Factors contributing to long-term vaginal pessary use: A mixed-methods study

One of the treatment options in pelvic organ prolapse (POP) is vaginal pessary therapy. For a well-informed decision, different aspects of the treatment option, including sustainable long-term outcomes, need to be discussed with the patient. However, long-term quality of life and psychological wellbeing of pessary use is unknown. This study explores the factors contributing to long-term pessary use.

A mixed-methods study was performed among patients with vaginal pessary use for at least 5 years. The quantitative part consisted of online, validated questionnaires on satisfaction with care (Patient Satisfaction Questionnaire Short Form [PSQ-18]), shared decision-making (Shared Decision Making Questionnaire [SDM-Q-9]) and decisional regret (Decision Regret Scale [DRS]). Health-related quality of life and pelvic floor complaints were measured by the Pelvic Floor Disability Index (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), and the EuroQol EQ-5D-5L questionnaire. The qualitative part comprised semi-structured interviews according to the Consolidated Criteria for Reporting Qualitative Research (COREQ) analyzed with grounded theory analysis.

In all, 35 patients filled in the questionnaires and seven were interviewed. Overall, patients indicated a good quality of life and satisfaction with the treatment. Three major themes were found in the interviews: effect of the treatment, contact with the healthcare provider, and choice in type of care. Four minor themes were psychosocial aspects, self-image, established habits, and sexuality.

When considering possible pessary use with a POP patient, these longterm effects of successful pessary treatment can be offered. The identified themes need to be addressed when applicable for the patient. Patients can be informed that long-term pessary use is feasible and can become a habit with little burden that relieves the complaints they experience.