title: Quality of life in women who use pessaries for longer than 12 months.
abstract: OBJECTIVE
  Pessaries are an effective treatment for pelvic organ prolapse and urinary incontinence; however, few data exist describing long-term pessary use. Our aim was to describe symptom bother and quality of life (QoL) in women using pessaries for urinary incontinence and/or prolapse for at least 12 months.
  
  
  METHODS
  Consecutive women who met inclusion criteria were approached for this observational cross-sectional study. Wilson and Cleary's Health-Related Quality of Life Model guided the inclusion of biologic, functional, and individual factors that impact the health-related QoL. Consenting participants completed a generalized QoL index, the Center for Epidemiologic Depression Symptoms, Medical Outcomes Study Social Support Survey, and condition-specific measures; the Pelvic Floor Distress Inventory (PFDI-20-SF) and the Pelvic Floor Impact Questionnaire.
  
  
  RESULTS
  Fifty-six women, mean age 74.4 years (range, 47-89 years), completed the survey. Mean length of time for pessary use was 4.5 years (1-15 years). Most of the women (n = 31, 55.4%) returned to the clinic for pessary care every 3 months. There was no difference in generalized QoL nor condition-specific total PFDI-20 in women performing self-care versus routine follow-up. Almost one third (29%) of participants reported complications related to pessary use (eg, vaginal erosion), and 41%were considering surgical repair in the near future. Women who were considering surgery had higher PFDI-20 scores relating to more bothersome prolapse symptoms than those not considering surgery (Pelvic Organ Prolapse Distress Inventory 6, 33.91 vs 24.73, P = 0.03).
  
  
  CONCLUSIONS
  Pessaries can be used to control pelvic floor symptoms for extended periods. Complication rates in this study were lower than previously reported, even in women not doing self-care. Not surprisingly, women considering surgical intervention reported greater symptom bother despite pessary use.
authors.affiliation: From the *Loyola University Chicago, Marcella Niehoff School of Nursing; †Department of Obstetrics and Gynecology, Loyola University Chicago, Stritch School of Medicine, Maywood; and ‡Department of Obstetrics and Gynecology and Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Sandi
authors.initials: S
authors.lastname: Tenfelde
authors.forename: Dina
authors.initials: D
authors.lastname: Tell
authors.forename: Tonya Nicole
authors.initials: TN
authors.lastname: Thomas
authors.forename: Kimberly
authors.initials: K
authors.lastname: Kenton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D033182:Intention; D008875:Middle Aged; D017773:Pelvic Floor / Q000601:surgery; D056887:Pelvic Organ Prolapse / Q000523:psychology / Q000628:therapy; D010570:Pessaries / Q000009:adverse effects*; D011788:Quality of Life; D012648:Self Care; D011795:Surveys and Questionnaires; D013997:Time Factors; D014549:Urinary Incontinence / Q000523:psychology / Q000628:therapy