An 82-year-old woman with grade III uterovaginal prolapse has severe cardiac failure and is considered a poor candidate for surgery. She is sexually inactive. Which is the most appropriate management?

• A Pelvic floor muscle training alone
• B Abdominal sacrohysteropexy
• C Sacrospinous ligament fixation
• D Ring pessary with periodic change and topical estrogen ✓

Explanation

In an elderly, medically unfit woman who is sexually inactive, a ring pessary provides effective palliation of symptomatic prolapse. It should be changed every 8 to 12 weeks, and topical estrogen is given to reduce the risk of pressure necrosis and ulceration of the vaginal epithelium. Surgery, whether abdominal or vaginal, carries unacceptable anaesthetic risk here. Pelvic floor muscle training alone is unlikely to control a grade III prolapse and is mainly useful for mild prolapse or as an adjunct.

Reference: Berek and Novak's Gynecology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.