Patient Perceptions of Pessaries for Treatment of Pelvic Organ Prolapse.

Abstract

Importance: A vaginal pessary is a highly effective treatment for patients with pelvic organ prolapse (POP). Patient views of pessaries and how their beliefs affect whether they choose pessary treatment is unknown.

Objective: Our objective of this study was to describe the knowledge, understanding, and patient concerns regarding pessary use for POP management.

Study design: We performed a qualitative study of women presenting with POP who were counseled about pessary use at their initial urogynecology visit. Participants completed interviews, which were recorded, de-identified, and transcribed. Transcriptions were coded for major themes by 2 independent researchers.

Results: Twenty patients with an average age of 63 ± 8.5 years participated. Most identified as sexually active (60%) and the majority had a high school education or less (80%). Thematic saturation was reached with themes of "Failure", "Convenience," "Self-Image," "Sexual Relations," "Cleanliness/Hygiene," "Physical Barriers," "Knowledge Deficits," and "Discomfort." Many patients not only viewed a pessary as a less invasive alternative to surgery but also considered it a temporary treatment. Many patients disliked the idea of having a "foreign body" in place and felt it may affect their hygiene. Although most patients believed it would alleviate their POP symptoms, many had concerns about sexual intercourse, discomfort, and fear that it may fall out. Most participants who were not sexually active thought a pessary would increase their sexual confidence.

Conclusions: Patient opinions about pessaries are often negative with preconceived notions surrounding utilization. Focused counseling addressing concerns and fears may improve a patient's comfort with a pessary as their choice of treatment modality.