Can the Pessary Use Modify the Vaginal Microbiological Flora? A Cross-sectional Study

Abstract

Introduction Vaginal pessary is used as a conservative treatment for pelvic organ prolapse (POP). Some studies have shown that common complaints of its use may include vaginal discomfort and increased vaginal discharge. Scant information is available about the microflora status after using this device.

Objective To determine if the usage of vaginal pessary can interfere with the vaginal environment.

Methods A cross-sectional study was performed from March of 2014 to July of 2015 including 90 women with POP. The study group was composed of 45 women users of vaginal pessary and 45 nom-users. All enrolled women answered a standardized questionnaire and were subjected to a gynecological exam to collect vaginal samples for microbiological evaluation under optic microscopy. Clinical and microbiological data were compared between study and control groups.

Results Vaginal discharge was confirmed in 84% of the study group versus 62.2% in the control group (p < 0.01); itching was reported in 20 and 2.2%, respectively (p < .05); genital ulcers were only found in the pessary group (20%). There was no difference with regard to the type of vaginal flora. Bacterial vaginosis was prevalent in the study group (31.1% study group versus 22.2% control group), (p =.34).

Conclusion Women using vaginal pessaries for POP treatment presented more vaginal discharge, itching and genital ulcers than non-users.

Resumo

Introdução O pessário vaginal é utilizado como tratamento conservador para o prolapso de órgãos pélvicos (POP). Alguns estudos demonstraram que as queixas mais comuns do seu uso são o desconforto vaginal e um aumento do fluxo vaginal. As informações são escassas a respeito do que ocorre com a microflora vaginal após o uso do pessário.

Objetivo Determinar se o uso do pessário pode interferir com o ambiente vaginal.

Métodos Um estudo transversal realizado de março de 2014 a julho de 2015 com 90 mulheres com POP; metade delas usaram pessário e a outra metade permaneceu como grupo controle. Todas preencheram um questionário e realizaram exame ginecológico para coleta de amostras vaginais para análise microbiológica. Dados clínicos e microbiológicos foram comparados entre os grupos de estudo e de controle.

Resultados O fluxo vaginal foi confirmado em 84% das mulheres do grupo de estudo versus 62,2% do grupo de controle (p < 0,01); prurido foi encontrado em 20 e 2,2%, respectivamente (p < 0,05). As úlceras genitais foram somente encontradas no grupo pessário (20%). Não houve diferenças com relação ao tipo de flora vaginal. A vaginose bacteriana fora encontrada em 31,1% das mulheres do grupo de estudo versus 22,2% do grupo de controle (p = 0,34).

Conclusão Mulheres usando pessários vaginais para tratamento do POP apresentaram maior fluxo vaginal, prurido e úlcera genital do que as não usuárias do dispositivo.

Keywords

vaginal pessary - itching - pelvic organ prolapse - vaginal flora - cross-sectional study

Palavras-chave

pessário vaginal - prurido - prolapso genital - flora vaginal - estudo transversal

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