The purpose of this study was to examine the association between
pessary use, smoking and changes in the vaginal flora. Patients using
pessaries were age matched with non-
pessary using controls. All candidates examined were women attending the Mount Sinai Hospital, Toronto, for genitourinary problems. Vaginal cultures were routinely performed on all women attending the unit, irrespective of symptoms. Forty-four
pessary users were age matched with 176 controls (4 controls per case). The mean age was 60.1 +/- 12.6 years, and 15% of these were premenopausal. The duration of
pessary use ranged from 0.5 to 8 years (mean 3.3 +/- 1.7). Weight, parity, smoking status,
diabetes mellitus,
thyroid disease, UTI and postvoid residual urine volume were not significantly different between
pessary users and controls.
Bacterial vaginosis (BV) was noted in 32% of
pessary users, versus 10% of controls. The relative risk of developing BV in
pessary users was 3.3 (OR, 4.37; 95% CI, 2.15-9.32), P = 0.0002. Smoking independently affected the vaginal flora, increasing the relative risk of developing BV to 2.9 (OR, 3.78; 95% CI, 2.05-8.25), P = 0.0013. It was concluded that
pessary use is a very effective and conservative method for the treatment of genital
prolapse. However, we found that the presence of a
foreign body was associated with changes in the vaginal flora, thereby increasing the odds of developing
bacterial vaginosis to 4.37; this was further compounded by smoking.