Conservative versus surgical management of prolapse: what dictates patient choice?

The aim of this study is to establish whether the presence of severe symptoms influences women's choice of pessaries or surgery for uterovaginal prolapse. This is a prospective study using the validated Sheffield Prolapse Symptoms Questionnaire. Women choosing surgery (n = 251) were younger (58 versus 66 years), more bothered by dragging lower abdominal pain (33% versus 25%, P = 0.04), need for vaginal digitation (8% versus 3%, P = 0.02), and incomplete bowel emptying (27% versus 19%, P = 0.01) than women choosing pessaries (n = 429). More women opting for surgery were sexually active (51% versus 29%, P < 0.0001), perceived avoidance of sex due to prolapse (28% versus 17%, P = 0.000), and perceived prolapse interfering with sexual satisfaction as a severe problem (26% versus 15%, P = 0.000). Nearly two thirds of women with symptomatic prolapse initially opted for conservative management. Women choosing surgery over pessaries for treatment of prolapse describe more severe symptoms related to bowel emptying, sexual function, and quality of life and are bothered by them.