Provider Practice Patterns Regarding Over-the-counter vaginal inserts for treatment of SUI

Objectives: The objectives of this study were to understand if medical professionals in specialties that treat women for incontinence are offering over the counter vaginal inserts for the treatment of SUI or stress-predominant mixed urinary incontinence (MUI) during patient counseling. Also, we aimed to understand if medical professionals in these specialties are familiar with three different OTC devices for treatment of SUI available in the United States, and perceived barriers to recommending OTC devices to patients.

Methods: A sample of medical providers was recruited electronically to complete an online survey with questions on current recommendations on OTC vaginal inserts for treatment of SUI. The survey was distributed to ACGME accredited obstetrics and gynecology and urology residency programs, ACGME accredited fellowship programs in female urology and urogynecology, and to the members of the Society of Urologic Nurses and Associates for participant recruitment. Descriptive statistics were performed. Logistic regression with resulting odds ratios were used to examine practice patterns. Statistical significance was conferred with p< 0.05; analysis was performed in STATA.

Results: Of the 292 respondents, most were female (83%), with an average age 40, practice in an academic setting (73%), and had an MD or DO (73%). Of all respondents, 175 (60%) were familiar with the use of OTC vaginal inserts for treatment of SUI (Table). Most respondents were familiar with the vaginal insert Poise Impressa (61%), with familiarity decreasing with the Revive] (10%), and was lowest for the Finess (7%). Of respondents that stated they regularly evaluate and treat women with SUI (n=235), 57% reported ever recommending OTC inserts for treatment of SUI. Recommending OTC vaginal inserts was associated with academic practice setting, non-resident status, and practice specialty. Of 140 respondents that answered questions regarding frequency of recommendation 55 (40%) recommended rarely, 49 (35%) monthly, 28 (20%) weekly, 7 ( < 1%) daily. Of physician respondents not currently in training, being fellowship-trained increased odds of recommending OTC devices (OR 8.13, {95%CI 2.89 – 22.89}, p = < 0.01). Of respondents that do not recommend OTC vaginal inserts frequently, barriers to using these devices was lack of training with device making provider uncomfortable with recommendation (37%) and difficulty remembering OTC devices as an option (7.5 %) (Figure).

Conclusions: In our survey, only about half of respondents that evaluate and treat SUI regularly have ever recommended OTC vaginal inserts, and most reporting they rarely recommend this treatment option to patients. We also identify perceived barriers to recommending such devices. Given the low risk to patients of using these easily accessible devices, we hope to draw attention to such barriers with the goal of increasing provider awareness and utilization of OTC vaginal inserts as a treatment option for the treatment of SUI and stress-predominant MUI moving forward.