Pelvic Organ + Pessary Review

**History** * Patient reports a sensation of bulge in the vagina, worse with standing and heavy lifting, and interfering with daily activities. * Patient reports urinary urgency and frequency. * Patient reports constipation. * Patient denies vaginal discharge or bleeding. * Patient currently uses a ring pessary, size 70mm, commenced 6 months ago. * Patient uses vaginal oestrogen cream twice weekly, no concerns reported. * Patient reports no pain or discomfort during intercourse. **Examination** * Pessary removed, in good condition. * Examination reveals a grade 2 cystocele and rectocele. * Speculum findings: vaginal mucosa appears healthy, no erosion or bleeding. * A new 75mm ring pessary was fitted, fit is good. **Impression** Patient presents with symptomatic pelvic organ prolapse, with a grade 2 cystocele and rectocele. The pessary is providing good support and symptom relief. No complications are noted. **Plan and follow up** * Discussed ongoing pessary care, including cleaning and re-insertion. * Advised to return for review in 6 months or earlier if symptoms worsen. * Scheduled follow-up review for 1 May 2025. * Provided advice on self-management of pessary, including care and re-insertion. * Continued vaginal oestrogen cream use as prescribed. * Patient was given the handout from the Australian Commission on Quality and Safety regarding Treatment Options for Pelvic Organ Prolapse.