Evaluation of vaginal pessary use by South African gynaecologists
Introduction. The use of vaginal pessaries for conservative management of pelvic organ prolapse (POP) is well established. However, there are limited data on current clinical practice among gynaecologists, and the aim of this survey was therefore to evaluate vaginal pessary use among South African gynaecologists. Methods. An anonymous self-administered one-page questionnaire was designed by the author and given out to South African gynaecologists at a local obstetrics and gynaecology meeting in 2009. Results. The response rate was 31.7% (133/420). Of the respondents, 23.6% (29/123) offered vaginal pessaries as first-line treatment for POP in their clinical practice. The ring pessary was the commonest pessary used for all compartmental defects. The two most favoured reasons for pessary use were surgical or anaesthetic risk (64.0%, 85/133) and patient declining surgery (49.6%, 66/133). Recurrent involuntary expulsion (51.9%, 69/133), discomfort (41.3%, 55/133) and opting for surgery (39.1%, 52/133) were the three top reasons for discontinuation of pessary use. Of the respondents 87.6% (92/105) indicated that they would review patients within 6 weeks after initial pessary insertion, and thereafter 45.8% (44/96) would review patients at 3 - 6-monthly intervals. Conclusion. Compared with surveys elsewhere, fewer South African gynaecologists offer vaginal pessaries as first-line treatment to patients with symptomatic pelvic organ prolapse. Practice trends similar to those elsewhere included choice of pessary, follow-up interval and reasons for pessary discontinuation.