title: The effect of pessaries on the vaginal microenvironment.
abstract: OBJECTIVE
  The objective of the study was to evaluate the differences in vaginal culture, microscopy, and Gram stain between postmenopausal women who wear pessaries and those who do not to explain pessary-related, bothersome vaginal discharge.
  
  
  METHODS
  Postmenopausal women not using exogenous estrogen who had either been wearing a pessary for at least 3 months or who were undergoing their first pessary fittings were approached for enrollment. Symptoms were assessed, and vaginal fluid was collected for culture, microscopy, and Gram stain. A cross-sectional analysis was performed, comparing the new and return pessary wearers. The new pessary users were also sampled at 2 weeks, 3 months, and 6 months after fitting.
  
  
  RESULTS
  Women who wore pessaries were more likely to be bothered by discharge (30.0% vs 2.1%, P < .001). They were also more likely to show microscopic evidence of vaginal inflammation and vaginitis. Prospective data showed that these changes developed during the first 2 weeks of pessary use. Aerobic and anaerobic organisms were nearly identical in women with and without bothersome vaginal discharge in the cross-sectional analysis and at all time points in the prospective analysis.
  
  
  CONCLUSIONS
  Pessary-related, bothersome vaginal discharge develops early and may be due to an inflammatory process in the vagina.
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, CT. Electronic address: scollins4@uchicago.edu.
authors.forename: Sarah
authors.initials: S
authors.lastname: Collins
authors.affiliation: Division of Reproductive Infectious Diseases and Immunology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Womens Hospital, University of Pittsburgh Health Center, Pittsburgh, PA.
authors.forename: Richard
authors.initials: R
authors.lastname: Beigi
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, CT.
authors.forename: Colleen
authors.initials: C
authors.lastname: Mellen
authors.affiliation: Department of Research Administration, Hartford Hospital, Hartford, CT.
authors.forename: David
authors.initials: D
authors.lastname: O'Sullivan
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, CT.
authors.forename: Paul
authors.initials: P
authors.lastname: Tulikangas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D010570:Pessaries / Q000009:adverse effects*; D011446:Prospective Studies; D014621:Vagina / Q000382:microbiology*; D019522:Vaginal Discharge / Q000382:microbiology*
keywords: pelvic organ prolapse; pessary; vaginal culture; vaginal discharge