RESUMEN
OBJECTIVE: To evaluate the acceptability, feasibility, and outcomes of pessary fitting in rural Nepali communities. METHODS: A 1-year prospective cohort study was conducted in the Ramechhap district of Nepal in January 2013-January 2014 among women attending a free gynecology health camp. All women with symptomatic pelvic organ prolapse (POP) were offered ring pessaries. Demographic information was collected and questionnaires on POP were completed. A urogynecologic examination was performed. At the 1-year follow-up, women were questioned on pessary use and underwent an examination. Logistic regression was used to identify associations. RESULTS: In total, 411 women attended the health camps, of whom 142 presented with symptomatic POP. Initial fitting was accomplished for 134 (94.4%) of the women. At the 1-year follow-up, 130 (97.0%) women in the cohort were evaluated, and 72 (55.4%) were still using the pessary. The primary reason for discontinuation was the pessary falling out (35/58, 60.3%). The most common complication was vaginal erosion (18/130, 13.8%), observed exclusively among postmenopausal women. Postmenopausal status was a predictor of continued use (odds ratio 3.12, 95% confidence interval 1.45-6.72; P=0.004). CONCLUSION: Pessaries were found to be an acceptable and feasible option with minimal complications for treating POP in rural Nepal.
Asunto(s)
Prolapso de Órgano Pélvico/terapia , Pesarios , Vagina/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Modelos Logísticos , Persona de Mediana Edad , Nepal , Estudios Prospectivos , Población Rural , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Vaginosis Bacteriana/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Although uterine prolapse (UP) occurs commonly in Nepal, little is known about the physical health and care-seeking practices of women with UP. This study aimed to explore women's experiences of UP and its effect on daily life, its perceived causes, and health care-seeking practices. METHODS: Using a convenience sampling method, we conducted 115 semi-structured and 16 in-depth interviews with UP-affected women during September-December 2012. All interviews occurred in outreach clinics in villages of the Dhading district. RESULTS: Study participants were 23-82 years of age. Twenty-four percent were literate, 47.2% had experienced a teenage pregnancy, and 29% had autonomy to make healthcare decisions. Most participants (>85%) described the major physical discomforts of UP as difficulty with walking, standing, working, sitting, and lifting. They also reported urinary incontinence (68%) bowel symptoms (42%), and difficulty with sexual activity (73.9%). Due to inability to perform household chores or fulfill their husband's sexual desires, participants endured humiliation, harassment, and torture by their husbands and other family members, causing severe emotional stress. Following disclosure of UP, 24% of spouses remarried and 6% separated from the marital relationship. Women perceived the causes of UP as unsafe childbirth, heavy work during the postpartum period, and gender discrimination. Prior to visiting these camps some women (42%) hid UP for more than 10 years. Almost half (48%) of participants sought no health care; 42% ingested a herb and ate nutritious food. Perceived barriers to accessing health care included shame (48%) and feeling that care was unnecessary (12.5%). Multiple responses (29%) included shame, inability to share, male service provider, fear of stigma and discrimination, and perceiving UP as normal for childbearing women. CONCLUSIONS: UP adversely affects women's daily life and negatively influences their physical, mental, and social well-being. The results of our study are useful to generate information on UP symptoms and female health care seeking practices. Our findings can be helpful for effective development of UP awareness programs to increase service utilization at early stages of UP and thereby might contribute to both primary and secondary prevention of UP.