Abstract

Introduction: Pelvic organ prolapse is a common problem affecting women, but there is currently a lack of research focusing on patient experience of pessary changes. This study aimed to capture the patient perspective of pessary changes and to formally assess pain during pessary removal and insertion.

Methods: A service evaluation request was granted by South Tees Hospitals NHS Trust. Patients undergoing pessary change (ring, shelf, or Gellhorn) in gynaecology outpatient clinics over a six-month period were asked to rate their pain scores on a 10 point numerical-pain-rating-scale. Other associated data was collected.

Results: Out of 213 women, 58.2% reported that pessary removal was more painful than insertion, 30.5% reported equal pain, and 10.8% reported insertion was more painful than removal. Pain scores were significantly higher for removal 4.37 (4, 4-7) than for insertion 2.66 (2, 2-4) [mean (median, IQR), p <.001]. Ring pessaries were significantly less painful to both remove and insert than shelf and Gellhorn pessaries. Smaller pessaries were more painful to both remove and insert. There was no significant difference in pain scores reported by those with or without diagnosed vulval conditions.

Conclusions: Pessary removal causes most women moderate pain, which should be communicated to patients beforehand. Ring pessaries are significantly less painful to change compared to other pessary types. Clinicians should consider pain as a factor in their decision-making surrounding pessary choice and when counselling patients. Future research should focus on ways to reduce pain during pessary removal.

Keywords: Patient experience, Pain, Pelvic-organ prolapse, Pessary changes, Vaginal pessaries