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Patient experience of pain during vaginal pessary removal and insertion: a service evaluation study

  • Original Article
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International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

Pelvic organ prolapse is a common problem affecting women, but there is currently a lack of research focusing on patient experience of pessary changes. This study was aimed at capturing the patient perspective of pessary changes and formally assessing pain during pessary removal and insertion.

Methods

A service evaluation request was granted by South Tees Hospitals NHS Trust. Patients undergoing pessary change (ring, shelf, or Gellhorn) in gynaecology outpatient clinics over a 6-month period were asked to rate their pain scores on a ten-point numerical pain-rating scale. Other associated data were collected.

Results

Out of 213 women, 58.2% reported that pessary removal was more painful than insertion, 30.5% reported equal pain, and 10.8% reported that insertion was more painful than removal. Pain scores were significantly higher for removal (mean 4.37, median 4, IQR 4–7) than for insertion (mean 2.66, median 2, IQR 2–4, p <0.001). Ring pessaries were significantly less painful to both remove and insert than shelf and Gellhorn pessaries. Smaller pessaries were more painful to both remove and insert. There was no significant difference in pain scores reported by those with or without diagnosed vulval conditions.

Conclusions

Pessary removal causes most women moderate pain, which should be communicated to patients beforehand. Ring pessaries are significantly less painful to change than other pessary types. Clinicians should consider pain as a factor in their decision-making surrounding pessary choice and when counselling patients. Future research should focus on ways to reduce pain during pessary removal.

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Abbreviations

HRT:

Hormone replacement therapy

NRS:

Numerical rating scale

POP:

Pelvic organ prolapse

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Acknowledgements

We wish to acknowledge Sister Colette Anderson, Sister Karla Kennedy and registered nurses Linda Rozsas and Jenny Hill, who deliver pessary clinic care and assisted in data collection. We wish to thank all patients who took the time to complete the service evaluation questionnaire.

Author information

Authors and Affiliations

  1. South Tees NHS Foundation Trust, Middlesbrough, UK

    Caitlin Renouf, Paul Ballard, Aethele Khunda, Victoria Kershaw & Sami Shawer

  2. University of Sunderland, Sunderland, UK

    Jon Rees

Authors
  1. Caitlin Renouf
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  2. Paul Ballard
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  3. Aethele Khunda
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  4. Victoria Kershaw
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  5. Sami Shawer
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Contributions

C. Renouf: project development, data collection, data analysis, manuscript writing and editing; P. Ballard: project development, data collection, data analysis and manuscript editing; A. Khunda: data collection, data analysis and manuscript editing; V. Kershaw: manuscript editing; S. Shawer: manuscript editing; J. Rees: data analysis and manuscript editing.

Corresponding author

Correspondence to Caitlin Renouf.

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Conflicts of interest

Aethele Khunda has received educational grants from Medtronic, Axonic, Olympus and international conference organising committees. Victoria Kershaw has received educational grants to attend courses from Medtronic and Olympus. The other authors declare that they have no conflicts of interest.

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Written informed consent was obtained from the patient for publication of this original article.

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Appendix 1: Proforma questionnaire

Appendix 1: Proforma questionnaire

  1. 1.

    Are you using any vaginal HRT: No/Oestrogen cream/Vagifem (please circle)

  2. 2.

    If yes, how often: Once a week/Twice a week/Other (please circle or write)

  3. 3.

    Have you been diagnosed with a specific vulval skin condition: No/Lichen sclerosus/Other

  4. 4.

    a. Is this your first pessary change: Yes/No. b. How long have you used pessaries for? (years)

  5. 5.

    How painful did you find the removal of your ring/shelf/Gellhorn pessary (on a 0–10 scale): 0 = no pain, 10 = worse pain, like labour pain

  6. 6.

    Size of the removed pessary

  7. 7.

    Trauma to the perineum: No/Yes, estimated size of tear (mm)

  8. 8.

    How painful did you find the (re-)insertion of your pessary (on a 0–10 scale): 0 = no pain, 10 = worse pain, like labour pain

  9. 9.

    Size of the newly inserted ring/shelf/Gellhorn pessary

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Renouf, C., Ballard, P., Khunda, A. et al. Patient experience of pain during vaginal pessary removal and insertion: a service evaluation study. Int Urogynecol J 35, 327–332 (2024). https://doi.org/10.1007/s00192-023-05643-w

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  • DOI: https://doi.org/10.1007/s00192-023-05643-w

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