Introduction and hypothesis

The objective of this study was to evaluate the outcomes of vaginal pessaries in managing symptomatic pelvic organ prolapse (POP) in a low-income setting.

Methods

A pre-post interventional study was conducted in the Kilimanjaro region, Tanzania. Seventy-one women with symptoms and a POP stage II or more on the POP quantification test were fitted with a vaginal pessary. Pelvic examination, POP Distress Inventory (POPDI-6) and POP Impact Questionnaire (POPIQ-7) were completed at baseline, after 3 months and after 12–18 months. Changes in the POPDI-6 and POPIQ-7 scores, complications and satisfaction associated with pessary use before and after the intervention were obtained.

Results

Pessary treatment was associated with a reduction in the overall POPDI score from 55.0 (50.0, 60.0) at baseline to 25.0 (25.0, 30.0) after 12–18 months’ use. The overall POPIQ score was reduced from 54.2 (41.7, 66.7) at baseline to 25.0 (25.0, 29.2) after 12–18 months’ use of the pessary. Vaginal discharge was reported in 72.4 and 32.4% of the women after 3 and 12–18 months’ use respectively, whereas 72.4 and 25% of the women had some degree of granuloma, erosion or infection at 3 and 12–18 months respectively. Despite the reported complications, 78% of the women were satisfied with the pessary when interviewed after 12–18 months and 81% wanted to continue using it.

Conclusions

Vaginal pessary improves symptoms and quality of life associated with symptomatic POP. Therefore, it may be a treatment option in managing POP in low-income countries such as Tanzania.