Feasibility of using pessaries for treatment of pelvic organ prolapse in rural Nepal

Objective: To evaluate the acceptability, feasibility, and outcomes of pessary fitting in rural Nepali communities. Methods: A 1-year prospective cohort study was conducted in the Ramechhap district of Nepal in January 2013-January 2014 among women attending a free gynecology health camp. All women with symptomatic pelvic organ prolapse (POP) were offered ring pessaries. Demographic information was collected and questionnaires on POP were completed. A urogynecologic examination was performed. At the 1-year follow- up, women were questioned on pessary use and underwent an examination. Logistic regression was used to identify associations. Results: In total, 411 women attended the health camps, of whom 142 presented with symptomatic POP. Initial fitting was accomplished for 134 (94.4%) of the women. At the 1-year follow-up, 130 (97.0%) women in the cohort were evaluated, and 72 (55.4%) were still using the pessary. The primary reason for discontinuation was the pessary falling out (35/58, 60.3%). The most common complication was vaginal erosion (18/130, 13.8%), observed exclusively among postmenopausal women. Postmenopausal status was a predictor of continued use (odds ratio 3.12, 95% confidence interval 1.45-6.72; P=0.004). Conclusion: Pessaries were found to be an acceptable and feasible option with minimal complications for treating POP in rural Nepal.