Department of Obstetrics and Gynecology, Wakamatsu Hospital of University of Occupational and Environmental Health, Kitakyushu, Japan.
Department of Microbiology, University of Occupational and Environmental Health, Kitakyushu, Japan.
J Obstet Gynaecol Res. 2020 Jun;46(6):931-938. doi: 10.1111/jog.14242. Epub 2020 Mar 18.
Continuous usage of a ring pessary for pelvic organ prolapse may cause a disturbance of intravaginal microbiota and intravaginal mucosal damage. To avoid the side effects of continuous ring pessary therapy, daily self-replacement of the ring pessary is recommended. The purpose of this study is to evaluate the outcomes of self-replacement versus continuous ring usage, by analysing clinical findings and intravaginal microbiota.
Thirty seven patients who managed self-replacement ring pessary therapy and 13 patients with continuous ring pessary therapy participated in this study. The clinical symptoms were checked at 1 month after the initial ring pessary insertion. The changes in the intravaginal microbiota were evaluated by conventional methods, i.e. pH in the vagina, Lactobacillary grade, Nugent score, inflammatory cell counts, and culture-based bacterial detection methods. In addition, our clone library method using 16S rRNA sequencing of vaginal fluid was performed.
Patients were divided into four groups: self-replacement pre/post-menopause and continuous and pre/post-menopause. Five patients of the self-replacement group (n = 37) and all patients of the continuous use group (n = 13) complained of increased discharge. However, both the conventional methods and the clone library method revealed that the number of the self-replacement group patients who had abnormal intravaginal microbiota were not significantly different from that of the continuous use group.
Daily self-replacement ring pessary therapy prevented adverse clinical symptoms. However, abnormal intravaginal microbiota was frequently observed during self-replacement of ring pessary therapy as with continuous usage. Regardless, pelvic examinations should be performed routinely.
盆腔器官脱垂患者连续使用环形子宫托可能会引起阴道内微生物群紊乱和阴道黏膜损伤。为避免连续环形子宫托治疗的副作用，建议每日自行更换环形子宫托。本研究旨在通过分析临床发现和阴道内微生物群来评估自行更换与连续使用环形子宫托的效果。
本研究纳入了 37 名接受自行更换环形子宫托治疗的患者和 13 名接受连续环形子宫托治疗的患者。在初次放置环形子宫托 1 个月后检查临床症状。采用传统方法评估阴道内微生物群的变化，即阴道 pH 值、乳杆菌分级、努金评分、炎症细胞计数和基于培养的细菌检测方法。此外，我们还采用阴道液 16S rRNA 测序的克隆文库方法进行分析。
患者被分为四组：自行更换绝经前后组和连续使用绝经前后组。在自行更换组（n=37）中有 5 名患者和连续使用组（n=13）中的所有患者都主诉分泌物增多。然而，无论是传统方法还是克隆文库方法都显示，自行更换组患者中出现异常阴道微生物群的人数与连续使用组无显著差异。
每日自行更换环形子宫托治疗可预防不良的临床症状。然而，与连续使用一样，在自行更换环形子宫托治疗期间经常观察到异常的阴道微生物群。无论如何，应常规进行盆腔检查。
