A survey of pessary use by members of the American Urogynecologic Society

Objective: To describe trends in pessary use for pelvic organ prolapse. Methods: An anonymous survey administered to the membership of the American Urogynecologic Society covered indications, management, and choice of pess ary for specific support defects. Results: The response rate was 48% (359 of 748). Two hundred fifty surveys were received at the scientific meeting and 109 were returned by mail. Seve nty-seven percent used pessaries as first-line therapy for prolapse, while 12% reserved pessaries for women who were not surgical candidates. With res pect to specific support defects, 89% used a pessary for anterior defects, 60% for posterior defects, 74% for apical defects, and 76% for complete pro cidentia. Twenty-two percent used the same pessary, usually a ring pessary, for all support defects. In the 78% who tailored the pessary to the defect , support pessaries were more common for anterior (ring) and apical defects (ring), while space-filling pessaries were more common for posterior defec ts (donut) and complete procidentia (Gellhorn). Less than half considered a prior hysterectomy or sexual activity contraindications for a pessary, whi le 64% considered hypoestrogenism a contraindication. Forty-four percent us ed a different pessary for women with a prior hysterectomy and 59% for wome n with a weak pelvic diaphragm. Ninety-two percent of physicians believed t hat pessaries relieve symptoms associated with pelvic organ prolapse, while 48% felt that pessaries also had therapeutic benefit in addition to reliev ing symptoms. Conclusion: While there are identifiable trends in pessary use, there is no clear consensus regarding the indications for support pessaries compared w ith space-filling pessaries, or the use of a single pessary for all support defects compared with tailoring the pessary to the specific defect. Random ized clinical trials are needed to define optimal pessary use. (Obstet Gyne col 2000;95:931-5. (C) 2000 by The American College of Obstetricians and Gy necologists).