Evaluation of vaginal pessary use by South African gynaecologists

Abstract

Introduction: The use of vaginal pessaries for conservative management of pelvic organ prolapse (POP) is well established. However, there is limited data on current clinical practice among gynaecologists, and thus the aim of this survey was to evaluate vaginal pessary use among South African gynaecologists. Methods: An anonymous self administered one page questionnaire was designed by the author and administered to South African gynaecologists at an Obstetrics and Gynaecology Update meeting in 2009. Results: The response rate was 32% (133 out of 420). 24% (29 out of 123) offered vaginal pessaries as first line treatment for pelvic organ prolapse in their clinical practice. The ring pessary was the commonest pessary for all compartmental defects. The two most favored reasons for pessary use was surgical or anaesthetic risk (64%) (85 out of 133) and patient declining surgery (50%) (66 out of 133). Recurrent involuntary expulsion (52%) (69 out of 133), discomfort (41%) (55 out of 133), opting for surgery (39%) (52 out of 133) were the three top reasons for pessary discontinuation. 88% (92 out of 105) responded that they would have reviewed patients within 6 weeks after initial pessary insertion, and thereafter 46% (44 out of 96) reviewed patients on 3-6 monthly interval. Conclusion: When compared to other surveys fewer South African gynaecologists offer vaginal pessaries as first line treatment to patients with symptomatic pelvic organ prolapse. Similar practice trends included the choice of pessary, follow up interval and reasons for pessary discontinuation.