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

Abstract

IntroductionPelvic organ prolapse (POP) can be managed with a pessary; however, regular follow-up may deter women from pessary management due to the inconvenience of frequent appointments, as well as preventing pessary users from autonomous decision-making. Pessary self-management, whereby the woman removes and inserts her own pessary may be a solution to these issues. However, there remains a number of uncertainties regarding the potential benefits and risks of pessary self-management. This scoping review aims to map available evidence about the subject of pessary self-management for POP to identify knowledge gaps providing the basis for future research.Methods and analysisThe scoping review will be conducted using the Joanna Briggs Institute scoping review methodology and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A search of Medline, CINAHL, Embase and PsycInfo will be undertaken to identify relevant articles which meet the eligibility criteria using the search terms ‘pessary’ and ‘self-management’ or ‘self-care’. A hand search of the reference list of non-original research identified during the search but excluded, will be conducted for additional publications which meet the inclusion and exclusion criteria. Data relevant to the topic of pessary self-management will be extracted and critical appraisal of all included publications undertaken.Ethics and disseminationNo ethical or Health Research Authority approval is required to undertake the scoping review. However, it has been registered with The Open Science Framework (DOI 10.17605/OSF.IO/DNGCP). The findings will inform future research exploring pessary self-management and be disseminated via both a presentation at a national conference and publications in peer reviewed journals.

How Satisfied Are Women 6 Months after a Pessary Fitting for Pelvic Organ Prolapse?

“…One solution to address this issue would be to teach women how to position the pessary themselves. There are however few robust data to scientifically support this practice [ 30 ]. In our study, 65% of the patients declared that they knew how to remove their pessary on their own.…”

Pessary management for pelvic organ prolapse: a review of clinical practice and Australian medical device regulations

“…When discussing treatment, conservative management options include observation, lifestyle intervention, PFMT, topical oestrogen and pessary 13,45 . Some patients may choose to have a pessary if they have not yet completed their family, they have a high risk of recurrence, surgical timing doesn't suit their lifestyle, they want to avoid surgical risks, or they are not fit for surgery 1 . When conservative management is selected, this does not preclude the individual from reconstructive or obliterative surgery in the future 37,48 .…”

“…Management for prolapse can be either through surgery or pessary use 20 . Evidence supports that pessary management can provide comparable treatment outcomes to surgery in reported symptoms and quality of life 1 . A prospective study comparing pessary management with surgery in women with symptomatic POP reports equivocal outcomes in urinary and bowel symptoms, sexual function and quality of life improvements 21 .…”

“…Pessary devices for POP have a beneficial therapeutic impact on quality of life, sexual function and body image. Pessary use promotes a significant reduction in POP symptoms, with low complication rates 1,4 .…”

“…Pelvic organ prolapse (POP) affects up to 50% of women 1,[3][4][5] . POP has been defined as the descent of at least one of the vaginal walls to or beyond the hymen with maximal Valsalva, plus the presence of bothersome characteristics such as vaginal bulge or functional compromise.…”