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Vaginal Ulcers Less Common in Women Who Use Supported-Ring Pessary for Pelvic Organ Prolapse: Presented at AUGS

By Cheryl Lathrop

PROVIDENCE, RI -- September 19, 2011 -- Data presented here September 15 at the 32nd Annual Scientific Meeting of the American Urogynecologic Society (AUGS) shows that women using a supported-ring pessary for the management of pelvic organ prolapse have a lower risk of developing vaginal ulcers compared with women who use the Gellhorn pessary.

A supported-ring pessary fits approximately 70% of women and is the most commonly used type, it can be self-managed, and is the easiest to insert and remove. The Gellhorn (either short-stem or long-stem) pessary is a 3-dimensional space-filling pessary with a base and a stem; the base is slightly concave which creates suction helping to hold the pessary in place, but making it difficult to remove manually.

Caroline Foust-Wright, MD, Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine, and colleagues retrospectively compared the occurrence of vaginal ulcers among 90 women aged 42 to 96 years using a supported-ring pessary or a Gellhorn pessary.

Women received followed-up care at 3 to 6 month intervals, at which time the pessary was removed and a thorough vaginal exam was performed.

Of the 40 patients that used a supported-ring pessary, 95% had no vaginal ulcers. Of the 22 patients using a short-stem Gellhorn pessary, 64% had no vaginal ulcers. Of the 28 patients using a long-stem Gellhorn pessary, 57% had no vaginal ulcers.

“The data from this study argues for the continued use of the supported ring pessary whenever feasible.” said Dr. Foust-Wright.

The researchers added that extended use of a pessary tends to lead to more vaginal ulcers, likely due in part to long-term effects of pressure from the pessary on the vaginal wall as well as simply having a longer period of exposure in which ulceration may occur.

The authors suggest careful follow-up to reduce the incidence of vaginal ulcers, particularly in women who are using the pessary for many years.

They added that due to the retrospective nature of the study, a longer prospective study would be useful to confirm these findings

[Presentation title: Comparison of Vaginal Ulcer Occurrence With Pessary Use for Pelvic Organ Prolapse. Abstract 35]

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