Priority 4 from the Pessary use for Prolapse PSP

UNCERTAINTY: What are the risks and complications of pessary use for prolapse? (JLA PSP Priority 4)
Overall ranking	4
JLA question ID	0054/4
Explanatory note	It is widely understood that a woman using a pessary should be under regular review to avoid the complications of pessary neglect. Research has not yet provided information for clinicians and women about how best to minimise any complications from pessary use nor identified what risks exist from pessary use. Examples: Is there any risk of infection by using a pessary? Why does inserting and removing the pessary cause bleeding? Can a pessary travel further up and cause damage to my vagina?
Evidence	The best available review is :Abdulaziz M et al (2015) An integrative review and severity classification of complications related to pessary use in the treatment of female pelvic organ prolapse https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4479661/
Health Research Classification System category	Renal and urogenital

Extra information provided by this PSP
Original uncertainty examples	Does the use of a pessary increase the risk of urinary tract infection? ~ Is there any risk of infection by using a pessary? ~ Why does inserting and removing the pessary cause bleeding? ~ How to avoid infection? ~ Does it ever block the urethra? ~ Can pessary travel further up and cause damage to my vagina? ~ Is a vaginal pessary one of the causative factors of vaginal evisceration? ~ Increase in vaginal infections which might be due to non-hygienic insertion or the antibiotic-resistant pathogens of vagina? ~ The most common complication associated with use of a pessary is the development of a vaginal ulcer.
Submitted by	2 x both, 3 x other, 21 x women, 5 x healthcare professionals

Extra information provided by this PSP

Original uncertainty examples

Does the use of a pessary increase the risk of urinary tract infection? ~ Is there any risk of infection by using a pessary? ~ Why does inserting and removing the pessary cause bleeding? ~ How to avoid infection? ~ Does it ever block the urethra? ~ Can pessary travel further up and cause damage to my vagina? ~ Is a vaginal pessary one of the causative factors of vaginal evisceration? ~ Increase in vaginal infections which might be due to non-hygienic insertion or the antibiotic-resistant pathogens of vagina? ~ The most common complication associated with use of a pessary is the development of a vaginal ulcer.

Submitted by

2 x both, 3 x other, 21 x women, 5 x healthcare professionals

PSP information
PSP unique ID	0054
PSP name	Pessary use for Prolapse
Total number of uncertainties identified by this PSP.	66 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	8 September 2017