Self-management of vaginal cube pessaries may be a game changer for pelvic organ prolapse treatment: a long-term follow-up study

Long-Term Self-Management of Vaginal Cube Pessaries Can Improve Sexual Life in Patients with Pelvic Organ Prolapse, Results from a Secondary Analysis

INTRODUCTION AND HYPOTHESIS

Currently, little is known about how daily self-management of cube pessaries influences sexual function. We hypothesized that removing the cube pessary prior to sexual activity did not negatively influence the sexual function, and pessary self-care did not lead to a deterioration of sexual wellbeing.

METHODS

We conducted a planned secondary analysis of a prospective cohort study in which 214 patients with symptomatic pelvic organ prolapse (stage 2+) were enrolled (2015). Each patient was size fitted with a cube pessary and completed a questionnaire online or by phone ≥ 5 years after her initial fitting. Changes in quality of life were measured using the Patient Global Impression of Improvement (PGI-I).

RESULTS

Of the 143 women included in our analyses, 92 (64.3%) were sexually active during the study period. These patients (73.9%; 68 out of 92) described their sexual wellbeing as "better" or "much better" than their pretreatment status. Sexually active patients had a better quality of life as measured by the PGI-I than the sexually inactive patients. Of the sexually active patients, 91.3% (84 out of 92) described their condition as "better" or "much better" than their pretreatment status, whereas 84.3% (43 out of 51) of the sexually inactive patients reported the same improvement. Over 90% of sexually active patients reported that removal of the vaginal cube pessary before sexual activity is not disruptive.

CONCLUSIONS

The overwhelming majority of the patients with symptomatic pelvic organ prolapse using daily self-management of cube pessaries reported that removal of the vaginal cube pessary before sexual activity is not disruptive, and its use was accompanied by improved sexual wellbeing.

Self-care of vaginal pessary for pelvic organ prolapse: a systematic review and meta-analysis

INTRODUCTION

There is no evidence about the efficacy of self-care of vaginal pessary in women with symptomatic pelvic organ prolapse (POP). The aim of this systematic review and meta-analysis is to assess the adherence to pessary treatment among women who engage in self-management of their pessary.

METHODS

We performed a systematic review and meta-analysis, according to PRISMA 2020 guidelines, and selected seven publications for inclusion in the analysis.

RESULTS

Pooled continuation rate of self-cared vaginal pessary was the 76% (95%CI: 66-85%) with a I2-test of 93.3% (p < 0.001). Pooled conversion to POP surgery was the 12% (95%CI: 1-23%) with a I2-test of 96% (p < 0.001). Continuation rate was not statistically different between women who were treated by self-care and non-self-care management of vaginal pessary (RR 1.11, 95%CI 0.96-1.27; p = 0.15), with a related I2-test of 37% (p = 0.21).

CONCLUSION

Self-care vaginal pessary management presented a high continuation rate in women affected by pelvic organ prolapse at a long follow-up. The rate of conversion to surgical management of POP was low. No significant difference in continuation rate were highlighted between women who adopted the self-care or the clinical-based management of pessary.