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Ramaseshan AS, Mellen C, O'Sullivan DM, et al. Host inflammatory response in women with vaginal epithelial abnormalities after pessary use. Int Urogynecol J. 2021;doi: 10.1007/s00192-021-05001-8.
Ramaseshan, A. S., Mellen, C., O'Sullivan, D. M., Nold, C., & Tulikangas, P. K. (2021). Host inflammatory response in women with vaginal epithelial abnormalities after pessary use. International urogynecology journal, . https://doi.org/10.1007/s00192-021-05001-8
Ramaseshan, Aparna S, et al. "Host inflammatory response in women with vaginal epithelial abnormalities after pessary use." International urogynecology journal vol. (2021). doi: https://doi.org/10.1007/s00192-021-05001-8
Ramaseshan AS, Mellen C, O'Sullivan DM, Nold C, Tulikangas PK. Host inflammatory response in women with vaginal epithelial abnormalities after pessary use. Int Urogynecol J. 2021 Nov 08; doi: 10.1007/s00192-021-05001-8. Epub 2021 Nov 08. PMID: 34748034.
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Int Urogynecol J. 2021 Nov 08; doi: 10.1007/s00192-021-05001-8. Epub 2021 Nov 08.

Host inflammatory response in women with vaginal epithelial abnormalities after pessary use.

International urogynecology journal

Aparna S Ramaseshan, Colleen Mellen, David M O'Sullivan, Christopher Nold, Paul K Tulikangas

Affiliations

  1. Division of Female Pelvic Medicine & Reconstructive Surgery, Hartford Hospital, 85 Seymour St, Suite 525, Hartford, CT, 06106, USA. [email protected].
  2. Anne Arundel Medical Center, 2003 Medical Pkwy, Wayson Pavillion, Suite 150, Annapolis, MD, 21401, USA. [email protected].
  3. Division of Female Pelvic Medicine & Reconstructive Surgery, Hartford Hospital, 85 Seymour St, Suite 525, Hartford, CT, 06106, USA.
  4. Department of Research Administration, Hartford Healthcare, 80 Seymour St, Hartford, CT, 06102, USA.
  5. Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, CT, USA.

PMID: 34748034 DOI: 10.1007/s00192-021-05001-8

Abstract

BACKGROUND: Vaginal epithelial abnormalities (VEA) are a common complication associated with pessary use. The objective of this study was to determine if there is a host pro-inflammatory response associated with pessary use and VEA.

METHODS: Patients wearing pessaries for at least two weeks for the management of pelvic organ prolapse and/or urinary incontinence were screened for eligibility. Vaginal swabs were collected from women with VEA (cases) and without VEA (controls). Cases were matched to controls in a 1:3 ratio. Cytokine analysis of the collected samples was performed using multiplex analysis to determine the concentrations of interleukin (IL)6, interferon alpha 2 (IFNα2), tumor necrosis factor alpha (TNFα) and IL1β. A cross-sectional analysis was performed, comparing vaginal cytokine concentrations in women with and without VEA.

RESULTS: We enrolled 211 patients in this analysis: 50 cases and 161 controls. The median concentrations (pg/mL) of the four cytokines for cases and controls respectively were; IL6: 6.7 (IQR <2.9 [the lower limit of detection, LLD]-14.2) and < 2.9 (LLD) (IQR <2.9 [LLD]-5.5), IFNα2: 8.2 (IQR 6.1-13.9) and 7.9 (IQR 3.9-13.6), TNFα: 15.2 (IQR 6.1-30.4) and 4.68 (IQR <2.3 [LLD]-16.3), IL1β 195.7 (IQR 54.5-388.6) and 38.5 (IQR 6.7-154.9). The differences in median cytokine levels were statistically higher in cases for IL6, TNFα, and IL1β (all p < 0.001) compared to controls. Older age (OR: 1.062, 95% CI, 1.015-1.112), lower BMI (OR: 0.910, 95% CI, 0.839-0.986) and presence of VEA at last check (OR: 5.377, 95% CI, 2.049-14.108) were associated with higher odds of having VEA on multivariate analysis.

CONCLUSION: Pro-inflammatory cytokines, specifically IL6, TNFα, and IL1β, are elevated in pessary-wearing patients who have VEA. Additional prospective studies are needed to assess baseline vaginal inflammatory profiles before and after pessary placement to understand VEA formation in pessary patients.

© 2021. The International Urogynecological Association.

Keywords: Cytokines; Pelvic organ prolapse; Pessary; Vaginal discharge; Vaginal epithelial abnormalities; Vaginal erosions

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