Should we use pessaries for pelvic organ prolapse?

Abstract

The true incidence of pelvic organ prolapse (POP) is difficult to determine, however, it is a common condition reported to affect 50% of parous women over 50 years of age. In their widely cited study, Olsen et al found a lifetime risk of 11% (by age 80 years) for women to undergo surgery for POP and urinary incontinence. The risk of recurrent POP after surgery is reported to be between 10-30%. Although non-life threatening, POP is an embarrassing condition that has been shown to negatively impact on various quality of life domains. Population modeling studies have projected a population of 9 billion by 2040 and also an increase in demand for services to care for female pelvic floor disorders. Currently non-surgical treatment modalities include expectant management, pelvic floor exercises and the use of support devices i.e. vaginal pessaries. Vaginal support devices date back to at least 1550 BC, and have remained the mainstay of treatment for POP until recent advances in pelvic floor reconstructive surgery.