Fear, Shame, and Miscommunication: A Qualitative Study on Treatment Choice for Pelvic Organ Prolapse

Pelvic organ prolapse (POP) negatively impacts the quality of life of many women. Effective treatment options include the use of a pessary and surgery. This study was aimed at exploring the facilitators and barriers influencing decision-making between pessary and surgical treatment from both the patients' and gynecologists' perspectives.

This qualitative study involved semi-structured interviews with 14 women from the own choice cohort in the PEOPLE study and 12 gynecologists from various hospitals throughout the Netherlands. Participants were purposively sampled to capture a range of experiences and professional backgrounds. The women varied in age and prolapse severity and had differing experiences with both pessary use and surgery, whereas gynecologists represented a mix of junior and senior specialists from academic and regional hospitals. Interviews were conducted until thematic saturation was reached. Data were analyzed using thematic analysis following Braun and Clarke.

Three main themes emerged. Treatment goals were a reflection of fears and misconceptions, illustrating the reasons behind women's treatment choices; patient presentation delay as a result of ignorance and shame, addressing the societal taboos surrounding POP; and consultation at the gynecologist with communication gaps and decision-making challenges, highlighting the barriers faced during consultations with gynecologists.

Optimal decision-making can be limited because of a lack of knowledge among the general population, patients, and general practitioners. Ignorance and feelings of fear and shame on the subject in patients further hinder the decision-making process. Addressing these barriers could improve the shared decision-making process and enhance patient satisfaction with their chosen treatment.