Abstract
Introduction and hypothesis
The purpose of this paper is to report our evaluation of changes in intravaginal microbial flora after ring pessary therapy for pelvic organ prolapse (POP) using conventional and our clone library method.
Methods
Thirteen patients with POP who were fitted with a ring pessary participated in this longitudinal study that incorporates data from before and 1 month after beginning ring pessary therapy. Changes in intravaginal microbial flora were evaluated by conventional methods, i.e., vaginal pH, lactobacillary grade (LAC grade), Nugent score, and culture-based bacterial detection methods. In addition, we performed our clone library method using 16S ribosomal RNA (rRNA) sequencing of vaginal fluid.
Results
Conventional methods revealed that most patients had abnormal intravaginal microbial flora. Mean numbers of detected bacterial species by the culture-based and our clone library method were 3.1 (1–6) and 11.8 (1–25), respectively. Our clone library method showed that Lactobacillus spp. increased in four and decreased in two cases after ring pessary therapy but reappeared after therapy in two cases; no Lactobacillus spp. were detected in five cases.
Conclusions
Our study showed that ring pessary therapy did not always disturb intravaginal microbial flora, especially for patients with Lactobacillus spp. prior to ring pessary insertion. Anaerobic circumstances in the vagina after therapy seem to have induced the growth of anaerobic bacteria.
Similar content being viewed by others
References
Atnip SD (2009) Pessary use and management for pelvic organ prolapse. Obstet Gynecol Clin North Am 36(3):541–563. doi:10.1016/j.ogc.2009.08.010
Richter HE, Burgio KL, Brubaker L, Nygaard IE, Ye W, Weidner A, Bradley CS, Handa VL, Borello-France D, Goode PS, Zyczynski H, Lukacz ES, Schaffer J, Barber M, Meikle S, Spino C, Pelvic Floor Disorders N (2010) Continence pessary compared with behavioral therapy or combined therapy for stress incontinence: a randomized controlled trial. Obstet Gynecol 115(3):609–617. doi:10.1097/AOG.0b013e3181d055d4
Abdool Z, Thakar R, Sultan AH, Oliver RS (2011) Prospective evaluation of outcome of vaginal pessaries versus surgery in women with symptomatic pelvic organ prolapse. Int Urogynecol J 22(3):273–278. doi:10.1007/s00192-010-1340-9
Sarma S, Ying T, Moore KH (2009) Long-term vaginal ring pessary use: discontinuation rates and adverse events. BJOG 116(13):1715–1721. doi:10.1111/j.1471-0528.2009.02380.x
Penrose KJ, Ma Yin J, Tsokos N (2014) Delayed vesicovaginal fistula after ring pessary usage. Int Urogynecol J 25(2):291–293. doi:10.1007/s00192-013-2143-6
Khaja A, Freeman RM (2014) How often should shelf/Gellhorn pessaries be changed? A survey of IUGA urogynaecologists. Int Urogynecol J 25(7):941–946. doi:10.1007/s00192-014-2329-6
Alnaif B, Drutz HP (2000) Bacterial vaginosis increases in pessary users. Int Urogynecol J Pelvic Floor Dysfunct 11(4):219–222, discussion 222-213
Collins S, Beigi R, Mellen C, O’Sullivan D, Tulikangas P (2015) The effect of pessaries on the vaginal microenvironment. Am J Obstet Gynecol 212(1):60 e61–66. doi:10.1016/j.ajog.2014.07.024
Yoshimura K, Morotomi N, Fukuda K, Nakano M, Kashimura M, Hachisuga T, Taniguchi H (2011) Intravaginal microbial flora by the 16S rRNA gene sequencing. Am J Obstet Gynecol 205(3):235 e231–239. doi:10.1016/j.ajog.2011.04.018
Kawanami T, Fukuda K, Yatera K, Kido T, Yoshii C, Taniguchi H, Kido M (2009) Severe pneumonia with Leptotrichia sp. detected predominantly in bronchoalveolar lavage fluid by use of 16S rRNA gene sequencing analysis. J Clin Microbiol 47(2):496–498
Donders GG, Vereecken A, Dekeersmaecker A, Van Bulck B, Spitz B (2000) Wet mount microscopy reflects functional vaginal lactobacillary flora better than Gram stain. J Clin Pathol 53(4):308–313
Nugent RP, Krohn MA, Hillier SL (1991) Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol 29(2):297–301
Fredricks DN, Fiedler TL, Marrazzo JM (2005) Molecular identification of bacteria associated with bacterial vaginosis. N Engl J Med 353(18):1899–1911. doi:10.1056/NEJMoa043802
Harris KA, Hartley JC (2003) Development of broad-range 16S rDNA PCR for use in the routine diagnostic clinical microbiology service. J Med Microbiol 52(Pt 8):685–691
Zhou X, Bent SJ, Schneider MG, Davis CC, Islam MR, Forney LJ (2004) Characterization of vaginal microbial communities in adult healthy women using cultivation-independent methods. Microbiology 150(Pt 8):2565–2573. doi:10.1099/mic.0.26905-0
Fredricks DN, Marrazzo JM (2005) Molecular methodology in determining vaginal flora in health and disease: its time has come. Curr Infect Dis Rep 7(6):463–470
Verhelst R, Verstraelen H, Claeys G, Verschraegen G, Van Simaey L, De Ganck C, De Backer E, Temmerman M, Vaneechoutte M (2005) Comparison between Gram stain and culture for the characterization of vaginal microflora: definition of a distinct grade that resembles grade I microflora and revised categorization of grade I microflora. BMC Microbiol 5:61
Falagas ME, Betsi GI, Athanasiou S (2007) Probiotics for the treatment of women with bacterial vaginosis. Clin Microbiol Infect 13(7):657–664
Ocana V, Silva C, Nader-Macias ME (2006) Antibiotic susceptibility of potentially probiotic vaginal lactobacilli. Infect Dis Obstet Gynecol 2006:18182. doi:10.1155/IDOG/2006/18182
Conflicts of interest
None
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Yoshimura, K., Morotomi, N., Fukuda, K. et al. Effects of pelvic organ prolapse ring pessary therapy on intravaginal microbial flora. Int Urogynecol J 27, 219–227 (2016). https://doi.org/10.1007/s00192-015-2811-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-015-2811-9