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Host inflammatory response in women with vaginal epithelial abnormalities after pessary use

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Abstract

Background

Vaginal epithelial abnormalities (VEA) are a common complication associated with pessary use. The objective of this study was to determine if there is a host pro-inflammatory response associated with pessary use and VEA.

Methods

Patients wearing pessaries for at least two weeks for the management of pelvic organ prolapse and/or urinary incontinence were screened for eligibility. Vaginal swabs were collected from women with VEA (cases) and without VEA (controls). Cases were matched to controls in a 1:3 ratio. Cytokine analysis of the collected samples was performed using multiplex analysis to determine the concentrations of interleukin (IL)6, interferon alpha 2 (IFNα2), tumor necrosis factor alpha (TNFα) and IL1β. A cross-sectional analysis was performed, comparing vaginal cytokine concentrations in women with and without VEA.

Results

We enrolled 211 patients in this analysis: 50 cases and 161 controls. The median concentrations (pg/mL) of the four cytokines for cases and controls respectively were; IL6: 6.7 (IQR <2.9 [the lower limit of detection, LLD]-14.2) and < 2.9 (LLD) (IQR <2.9 [LLD]-5.5), IFNα2: 8.2 (IQR 6.1–13.9) and 7.9 (IQR 3.9–13.6), TNFα: 15.2 (IQR 6.1–30.4) and 4.68 (IQR <2.3 [LLD]-16.3), IL1β 195.7 (IQR 54.5–388.6) and 38.5 (IQR 6.7–154.9). The differences in median cytokine levels were statistically higher in cases for IL6, TNFα, and IL1β (all p < 0.001) compared to controls. Older age (OR: 1.062, 95% CI, 1.015–1.112), lower BMI (OR: 0.910, 95% CI, 0.839–0.986) and presence of VEA at last check (OR: 5.377, 95% CI, 2.049–14.108) were associated with higher odds of having VEA on multivariate analysis.

Conclusion

Pro-inflammatory cytokines, specifically IL6, TNFα, and IL1β, are elevated in pessary-wearing patients who have VEA. Additional prospective studies are needed to assess baseline vaginal inflammatory profiles before and after pessary placement to understand VEA formation in pessary patients.

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Financial support

Hartford Hospital Medical Staff Research Grant.

Presented as short oral presentation at 2019 AUGS/IUGA joint meeting. Nashville, TN.

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Authors and Affiliations

  1. Division of Female Pelvic Medicine & Reconstructive Surgery, Hartford Hospital, 85 Seymour St, Suite 525, Hartford, CT, 06106, USA

    Aparna S. Ramaseshan, Colleen Mellen & Paul K. Tulikangas

  2. Anne Arundel Medical Center, 2003 Medical Pkwy, Wayson Pavillion, Suite 150, Annapolis, MD, 21401, USA

    Aparna S. Ramaseshan

  3. Department of Research Administration, Hartford Healthcare, 80 Seymour St, Hartford, CT, 06102, USA

    David M. O’Sullivan

  4. Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, CT, USA

    Christopher Nold

Authors
  1. Aparna S. Ramaseshan
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  2. Colleen Mellen
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  3. David M. O’Sullivan
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  4. Christopher Nold
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  5. Paul K. Tulikangas
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Contributions

AS Ramaseshan: Project development, sample collection and processing, data collection, manuscript writing.

C Mellen: Patient recruitment and sample collection.

DM O’Sullivan: Statistical support and manuscript writing.

C Nold: Project development, sample processing and manuscript writing.

PK Tulikangas: Project development and manuscript writing.

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Correspondence to Aparna S. Ramaseshan.

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Ramaseshan, A.S., Mellen, C., O’Sullivan, D.M. et al. Host inflammatory response in women with vaginal epithelial abnormalities after pessary use. Int Urogynecol J 33, 2151–2157 (2022). https://doi.org/10.1007/s00192-021-05001-8

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  • DOI: https://doi.org/10.1007/s00192-021-05001-8

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