Priority 23 from the Pessary use for Prolapse PSP

UNCERTAINTY: How safe are pessaries? (JLA PSP Priority 23)
Overall ranking 23
JLA question ID 0054/23
Explanatory note Pessaries are considered safe and easy to fit. It is not clearly known what effect different pessaries have on the vagina and whether the presence of a foreign object is completely safe or whether the woman should be advised of possible side effects and complications. Examples: Can a pessary do harm? Does pessary use increase/ add to risk of toxic shock syndrome ? Are pessaries safe to use over many years and do they cause infections? 

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

Health Research Classification System category Renal and urogenital
Extra information provided by this PSP
Original uncertainty examples

What side effects do you 'truthfully' expect with the use of a pessary? I ask this because I got a lot of smelly discharge from wearing a ring pessary. I started to become urinary incontinent and my doctor said I might have a UTI and not feel it. It seemed to be worse almost than the prolapse symptoms and it took me quite a lot of courage to even tell the GP about this. She tried to persuade me to keep it in because I had been so upset about having a prolapse in the first place. Although she is a very kind doctor I did not feel that they can even begin to understand how I felt.  ~  Does pessary use increase/ add to risk of toxic shock syndrome ?  ~  Can a pessary do harm?  ~  How safe is a pessary?  ~  My mother had a ring pessary fitted for a prolapse many years ago. The following year she developed bowel cancer. Could this device somehow have caused her bowel problem?  ~  Death, although rare, is a reported compilation and should be included in the informed consent of patients undertaking long-term pessary use.

Submitted by 5 x healthcare professionals, 1 x literature, 1 x other, 8 x woman
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