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EFFECTS OF PELVIC ORGAN

PROLAPSE RING PESSARY
THERAPY ON INTRAVAGINAL
MICROBIAL
FLORA
Kazuaki
Yoshimura, Nobuo Morotomi,
Kazumasa
Fukuda, Toru Hachisuga, Hatsumi Taniguchi

D I V I S I U R O G I N E KO LO G I D A N R E KO N S T R U K S I O R G A N
PA N G G U L
D E PA R T E M E N O B S T E T R I D A N G I N E K O L O G I
FA K U LT A S K E D O K T E R A N U N I V E R S I T A S H A S A N U D D I N
M A K A SS A R
2016

I
N
T
R
O
D
U
C
T
I
O
N

RING PESSARY

urinary, bowel,sexual
function

Pessary vaginitis &

pessary erosion

QO
L

POP

Conventional
methods

BV

Clone library
methods

Culture based
methods

AIM :
To evaluate intravaginal microbial flora
of POP patients using the ring pessary
with conventional and clone library
methods

Study population &

speciemen sampling
July december 2007
13 POP patients

Wallace ring pessary

Informed consent
Measure Vaginal pH
Specimen from
posterior fornix
Wallace Ring pessary
4 weeks later
Check pessary position
& repeat intravaginal
microbial analysis

Lateral vaginal wall

Placed into
TRANSWAB
for 6 hours
Glass slide for
gram staining

pH-Fix 3.66.1:
MACHEREYNAGEL, Duren,
Germany

Nugent Score
+ clue cells

LACTOBACILLARY GRADE (LAC

GRADE) donders criteria
LAC grade 0 no detected flora
LAC grade I normal flora
LAC grade II intermediate flora
LAC grade IIa
LAC grade IIb
LAC grade III - BV

Nugent Score
Examined presence of BV
One trained technician who was blinded to the
origin of slides
Criteria :
0-3: normal flora
4-6 : intermediate vaginal flora
7-10 : BV

Culture Based bacterial identification

`inoculated in many medium
Categories: 1+; 2+; 3+

Clone library
16S rRNA gene sequencing

RESULTS

D
I
S
C
U
S
S
I
O
N

Broad-range PCRs of the 16S rRNA gene

Detect most causative bacteria
Detect bacteria that cannot be cultivated

Intravaginal microbial flora

Lactobacillus spp. were detected most
Grew under the anaerobic conditions suppress
the growth of other bacteria

results of this study

if Lactobacillus spp. are the predominant bacteria at
the beginning of ring pessary therapy normal
flora posttherapy
Metronidazole is reported to be effective in curing
BV without diminishing Lactobacillus (falagas)

LIMITATIONS
There was a wide
variety of clinical
features among
patients, even with the
same POP-Q stage.

Original intravaginal
microbial flora (before
ring pessary therapy)
were different.

Each method of
microbial detection has
advantages and
disadvantages

CONCLUSION

Ring pessary therapy did not

always disturb intravaginal
microbial flora, especially in
patients who already
had Lactobacillus spp. present

TERIMA
KASIH