**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.
**History**
[Document symptoms of prolapse including sensations of bulge, falling out, tissue protrusion, or pressure in the vagina; note activities that worsen symptoms, frequency or intermittency of symptoms, and whether they interfere with daily activities] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in brief bullet points.)
[Document bladder-related symptoms including urgency, frequency, incomplete emptying, incontinence, or leakage] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in brief bullet points.)
[Document bowel symptoms relevant to prolapse, such as constipation, incomplete evacuation, or faecal incontinence] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in brief bullet points.)
[Document presence of vaginal discharge or bleeding] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in brief bullet points.)
[Document current use of silicone vaginal pessary, including type, size, shape, and date use commenced] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in brief bullet points.)
[Document current use of vaginal oestrogen pessary or cream, frequency of use, and any patient concerns or issues with use] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in brief bullet points.)
[Document sexual activity and any symptoms related to intercourse such as pain, discomfort, or difficulties] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in brief bullet points.)
**Examination**
[Document whether pessary was removed, and comment on its condition at removal] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in brief bullet points.)
[Document findings related to pelvic organ prolapse, including degree of weakness, presence of cystocele or rectocele] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in brief bullet points.)
[Document speculum findings including tissue integrity, presence of erosion, irritation, atrophy, bleeding, or discharge] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in brief bullet points.)
[Document whether pessary was replaced or a new pessary fitted, and note size and fit] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in brief bullet points.)
**Impression**
[Summarise clinical impression based on history and examination, including type and severity of prolapse and any complications] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in paragraphs of full sentences.)
**Plan and follow up**
[Summarise discussion regarding ongoing pessary care and any patient instructions provided] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in brief bullet points.)
[Document guidance on when to return for review or earlier if needed] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in brief bullet points.)
[Document timing and details of scheduled follow-up review] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in brief bullet points.)
[Detail any advice provided on self-management of pessary, including care and re-insertion if applicable] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in brief bullet points.)
[Document any instructions provided regarding vaginal oestrogen use] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in brief bullet points.)
[Document whether patient was given the handout from the Australian Commission on Quality and Safety regarding Treatment Options for Pelvic Organ Prolapse] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in brief bullet points.)
(Never come up with your own patient details, assessment, plan, interventions, evaluation, and plan for continuing care - use only the transcript, contextual notes or clinical note as a reference for the information included in your note. If any information related to a placeholder has not been explicitly mentioned in the transcript, contextual notes or clinical note, you must not state the information has not been explicitly mentioned in your output, just leave the relevant placeholder or omit the placeholder completely. Use as many lines, paragraphs or bullet points, depending on the format, as needed to capture all the relevant information from the transcript.)
