Loss of anatomical support for the pelvic organs results in pelvic organ prolapse (POP) that results in a diminution of quality of life (QoL). The most common therapeutic tool used for conservativ POP for doctor-led treatment internationally is a ring pessary. A Gellhorn pessary is commonly recommended in more severe cases. We hypothesized that daily self-management of a cube pessary is a safe, feasible long-term treatment in women with symptomatic POP.

In this prospective study, 214 symptomatic POP patients were enrolled between January 2015 and December 2015. All of these patients suffered from symptomatic stage 2 or higher POP, and either the anterior, middle, and/or posterior compartments were affected. As a conservative self-therapy, various sizes of space-filling cube pessaries (Dr Arabin®) were fitted to each patient. The patients received detailed instructions on pessary use and care, with particular attention being given to the removal technique. They were interviewed via online questionnaire more than 5 years after of initial fitting. Those, who hadn`t any online access completed telephone interviews. The change of quality of life (QOL) was measured by Patient Global Impression of Improvement (PGI-I).

Of the 214 women who were fitted with vaginal pessary 29 (29/214, 13.5%) women were lost to follow-up. Of the 185 woman included in the analysis 174 (94%) successfully retained the pessary 4 weeks after insertion. 143 (82.2%) used the pessary successfully over 5 years, whereas 31 (17.8%) discontinued use at some point after 4 weeks. 88.8% (127/143) of the patients described their condition compared with how it was before the therapy as very much better or much better (PGI – I: 1,6). Side effects were found to be minor, with a rate of 15.4 % (22/143) during the follow-up period, and they included mild vaginal discharge (15/22), and (6/22) light vaginal bleeding, due to fitting caused mild vaginal epithelial lesions.

In the current prospective study, we report for the first time the long-term effects and experiences with self-management on daily basis of cube vaginal pessaries in symptomatic POP patients. Despite the use of pessaries are widely accepted in the conservative treatment of symptomatic POP, there is limited data available on self-management and long-term results. Our results indicated, that by always removing the pessary in the evening daily, the vaginal tissues can regenerate every night, and it is associated with low complication rates, We also demonstrate the future of pessary therapy, which is self-management.

Daily self-managed cube pessary use was found to be safe and effective. This treatment modality offers a convenient and cost-effective method for treating POP-related symptoms and thus improving QoL in the long term. Given our clinical experience and the present empirical data, it is our view that self-management is a critical factor in the long-term success of pessary treatment.

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