Age [greater than or equal to] 65 years is one of the strongest predictors of continued, long-term use of pessaries
. Additionally, patient desire to either undergo or to avoid surgery, severe posterior compartment prolapse, apical prolapse, large genital hiatus, as well as advanced prolapse (POP-Q stage 3 and 4) are all associated with decreased likelihood of long-term (>1 year) PR.[12,16]
Accordingly, he and his colleagues at My Due Hospital in Ho Chi Minh City, Vietnam, conducted a comparative effectiveness trial to provide a head-to-head comparison of the use of cervical pessaries
versus vaginal progesterone for women with twin gestations and short cervixes.
Anecdotally, at our institution, it was routine to discard all used pessaries
, irrespective of its condition or the amount of time worn.
A 2004 Cochrane review of pessaries
use for POP and updated in 2013 (13,18) found only 1 randomized controlled trial examining the efficacy of pessary use.
A 2013 Cochrane Review seeking to determine the effectiveness of pessaries
in POP, identified one RCT (crossover, 3 month, multicenter, United States) that compared symptom relief and change in life impact over baseline for 134 women (parous, mean age 61 years, range 30-89 years) with POP stage II or greater who were treated with ring with support or Gellhorn pessaries
More recently, silicon has replaced other materials for vaginal pessaries
and approximately 20 types of either supportive or space filling pessaries
are used worldwide.
come in many shapes and sizes, with clinicians' choice often coming down to personal preference.
Conservative treatment, most commonly pelvic floor exercises and use of vaginal pessaries
, is generally considered for women with a mild degree of prolapse, those wishing to have more children, frail patients or those who are unwilling to undergo surgery.
Even very young women--and certainly many older women who lead physically active lives--may leak urine during vigorous exercise, but that doesn't mean they all need pessaries
or surgery to get them on the court or the playing field, according to Dr.
Pregnant women can use the creams and pessaries
but not the tablets.
(devices worn internally by women) can support the bladder and improve control.
He gives me creams and pessaries
but they don't always work.