What is known from the existing literature about self-management of pessaries for pelvic organ prolapse? A scoping review

Dwyer, Lucy; Dowding, Dawn; Kearney, Rohna

doi:10.1136/bmjopen-2021-060223

Cited by 5 publications

(1 citation statement)

References 49 publications

(199 reference statements)

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“…Our findings contrast with those of another Canadian study that found that most women preferred regular appointments with health care providers to the option of self-care [ 9 ]. Storey et al [ 9 ] identified psychological comfort with touching oneself as a factor in choice for provider-led care and hypothesized that this might be related to generational differences and patient age [ 10 ]. Our study, completed 13 years later, included patients with a similar median age but noted a much higher acceptability of self-care.…”

Section: Discussionmentioning

confidence: 99%

Women’s attitudes towards pessary self-care: a qualitative study

et al. 2023

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Introduction and hypothesis Patients with vaginal pessaries can learn to care for their pessary by themselves or they can have provider-led care, which requires more frequent follow-up visits. We aimed to understand motivations for and barriers to learning self-care of a pessary to inform strategies to promote pessary self-care. Methods In this qualitative study, we recruited patients recently fitted with a pessary for stress incontinence or pelvic organ prolapse, and providers who perform pessary fittings. Semi-structured, one-on-one interviews were completed to data saturation. A constructivist approach to thematic analysis using the constant comparison method was used to analyze interviews. A coding frame was created following independent review of a subset of interviews by three members of the research team and this frame was used to code interviews and develop themes through interpretive engagement with the data. Results Ten pessary users and four health care providers (physicians and nurses) participated. Three major themes were identified: motivators, benefits, and barriers. There were several motivators for learning self-care, including care provider advice, personal hygiene, and ease of care. Benefits of learning self-care included autonomy, convenience, facilitation of sexual relations, avoidance of complications, and decreased burden on the health care system. Barriers to self-care included physical, structural, mental, and emotional barriers; lack of knowledge; lack of time; and social taboo. Conclusions Promotion of pessary self-care should focus on patient education about benefits and ways of mitigating common barriers while focusing on normalizing patient engagement in pessary self-care.

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Section: Discussionmentioning

confidence: 99%

Women’s attitudes towards pessary self-care: a qualitative study

et al. 2023

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Understanding Factors That Affect Willingness to Self-Manage a Pessary for Pelvic Organ Prolapse: A Questionnaire-Based Cross-Sectional Study of Pessary-Using Women in the UK

Dwyer,

Rajai,

Dowding

et al. 2024

Int Urogynecol J

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Introduction and Hypothesis Pessary self-management offers benefits to women with no increased risk of complications. However, many are unwilling to self-manage, preferring clinician-led care. This study is aimed at exploring factors associated with willingness to self-manage a pessary. Methods Women attending pessary clinic at a UK hospital were asked to complete a questionnaire providing responses on pessary use, comorbidities, female genital self-image, self-management experience and willingness (or not) to learn self-management. Based upon statistical advice we aimed to recruit 90 women. Data were analysed using the non-parametric Kruskal–Wallis test and Chi-squared test. Free text data were analysed thematically. Results A total of 89 women completed the questionnaire. Thirty-three women (38%) had previously been taught pessary self-management. Of the remaining women, 12 (21%) were willing to learn, 28 (50%) were not willing and 16 (29%) were unsure. There was no correlation between female genital self-image and willingness to self-manage a pessary. Younger women were more willing to learn self-management (p = < 0.001). Willing women were motivated by reduced follow-up visits. Self-managing women reported benefits including increased autonomy, cleanliness and giving their body “a break”. Reasons discouraging women from self-managing were a lack of confidence; feeling physically unable; wanting clinician-led care; fear of problems or previous problems with their pessary. Conclusions Most women were either unsure about pessary self-management or unwilling to self-manage. Age was the only factor we found that had a significant relationship with willingness to self-manage a pessary. With robust self-management teaching, support and follow-up, it is likely that many of the barriers women report can be overcome.

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The Role of Self-Management in Pessary Therapy for Pelvic Organ Prolapse—A retrospective cohort study

Paulussen,

Börger,

van Eijndhoven

et al. 2024

Int Urogynecol J

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Introduction and Hypothesis This study investigated pessary self-management (PSM). The primary outcome was how often PSM was taught to patients with pelvic organ prolapse (POP). Secondary outcomes were associations of PSM with treatment continuation, side effects, changing to surgery, and number of doctor consultations in the first year after treatment initiation compared with clinical management (CM). Methods A retrospective cohort study was conducted in 300 patients visiting three Dutch medical centres in 2019, and receiving a pessary for POP. The t test, Chi-squared test and logistic regression were performed to compare PSM with CM and to identify factors associated with treatment continuation. Results A total of 35% of patients received PSM instructions, of which 92% were able to perform PSM successfully. Treatment was continued by 83% of patients practicing PSM and 75% of patients having CM (p = 0.16), side effects occurred in 26% and 39% respectively (p = 0.18). Pain or discomfort was associated with treatment discontinuation (p < 0.01). In a subgroup analysis of patients who had a pessary suitable for PSM, treatment continuation was significantly higher in the PSM group (97%) than in the CM group (74%; p < 0.01). Conclusions Pessary self-management was only taught to 35% of patients who received a pessary, although the ability to perform PSM was high (92%). Treatment discontinuation was significantly lower in the PSM subgroup, when assessing the subgroup of patients using a pessary suitable for PSM. The large number of patients using a pessary suitable for PSM in the CM group implies that there is a lot to gain by promoting PSM.

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What is known from the existing literature about self-management of pessaries for pelvic organ prolapse? A scoping review

Cited by 5 publications

References 49 publications

Women’s attitudes towards pessary self-care: a qualitative study

Women’s attitudes towards pessary self-care: a qualitative study

Understanding Factors That Affect Willingness to Self-Manage a Pessary for Pelvic Organ Prolapse: A Questionnaire-Based Cross-Sectional Study of Pessary-Using Women in the UK

The Role of Self-Management in Pessary Therapy for Pelvic Organ Prolapse—A retrospective cohort study

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