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Introduction
Pelvic organ prolapse (POP) is a protrusion of the pelvic organs into or outside the
vaginal introitus. At least 20% (3.4-56.4%) of women in the developing countries are
thought to have POP. Women with POP may present with a vaginal bulge, pelvic
heaviness or pressure, urinary and sexual dysfunction. In addition, their ability to
work or perform house chores is impaired, have low self-esteem and dysfunctional
sexual relations due to pelvic pain and discomfort. POP can be managed
conservatively or through using vaginal pessaries or surgery. However, compounded
by poverty, poor access to health care services, and scarcity of trained surgeons,
surgery for symptomatic POP remains costly in the developing countries and reserved
for severe forms of POP. Vaginal pessaries for managing symptomatic POP are nearly
as effective as surgery in improving symptoms and quality of life, with relatively mild
and manageable complications resulting in high satisfaction rates as seen in the
developed countries. Thus, vaginal pessaries may be a treatment option of choice in
treating and managing symptomatic POP in developing countries as well where
surgical treatment is expensive or otherwise not available.
Aim: To evaluate the outcome of vaginal pessaries in the management if symptomatic
POP in rural Kilimanjaro, Tanzania.
Methodology
A pre-post interventional study of women with symptomatic POP and who will show
interest in pessary treatment will be fitted with the ring with support pessary and
followed for 3 months. One group of these women will be enrolled from a
community-based cross sectional survey on the prevalence of POP in rural
Kilimanjaro while others will be enrolled at selected local health centers following
public sensitization. Anatomic staging will be done using the standard Pelvic Organ
Prolapse Quantification test (POP-Q). Pelvic Organ Prolapse Distress Inventory
(POPDI-6) and Pelvic Floor Impact Questionnaire (PFIQ) will be completed at
baseline and at 3-months to assess changes in symptoms following treatment and
patient satisfaction respectively. |
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