Please select the eligibility criteria that correspond to the clinical trial below.
Title: The Use of Trimo-San Gel for the Prevention of Pessary-associated Bacterial Vaginosis
Brief Summary: The primary objective of this prospective, randomized, controlled study is to assess the effect of Trimo-San vaginal gel on the rate of bacterial vaginosis in women who use pessaries. Women being fitted for a pessary for the first time or not wearing a pessary for \>1 year are recruited in to the study and randomized to using Trimo-San gel daily or not using Trimo-San gel. The investigators use two objective measures of bacterial vaginosis (OSOM BV blue and gram stain) and subjective questionnaires regarding the presence and effect of vaginal symptoms on the pessary user prior to pessary fitting and at 3 months post pessary fitting. The investigators hypothesize that Trimo-San gel with not significantly affect the rate of bacterial vaginosis in pessary wearers as measures by OSOM BV blue and Gram stain, but will have a positive effect on the subjective symptoms experienced by women wearing pessaries.


Options:
A: Inclusion Criteria:

* Women aged 45 years or older
* Postmenopausal (\>55 if natural menopause)
* Clinical atrophic vaginitis (at least mild atrophy)
* Pelvic organ prolapse(at least stage 2 or greater)
* Posthysterectomy
* Surgery date between 2-12 weeks after recruitment

Exclusion Criteria:

* Uterus present
* Well-estrogenized appearing vagina
* Known or suspected history of breast carcinoma
* Hormone-dependent tumor
* Genital bleeding of unknown cause
* Acute thrombophlebitis or thromboembolic disorder associated with estrogen use
* Vaginal infection requiring treatment
* Allergy to estrogen or its constituents
* Any serious disease or chronic condition that would interfere with study compliance or preoperative surgical clearance.
* Use of exogenous corticosteroid or sex hormones (including homeopathic preparation) within the 8 weeks prior to recruitment
* Initiation or continuation of anticholinergic medication (which could bias the results of the pelvic floor questionnaires)
B: Inclusion Criteria:

* Women, still with uterus, planning total hysterectomy as part of surgical repair for pelvic organ prolapse
* Symptomatic anterior and/or apical vaginal prolapse greater than or equal to Stage 2 (i.e., bulge extends to at least 1 cm of the hymen or beyond)
* Women between 1 and 10 years after menopause. Menopause is defined as one year of amenorrhea or surgical ovariectomy.
* Age 40-70 years old
* No estrogen replacement therapy in the last 1 month
* Physically capable of daily application of vaginal cream

Exclusion Criteria:

* BMI \>35
* Prior surgical repair of prolapse involving the vaginal cuff.
* Prior total hysterectomy
* Premenopausal or postmenopausal \>10 years
* Prior steroid hormone replacement therapy of duration \>1 month (oral or vaginal estrogen, testosterone or corticosteroids)
* History of connective tissue disease (Ehlers-Danlos, Marfan, etc)
* History of vaginal radiation
* Contraindications for estrogen replacement therapy (current, or history of, spontaneous deep vein thrombosis, stroke, coronary artery disease, breast or endometrial cancer)
* Concurrent use of steroid cream for treatment of Lichen sclerosis
* Recent history (within last month) of vaginal infection or vaginitis
* Current tobacco use
C: Inclusion Criteria:

* Stress urinary incontinence or stress-predominant mixed urinary incontinence, with at least 2 episodes of stress incontinence on 7-day bladder diary and the number of stress incontinence episodes exceeding the number of urge incontinence episodes.
* Urinary incontinence for at least three months.
* Ambulatory adult women.
* Stage 0-I-II pelvic organ prolapse.

Exclusion Criteria:

* Continual urine leakage.
* Pregnancy or planning pregnancy within 1 year.
* Active urinary tract infection.
* Urinary retention.
* Currently on medication for incontinence.
* Currently using a pessary.
* Neurologic condition that affects bladder function.
D: Inclusion Criteria:

* Female
* Indications for initiation of pessary use and planning to be fitted for and wear a pessary

Exclusion Criteria:

* Male
* Already using a pessary or have used in the last year
* History of recurrent or chronic bacterial vaginosis with \> 2 episodes per year or symptoms reported for \> 6 months out of last year
* Active known vaginal infection (symptomatic and/or untreated) or completion of treatment for BV or cervical/vaginal infection within one week of recruitment
* History of active vaginal ulcerative disease (active ulcers from atrophy, herpes symptoms at recruitment, or HSV with \> 2 outbreaks per year or last outbreak \< 1 month ago)
* Chronic antibiotic use for indications not listed above

Answer: D