title: Nonsurgical management of a rectovaginal fistula caused by a Gellhorn pessary.
abstract: BACKGROUND
  Pessaries are generally thought to be a safe, well-tolerated treatment for pelvic organ prolapse.
  
  
  METHODS
  An 85-year-old woman had a Gellhorn pessary placed for pelvic organ prolapse. Although she was seen regularly for care, the pessary had not been removed for several years. She presented stating that she felt the pessary had shifted. On examination, the patient's pessary stem had eroded through the vagina into the rectum. The pessary was removed and the patient was treated with vaginal estradiol cream. One month later the fistula tract had resolved and the patient continued to desire a pessary to manage her pelvic organ prolapse.
  
  
  CONCLUSIONS
  Pessaries require care and maintenance. Patients' desires for conservative management should be coupled with education and routine follow-up.
authors.affiliation: University of New Mexico, Albuquerque, New Mexico.
authors.forename: Sara
authors.initials: S
authors.lastname: Cichowski
authors.forename: Rebecca G
authors.initials: RG
authors.lastname: Rogers
mesh_terms: D000369:Aged, 80 and over; D004958:Estradiol / Q000627:therapeutic use*; D004967:Estrogens / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D056887:Pelvic Organ Prolapse / Q000628:therapy; D010570:Pessaries / Q000009:adverse effects; D012006:Rectovaginal Fistula / Q000188:drug therapy* / Q000209:etiology; D014622:Vaginal Creams, Foams, and Jellies / Q000627:therapeutic use
chemical_list: D004967:Estrogens; D014622:Vaginal Creams, Foams, and Jellies; D004958:Estradiol