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Pessaries for pelvic organ prolapse: evaluation of vaginal discharge and pain during pessary cleaning in an outpatient setting

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Abstract

Introduction and hypothesis

Pessary treatment for pelvic organ prolapse (POP) is effective and safe, but long-term continuation is low. Pain and vaginal discharge may play a role. This study was aimed at evaluating vaginal discharge and pain during pessary cleaning in an outpatient setting and in continuous pessary use.

Methods

Women with POP who attended the outpatient clinic for pessary cleaning between January and October 2021 were included. Primary outcome was pain during removal and reinsertion of the pessary, measured by an 11-point numeric rating scale (NRS). Secondary outcome was vaginal discharge, measured by the NRS and Patient Global Impression of Change scale (PGI-C). Multiple linear regression analysis was used to identify associated variables for pain and discharge.

Results

A total of 150 women were included. Mean NRS during pessary removal was 4.3 (± 2.7), with 25% of women scoring a 7 or higher. Mean NRS during reinsertion was 1.8 (± 2.0). A smaller genital hiatus and presence of vaginal atrophy or vulvar skin disease were associated with pain during pessary removal. Mean NRS for vaginal discharge was 2.5 (± 2.3). Twenty-five percent of women reported that their vaginal discharge was “(very) much worse” than before they used a pessary. Presence of vaginal erosions was associated with vaginal discharge in this study population.

Conclusions

Removing a pessary in an outpatient setting is a painful procedure for many women who use a pessary continuously. Moreover, 25% of these women experience an increase in vaginal discharge while using a pessary. Future research should focus on reducing these disadvantages.

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Data Availability

The data that support the findings of this study are available from the corresponding author, Kruyt LM, upon request.

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Authors and Affiliations

  1. Department Obstetrics & Gynecology, Martini Hospital, PO Box 30033, 9700 RM, Groningen, The Netherlands

    Lara M. Kruyt, J. Marinus van der Ploeg, Britt A. van Etten-Debruijn & Robert A. Hakvoort

  2. Department Obstetrics & Gynecology, Ommelander Hospital, Scheemda, The Netherlands

    Karin Lammers

  3. Scientific Institute, Martini Hospital, Groningen, The Netherlands

    Anuschka S. Niemeijer

Authors
  1. Lara M. Kruyt
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  2. J. Marinus van der Ploeg
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Contributions

Lara M. Kruyt: protocol development, data collection, data analysis, manuscript writing; J. Marinus van der Ploeg: protocol development, data collection, data analysis, manuscript writing; Karin Lammers: data collection, manuscript editing; Britt A. van Etten-Debruijn: data collection, manuscript editing; Anuschka S. Niemeijer: statistical analysis, manuscript editing; Robert A. Hakvoort: protocol development, data collection, data analysis, manuscript writing.

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Correspondence to Lara M. Kruyt.

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Kruyt, L.M., van der Ploeg, J.M., Lammers, K. et al. Pessaries for pelvic organ prolapse: evaluation of vaginal discharge and pain during pessary cleaning in an outpatient setting. Int Urogynecol J 35, 333–339 (2024). https://doi.org/10.1007/s00192-023-05648-5

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