Abstract
Objective
International guidelines recommend vaginal pessaries as a first-choice treatment of symptomatic pelvic organ prolapse (POP). Gynecologists rarely receive systematic training or just do not take the time to communicate with their patients. We hypothesized that we could identify key deficits and limitations of counseling before or during pessary therapy from questions directed to manufacturers with the aim to improve and promote health literacy of women with POP.
Methods
We approached five manufacturers to provide anonymized inquiries related to pessary use. After exclusion of duplicates and questions about obstetric pessaries, 174 data sets from 145 patients remained.
Results
In 19/145 patients (13.1%), a 2nd degree, and in 94/145 (64.8%), a 3rd–4th degree of POP was identified. Four patients had additional urinary incontinence. In 32/145 (22.1%), the severity of POP could not be identified. The age of patients ranged from 27 to 98 (mean = 63.7) years. Most inquiries were related to the selected pessary models or sizes (40/174; 22.9%), self-management (20/174; 11.5%), and technical aspects such as shelf life or appropriate cleaning (26/174; 14.9%). Pain or voiding dysfunction was present in 17/174 remarks (9.7%). Lifestyle questions related to the use of pessaries during sport, menstruation, or mechanical anticonception. The cube pessary was in the focus of interest followed by the sieve bowl, urethra, ring, and Gellhorn device. The list of questions was summarized as a checklist stratified according to priorities.
Conclusion
The checklist should help improve counseling and self-management of patients to optimize the benefit/risk ratio of conservative treatment of pelvic floor diseases.
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Data availability
There is no data availability statement.
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JRW: Protocol/project development, Data collection and analysis, Manuscript writing/editing, visualization, TF: Support of the protocol, Manuscript editing, visualization, BA: Protocol/project development, Manuscript writing/editing, supervision, visualization.
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In addition to clinical and academic activities, the last author (BA) owns a company for vaginal pessaries. The profit of this company exclusively supports creative projects for mothers and children within the Clara Angela Foundation. Thus, the author has no personal or financial interests to disclose. The other two authors (JW & TF) declare that they have no competing interests.
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This study is an analysis of exclusively anonymized secondary data. In accordance with the guidelines of the working group of secondary data analyses (AGENS) as part of DGSMP (German Society for Social Medicine and Prevention) and DGEpi (Guidelines of the German Society of Epidemiology), it was not submitted to an ethical committee.
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Wagner, J.R., Fink, T. & Arabin, B. Analysis of questions by patients with pelvic organ prolapse about vaginal pessaries resulting in a checklist for their physicians. Arch Gynecol Obstet 309, 329–337 (2024). https://doi.org/10.1007/s00404-023-07177-4
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DOI: https://doi.org/10.1007/s00404-023-07177-4