Research
Gynecology
The effect of pessaries on the vaginal microenvironment

Presented in poster format at the 34th Annual Scientific Meeting of the American Urogynecologic Society, Las Vegas, NV, Oct. 16-19, 2013, and in oral poster format at the 32nd Annual Scientific Meeting of the American Urogynecologic Society, Providence, RI, Sept. 14-17, 2011.
https://doi.org/10.1016/j.ajog.2014.07.024Get rights and content

Objective

The objective of the study was to evaluate the differences in vaginal culture, microscopy, and Gram stain between postmenopausal women who wear pessaries and those who do not to explain pessary-related, bothersome vaginal discharge.

Study Design

Postmenopausal women not using exogenous estrogen who had either been wearing a pessary for at least 3 months or who were undergoing their first pessary fittings were approached for enrollment. Symptoms were assessed, and vaginal fluid was collected for culture, microscopy, and Gram stain. A cross-sectional analysis was performed, comparing the new and return pessary wearers. The new pessary users were also sampled at 2 weeks, 3 months, and 6 months after fitting.

Results

Women who wore pessaries were more likely to be bothered by discharge (30.0% vs 2.1%, P < .001). They were also more likely to show microscopic evidence of vaginal inflammation and vaginitis. Prospective data showed that these changes developed during the first 2 weeks of pessary use. Aerobic and anaerobic organisms were nearly identical in women with and without bothersome vaginal discharge in the cross-sectional analysis and at all time points in the prospective analysis.

Conclusion

Pessary-related, bothersome vaginal discharge develops early and may be due to an inflammatory process in the vagina.

Section snippets

Materials and Methods

Recruitment began after approval was obtained from the Hartford Hospital Institutional Review Board. Subjects were postmenopausal women who had either worn pessaries for at least 3 months (established users, hereafter termed ESTs) or who never had worn pessaries and were presenting for pessary fitting (new users, hereafter termed NEW). Women were approached for enrollment at outpatient visits to the urogynecology practice at Hartford Hospital, a tertiary care center.

Subjects met inclusion

Cross-sectional analysis

Each group (EST and NEW) consisted of 50 women (Table 1 presents baseline demographic and medical characteristics of both groups). The EST group was older and had been menopausal longer than the NEW group. Body mass index (EST, 27.0, SD, 4.6; NEW, 26.4, SD, 4.9; P = .57) and racial composition (white in 96% EST and 94% NEW subjects, P = 1.00) were similar between groups. Only 1 subject (in the EST group) was a smoker. Women in the EST group were more likely to be bothered by vaginal discharge

Comment

There are few objective differences between the vaginal microenvironments of women who wear pessaries and are bothered by discharge and those who wear pessaries and are not bothered. Although previous studies describe pessary-related vaginal discharge using diagnostic criteria for BV, we demonstrated that criteria for BV do not reliably identify correlate with bothersome discharge in postmenopausal women who wear pessaries. Furthermore, the microscopic changes that accompany an increase in

References (17)

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    Previous studies have shown that there was a change in intravaginal microbial flora after ring pessary therapy. There were inflammatory change and the anaerobic circumstances in vagina induced the growth of anaerobic bacteria [19,20]. Fregosi et al [21] found that the frequency of pessary removal was associated with changes in vaginal microenvironment.

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    Pessary users with complaints of vaginitis were found to be carriers of enterococci, viridans streptococci and GBS more often, while new users more often had E. coli, viridans streptococci and enterococci. Diagnosis of AV using microscopy instead of cultures could help pessary users to better support the devices and better manage the vaginal discharge they sometimes have [30]. As is the case for BV, the pathogenesis of AV is not yet unravelled.

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This study was supported by the Hartford Hospital Small Grant Program grant SG-123550.

The authors report no conflict of interest.

Cite this article as: Collins S, Beigi R, Mellen C, et al. The effect of pessaries on the vaginal microenvironment. Am J Obstet Gynecol 2015;212:60.e1-6.

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