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Supporting pessaries helpful for prolapse management

19 October 2020

Pelvic organ prolapse is a common problem in the perimenopause and can cause significant discomfort and distress.

Pelvic floor exercises are important for all women to help maintain pelvic floor health, but if other treatments are required, one option is the use of a supporting vaginal pessary. A new study by Camila Teixeira Moreira Vasconcelos, Maria Laura Silva Gomes et al. published in Neurourol Urodyn. 2020 Aug 26, has shown that successful use of pessaries is possible.

The study collected details of women with symptoms of genital prolapse referred to a public hospital tertiary care clinic (2013-2019). Ring and ring with support pessaries were used for fittings. An unsuccessful fit was defined as failure to continue pessary use at 4 weeks post fitting trial.

All 170 women with symptomatic prolapse referred to the clinic accepted to undergo a pessary fitting. More than 70% were successful at 4 weeks. An average of 1.7 pessaries (range: 1-6) per patient were used to identify the best-fitting pessary and a range of sizes were used. Women with body mass index greater than or equal to 30kg/m, total vaginal length of less than 7.5cm, and sexually active women were associated with increased unsuccessful fitting.

The authors concluded that the vaginal pessary proved to be an excellent choice, with high acceptance and successful fitting rates.

With ongoing controversies about surgical management of prolapse, more conservative management including the use of vaginal pessaries, should continue to be offered.

Pessary evaluation for genital prolapse treatment: From acceptance to successful fitting

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