South Tees NHS Foundation Trust, Middlesbrough, UK.
University of Sunderland, Sunderland, UK.
Int Urogynecol J. 2024 Feb;35(2):327-332. doi: 10.1007/s00192-023-05643-w. Epub 2023 Sep 2.
Pelvic organ prolapse is a common problem affecting women, but there is currently a lack of research focusing on patient experience of pessary changes. This study was aimed at capturing the patient perspective of pessary changes and formally assessing pain during pessary removal and insertion.
A service evaluation request was granted by South Tees Hospitals NHS Trust. Patients undergoing pessary change (ring, shelf, or Gellhorn) in gynaecology outpatient clinics over a 6-month period were asked to rate their pain scores on a ten-point numerical pain-rating scale. Other associated data were collected.
Out of 213 women, 58.2% reported that pessary removal was more painful than insertion, 30.5% reported equal pain, and 10.8% reported that insertion was more painful than removal. Pain scores were significantly higher for removal (mean 4.37, median 4, IQR 4-7) than for insertion (mean 2.66, median 2, IQR 2-4, p <0.001). Ring pessaries were significantly less painful to both remove and insert than shelf and Gellhorn pessaries. Smaller pessaries were more painful to both remove and insert. There was no significant difference in pain scores reported by those with or without diagnosed vulval conditions.
Pessary removal causes most women moderate pain, which should be communicated to patients beforehand. Ring pessaries are significantly less painful to change than other pessary types. Clinicians should consider pain as a factor in their decision-making surrounding pessary choice and when counselling patients. Future research should focus on ways to reduce pain during pessary removal.
盆腔器官脱垂是一种常见的影响女性的问题，但目前缺乏针对患者对子宫托更换体验的研究。本研究旨在从患者的角度了解子宫托更换的情况，并对子宫托取出和插入过程中的疼痛进行正式评估。
South Tees Hospitals NHS Trust 批准了一项服务评估请求。在 6 个月的时间里，在妇科门诊接受子宫托更换（环形、支架或 Gellhorn 型）的患者被要求使用十分制疼痛评分量表对他们的疼痛评分进行评分。还收集了其他相关数据。
在 213 名女性中，58.2%的人报告说子宫托取出比插入更痛，30.5%的人报告说疼痛程度相同，10.8%的人报告说插入比取出更痛。取出时的疼痛评分明显高于插入时（平均 4.37，中位数 4，IQR 4-7）（p<0.001）。与支架和 Gellhorn 型子宫托相比，环形子宫托在取出和插入时的疼痛均明显较轻。较小的子宫托在取出和插入时都更痛。有无诊断性外阴疾病的患者报告的疼痛评分无显著差异。
子宫托取出会给大多数女性带来中度疼痛，应事先告知患者。与其他类型的子宫托相比，环形子宫托更换时疼痛较小。临床医生在决定选择子宫托和向患者提供咨询时，应将疼痛视为一个因素。未来的研究应侧重于减少子宫托取出过程中的疼痛。
