Pessaries are silicone devices inserted into the vagina for treatment of pelvic organ
prolapse or stress urinary incontinence. They are adequate treatment options for patients
who are poor surgical candidates, those who decline surgical intervention, or as a
temporizing measure in those ultimately planning surgery. Most studies suggest that about
75% of patients are able to be successfully fit with a pessary, but about 50% discontinue
pessary use within 12 months of initiation.
Research concerning pessary discontinuation is currently focused on identifying factors
that will predict outcomes of pessary use. It is generally agreed upon that pessaries are
one of the favored option to conservatively treat pelvic organ prolapse or stress urinary
incontinence, but there is not sufficient consensus on the rate of discontinuation,
factors leading to discontinuation, and patient satisfaction.
Most studies recorded reasons for discontinuation and any adverse events. Patients'
reasons for discontinuation of pessary use included frequent expulsion, difficulty
removing pessary, new or worsening urinary incontinence, vaginal erosion, and
pain/discomfort. Significant side effects or adverse events included vaginal discharge
and erosion.
Several studies focused on anatomic and medical variables that were correlated to pessary
discontinuation. A univariate analysis of factors contributing to discontinuation
conducted by Yimphong et al.1 found that higher BMI and history of pelvic surgery were
significant in predicting discontinuation. Similarly, Panman2 et al. conducted a
multivariate analysis that found higher BMI was a significant factor. Panman et al. also
found that both younger age and weaker pelvic floor muscles were predictors for
discontinuation. The former finding is further supported by Umchanger et al., which cited
that 33% of patients who discontinued pessary use within three months were generally less
than 65 years. Umchanger et al. hypothesized that despite data suggesting that pessaries
are as effective as surgery, younger patients may maintain the misconception that
pessaries are not as effective.
Despite the data suggesting contributing factors such as BMI and age, none of the
reviewed studies captured the qualitative reasoning behind patients' decisions. Only a
few of the studies investigate patients' satisfaction with pessary use, quality of life,
or opinion on their treatment.
Pessary use has been correlated to a wide variety of factors, such as a patient's medical
history, anatomic characteristics, beliefs about pessary use, and personal satisfaction
with treatment. Based on this review, a qualitative analysis of patient experience and
priorities as they decide to continue or discontinue pessary use would be incredibly
helpful for counseling and educating future patients when they are making treatment
decisions about pessaries.