Do vaginal pessaries used to treat pelvic organ prolapse impact on sexual function? A systematic review and meta-analysis

Wharton, Laura; Athey, Ruth A.

doi:10.1007/s00192-021-05059-4

Cited by 7 publications

(3 citation statements)

References 35 publications

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“…This implies that women experienced an increase in sexual desire, were more satisfied with the frequency of their sexual activity, and that pessary use was accepted by sexually active women. This finding is in line with a systematic review reporting that women who continue pessary use perceive some improvement in female sexual functioning . It is recommended for future studies to use the PISQ-IR as an outcome tool evaluating sexual functioning to collect more data.…”

Section: Discussionsupporting

confidence: 83%

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Effect of Pessary vs Surgery on Patient-Reported Improvement in Patients With Symptomatic Pelvic Organ Prolapse

Vaart

Vollebregt

Milani

et al. 2022

JAMA

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ImportancePelvic organ prolapse is a prevalent condition among women that negatively affects their quality of life. With increasing life expectancy, the global need for cost-effective care for women with pelvic organ prolapse will continue to increase.ObjectiveTo investigate whether treatment with a pessary is noninferior to surgery among patients with symptomatic pelvic organ prolapse.Design, Setting, and ParticipantsThe PEOPLE project was a noninferiority randomized clinical trial conducted in 21 participating hospitals in the Netherlands. A total of 1605 women with symptomatic stage 2 or greater pelvic organ prolapse were requested to participate between March 2015 through November 2019; 440 gave informed consent. Final 24-month follow-up ended at June 30, 2022.InterventionsTwo hundred eighteen participants were randomized to receive pessary treatment and 222 to surgery.Main Outcomes and MeasuresThe primary outcome was subjective patient-reported improvement at 24 months, measured with the Patient Global Impression of Improvement scale, a 7-point Likert scale ranging from very much better to very much worse. This scale was dichotomized as successful, defined as much better or very much better, vs nonsuccessful treatment. The noninferiority margin was set at 10 percentage points risk difference. Data of crossover between therapies and adverse events were captured.ResultsAmong 440 patients who were randomized (mean [SD] age, 64.7 [9.29] years), 173 (79.3%) in the pessary group and 162 (73.3%) in the surgery group completed the trial at 24 months. In the population, analyzed as randomized, subjective improvement was reported by 132 of 173 (76.3%) in the pessary group vs 132 of 162 (81.5%) in the surgery group (risk difference, −6.1% [1-sided 95% CI, −12.7 to ∞]; P value for noninferiority, .16). The per-protocol analysis showed a similar result for subjective improvement with 52 of 74 (70.3%) in the pessary group vs 125 of 150 (83.3%) in the surgery group (risk difference, −13.1% [1-sided 95% CI, −23.0 to ∞]; P value for noninferiority, .69). Crossover from pessary to surgery occurred among 118 of 218 (54.1%) participants. The most common adverse event among pessary users was discomfort (42.7%) vs urinary tract infection (9%) following surgery.Conclusions and RelevanceAmong patients with symptomatic pelvic organ prolapse, an initial strategy of pessary therapy, compared with surgery, did not meet criteria for noninferiority with regard to patient-reported improvement at 24 months. Interpretation is limited by loss to follow-up and the large amount of participant crossover from pessary therapy to surgery.Trial RegistrationNetherlands Trial Register Identifier: NTR4883

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Section: Discussionsupporting

confidence: 83%

“…This finding is in line with a systematic review reporting that women who continue pessary use perceive some improvement in female sexual functioning. 41 It is recommended for future studies to use the PISQ-IR as an outcome tool evaluating sexual functioning to collect more data.…”

Section: Discussionmentioning

confidence: 99%

Effect of Pessary vs Surgery on Patient-Reported Improvement in Patients With Symptomatic Pelvic Organ Prolapse

Vaart

Vollebregt

Milani

et al. 2022

JAMA

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“…Female sexual dysfunctions can have various causes, however, they are very common among women with pelvic floor problems, for example, pelvic organ prolapses (POP) or urinary incontinence (UI) (Bø, 2012; Frigerio et al, 2022; Hwang et al, 2021; Pruijssers et al, 2021; Wharton et al, 2022), which may influence sexual satisfaction and functioning. Midwives and nurses, as fundamental professionals in the accompaniment of women throughout their sexual and reproductive lives (Beek et al, 2019), must be able to address this problem effectively.…”

Section: Discussionmentioning

confidence: 99%

Effect of pelvic floor muscle training on female sexual function: A systematic review protocol and meta‐analysis

et al. 2023

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Aim: To recognize, appraise and summarize the research evidence that has explored the results of pelvic floor muscle training on female sexual function.Design: Systematic review and possible meta-analysis.Methodology: Between September and October 2022, the Cochrane Library, CINAHL, MEDLINE, EMBASE, PsycINFO and Scopus electronic databases will be searched. We will include RCT's in English, Spanish and Portuguese that investigate the results of pelvic floor muscle training on female sexual function. The data will be extracted by two researchers independently. Risk of bias will be measured from the Cochrane Risk of Bias Tool. The meta-analysis of the results will be performed using Comprehensive Meta-Analysis Version 2.Results: This systematic review and possible meta-analysis will contribute significantly to the promotion of pelvic floor health and women's sexual function and to strengthen clinical practice and define other areas of study.

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Pelvic Floor Disorders and Female Sexuality II: Pelvic Organ Prolapse

Anglès Acedo,

Ribera Torres,

Ros Cerro

2024

Trends in Andrology and Sexual Medicine

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Do vaginal pessaries used to treat pelvic organ prolapse impact on sexual function? A systematic review and meta-analysis

Cited by 7 publications

References 35 publications

Effect of Pessary vs Surgery on Patient-Reported Improvement in Patients With Symptomatic Pelvic Organ Prolapse

Effect of Pessary vs Surgery on Patient-Reported Improvement in Patients With Symptomatic Pelvic Organ Prolapse

Effect of pelvic floor muscle training on female sexual function: A systematic review protocol and meta‐analysis

Pelvic Floor Disorders and Female Sexuality II: Pelvic Organ Prolapse

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