emotional support as proposed by Storey, Aston.…”

Letter to the editor: The extended pessary interval for care (EPIC) study: a failed randomized clinical trial

“…One reason for not achieving sufficient sample size is the omission of these individuals. It was better to check the questionnaire in terms of validity and reliability and to give it to patients in a pilot study [3]. If the pilot study Roksana Janghorban…”