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Step-by-step approach to
managing pelvic organ prolapse
Information for physicians
Risa Bordman
MD CCFP FCFP
Deanna Telner
MD MEd CCFP
Bethany Jackson
MD CCFP
DArcy Little
MD CCFP
Tips on pessaries
There are 2 types: supportive for milder prolapses
and space-occupying for more serious prolapse.
Cost is $88 (Canadian) delivered to your office.
For women with atrophic changes, the vagina can
be prepared with topical estrogen 2 to 3 times a
week for a month before insertion.
Aim for the largest pessary that fits comfortably.
Examiners fingers should pass easily between the
pessary and the vagina wall.
After fitting the pessary in the office, have patients
walk around and then try to urinate or defecate.
Women can remove, wash with mild soap and
water, and replace the pessary weekly or monthly
(or it can be cleaned by a health care professional
every 3 to 6 months).
There is no evidence or consensus on which pessary is best, how often to clean it, or how often to
visit a health professional.
You can try to keep the vagina lubricated with
estrogen or Trimo-San vaginal jelly.
Adverse effects include discharge, odour, pain,
bleeding, failure to reduce prolapse, and expulsion.
Long-term use carries a risk of vaginal erosion, so vaginal examinations should be done every 3 to 6 months.
If forgotten, pessaries might become fixed in place.
To loosen fixed pessaries before removal, apply 2 g
of estrogen cream every second day for 2 weeks.
Change a pessary after about 5 years or when it
wears out.
Pessary companies
Milex (Cooper Surgical), 800 243-2974,
www.coopersurgical.com
Mentor, 800 668-6069, www.mentorcorp.com
Superior, 800 268-7944, www.superiormedical.com
Vol 53: march mars 2007 Canadian Family Physician Le Mdecin de famille canadien
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Canadian Family Physician Le Mdecin de famille canadien Vol 53: march mars 2007
Bottom line
Women are often reluctant to discuss prolapse symptoms. While there are no randomized controlled trials of treatment, pessaries are a good option for
those who wish to remain fertile or avoid surgery.
Resources
An Approach to Diagnosis and Management of Benign
Uterine Conditions in Primary Care is available on-line
with patient handouts and other useful resources at
www.benignuterineconditions.ca. Printed copies can be
obtained from the Ontario College of Family Physicians
on their website at www.ocfp.on.ca, by e-mail at
cme_ocfp@cfpc.ca, and by telephone at 416 867-8646.
Dr Bordman is a family doctor at North York General
Hospital in Toronto, Ont, and an Assistant Professor in the
Department of Family and Community Medicine at the
University of Toronto. Dr Telner is a family physician at the
Toronto East General Hospital and an Assistant Professor in
the Department of Family and Community Medicine at the
University of Toronto. Dr Jackson completed a fellowship in
womens health and is currently a family physician in Ottawa,
Ont. Dr Little is a Lecturer in the Department of Family and
Community Medicine at the University in Toronto.