Vaginal pessary in advanced pelvic organ prolapse: impact on quality of life

Introduction and hypothesis: Pelvic organ prolapse (POP) is a highly prevalent dysfunction of the pelvic floor affecting up to 40% of women. The symptoms of POP have a major impact on quality of life. Pessary treatment is a therapy option associated with high levels of satisfaction and few complications.

Objectives: The objective was to assess the impact and efficacy of vaginal pessary use on the quality of life of women with advanced POP stages III and IV.

Materials and methods: A multicenter, longitudinal, prospective observational study was conducted at the Urogynecology Sector of the Hospital Ipiranga and the Hospital Central of the Irmandade da Santa Casa de Misericórdia de São Paulo. A sociodemographic questionnaire was employed and two scales validated in Portuguese (ICIQVS and SF 12) were applied before and 6 months after pessary use. Student´s t test, Mann-Whitney test and Fisher´s exact test were applied, adopting a significance level of 0.05.

Results: The median age of participants was 71.5 (65-76) years and the median number of pregnancies was 4 (3-5). Deliveries were predominantly vaginal (82.5%). Women sexually active (16.49%) showed improvement in sexual function (78.6%). The participants showed improvement in vaginal symptoms (91.8%) and quality of life (92.8%) (p < 0.01) post-treatment. Of the total 97 women, the sample drop-out rate was 9.3% and 88 participants completed the two stages of the study.

Conclusions: Vaginal pessary use had 90.7% efficacy, a high level of treatment satisfaction (75.3%), and a positive impact on the improvement of vaginal and sexual symptoms, quality of life, and mental health.