Bacterial vaginosis increases in pessary users

The purpose of this study was to examine the association between pessary us e, smoking and changes in the vaginal flora. Patients using pessaries were age matched with non-pessary using controls. All candidates examined were w omen attending the Mount Sinai Hospital, Toronto, for genitourinary problem s. Vaginal cultures were routinely performed on all women attending the uni t, irrespective of symptoms. Forty-four pessary users were age matched with 176 controls (4 controls per case). The mean age was 60.1 +/- 12.6 years, and 15% of these were premenopausal. The duration of pessary use ranged fro m 0.5 to 8 years (mean 3.3 +/- 1.7). Weight, parity, smoking status, diabet es mellitus, thyroid disease, UTI and postvoid residual urine volume were n ot significantly different between pessary users and controls. Bacterial va ginosis (BV) was noted in 32% of pessary users, versus 10% of controls. The relative risk of developing BV in pessary users was 3.3 (OR, 4.37; 95% CI, 2.15-9.32), P = 0.0002. Smoking independently affected the vaginal flora, increasing the relative risk of developing BV to 2.9 (OR, 3.78; 95% CI, 2.0 5-8.25), P = 0.0013. It was concluded that pessary use is a very effective and conservative method for the treatment of genital prolapse. However, we found that the presence of a foreign body was associated with changes in th e vaginal flora, thereby increasing the odds of developing bacterial vagino sis to 4.37; this was further compounded by smoking.