Priority 6 from the Pessary use for Prolapse PSP

UNCERTAINTY: What is the best way to assess what type and size of pessary to use? (JLA PSP Priority 6)
Overall ranking	6
JLA question ID	0054/6
Explanatory note	Many different pessaries are available for clinicians to choose from but there is no evidence to help make the decision. Pessary manufacturers offer a guide as to which pessary works best with which type of prolapse but this has not been tested with enough studies to answer the question. Examples: Are there different sizes to fit different women? What technique of assessing for size/shape of pessary results in best fit/retention/comfort? How big can you progress with the Pessaries if they continue to fall out?
Evidence	None identified
Health Research Classification System category	Renal and urogenital

Extra information provided by this PSP
Original uncertainty examples	What is the most effective way of assessing the size of pessary to use? ~ Why do pessaries seem to be so difficult to size correctly? How do you appropriately change the size of a pessary? ~ Why can a pessary not come in more sizes ? I am between 2 sizes and therefore one drops out and one is too big. ~ How big can you progress with the Pessaries if they continue to fall out. ~ She has estimated that'll need a size 71 or 74 mm pessary. Can she tell without feeling? Is this the most common size pessary?
Submitted by	4 x women, 9 x healthcare professionals

Extra information provided by this PSP

Original uncertainty examples

What is the most effective way of assessing the size of pessary to use? ~ Why do pessaries seem to be so difficult to size correctly?
How do you appropriately change the size of a pessary? ~ Why can a pessary not come in more sizes ? I am between 2 sizes and therefore one drops out and one is too big. ~ How big can you progress with the Pessaries if they continue to fall out. ~ She has estimated that'll need a size 71 or 74 mm pessary. Can she tell without feeling? Is this the most common size pessary?

Submitted by

4 x women, 9 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