Women who continued using the pessary had a greater that 70% improvement in their symptom questionnaire scores. Few studies have compared QOL outcomes of RG-7388 mw surgery to pessary use in women with POP. One recent study reported that improvements

in QOL as well as urinary, bowel and sexual function were similar in both surgery and pessary treatment group.[50] Barber et al. found that responses to PFDI and PFIQ questionnaires suggested that surgery (such as vaginal hysterectomy, anterior and posterior colporrhaphy, vaginal vault suspension sling procedure, anal sphincteroplasty and copocleisis) was associated with greater QOL improvements when compared to pessary use.[57] In the pessary treated group, the prolapse and urinary scales of the PFDI showed significant improvement with no change in the colorectal scale or the PFIQ. In the surgery group, there was significant improvement in all scales of the PFDI and PFIQ. Further, compared to the pessary group, women who underwent surgery had significant improvement in each scale of the PFDI as well as the prolapse and urinary scale of the PFIQ. Physiotherapy is another non-surgical intervention for POP that has been shown to significantly improve

urogenital symptoms, QOL and objective physical findings in women with POP,[58-60] though therapy may be less effective Pifithrin-�� order in women with POP-Q stage > II.[61] The aims of physiotherapy are to improve pelvic floor muscle strength and function.[62] Therapists utilize a combination of treatment modalities, including exercise, biofeedback, electrical stimulation and behavioral therapy. In a Norwegian randomized control trial, women with POP-Q stage < IV with no previous surgery and who could demonstrate the ability to contract pelvic floor muscles, were randomized to an intervention group that received weekly

physiotherapy visits for 3 months, then fortnightly visits Clomifene for a further 3 months, or to a control group with no intervention.[60] The women were given a four-point scale questionnaire that assessed the frequency and bother of prolapse symptoms such as feelings of vaginal bulging and heaviness. At 6 months, women in the intervention group demonstrated improved POP-Q staging compared to the control group (11.2% vs. 4.3%), greater elevation of the bladder (by ultrasound assessment) and reduced frequency and bother of prolapse symptoms. Physiotherapy has also been shown to be effective in improving sexual function and QOL in women with SUI. Sexual dysfunction is commonly associated with POP and is reported by nearly one-third of women.[35, 63] Simple guidelines have been proposed for the evaluation of sexual function in women with POP that can easily be administered during a routine office visit.