Abstract
OBJECTIVE: One of the treatment options in pelvic organ prolapse (POP) is vaginal pessary therapy. For a well-informed decision, different aspects of the treatment option, including sustainable long-term outcomes, need to be discussed with the patient. However, long-term quality of life and psychological wellbeing of pessary use is unknown. This study explores the factors contributing to long-term pessary use. METHODS: A mixed-methods study was performed among patients with vaginal pessary use for at least 5 years. The quantitative part consisted of online, validated questionnaires on satisfaction with care (Patient Satisfaction Questionnaire Short Form [PSQ-18]), shared decision-making (Shared Decision Making Questionnaire [SDM-Q-9]) and decisional regret (Decision Regret Scale [DRS]). Health-related quality of life and pelvic floor complaints were measured by the Pelvic Floor Disability Index (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), and the EuroQol EQ-5D-5L questionnaire. The qualitative part comprised semi-structured interviews according to the Consolidated Criteria for Reporting Qualitative Research (COREQ) analyzed with grounded theory analysis. RESULTS: In all, 35 patients filled in the questionnaires and seven were interviewed. Overall, patients indicated a good quality of life and satisfaction with the treatment. Three major themes were found in the interviews: effect of the treatment, contact with the healthcare provider, and choice in type of care. Four minor themes were psychosocial aspects, self-image, established habits, and sexuality. CONCLUSION: When considering possible pessary use with a POP patient, these longterm effects of successful pessary treatment can be offered. The identified themes need to be addressed when applicable for the patient. Patients can be informed that long-term pessary use is feasible and can become a habit with little burden that relieves the complaints they experience.