Anxiety in Women Receiving Clinician-Managed Pessary Care for Pelvic Organ Prolapse

Vaginal pessaries are an effective nonsurgical treatment for pelvic organ prolapse, but routine pessary care can be associated with pain. Anxiety is known to influence pain perception in clinical procedures but its role in pessary care has not been studied. We hypothesised that anticipatory anxiety is present in women receiving continuous, non-self-managed pessary care and is associated with procedural pain.

In this prospective observational cohort study, women with pelvic organ prolapse receiving continuous clinician-managed pessary care in a tertiary urogynaecology unit were included. Pain during pessary removal and insertion was assessed using the Numeric Rating Scale (NRS). Anticipatory anxiety regarding future pessary care was evaluated 4-6 weeks later using an adapted version of Corah's Dental Anxiety Scale. Logistic regression was performed to identify factors associated with moderate to high anxiety.

A total of 150 women were included, of whom 128 (85%) completed the anxiety questionnaire. Median age was 70 years (range 46-86). Moderate to high anticipatory anxiety was reported by 28% of women. Higher pain scores during previous pessary removal or insertion and care provided by a male gynaecologist were independently associated with increased anticipatory anxiety.

Clinically relevant anticipatory anxiety is common in women receiving clinician-managed pessary care and is associated with procedural pain and physician gender. These findings highlight the importance of addressing both physical discomfort and psychological distress in routine pessary care to optimise patient experience.