Priority 24 from the Pessary use for Prolapse PSP

UNCERTAINTY: Can women be taught to manage their own pessary? (JLA PSP Priority 24)
Overall ranking 24
JLA question ID 0054/24
Explanatory note Self-management of pessaries is taught by some care providers but not all. Identifying which women should be offered a self-management option for their pessary use would have significant implications for the cost of pessary provision. Understanding which pessary types could be self-managed might mean pessary use for prolapse would be more widely available. Equally important is future research to identify those who will not be successful with a self-management programme. Future research needs to find out what works for women and why. Examples: Can they be put in easily by the patient? Why can't I put it in and take it out myself? Which pessaries are easiest for the patient to fit and remove themselves? 

A trial is underway: The TOPSY trial is a multi-centre randomised control trial, with nested process evaluation, to test the clinical and cost-effectiveness of self-management of vaginal pessaries to treat pelvic organ prolapse, compared to standard care to improve women’s quality of life.

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

Is it really necessary for women to attend to clinics to have their pessary changed - if appropriately selected they could self manage?  ~  
Can they be put in easily by the patient?  ~  Can the patients not do it them selves?  ~  Why don't you teach me how to take it out right away?  ~  I wish you told me how to take it out... it was really uncomfortable and I didn't want to travel 4 hours to have it removed by you...  ~  Why can't I put it in and take it out myself?  ~  Can a patient change her own pessary?  ~  Some women are taught to remove and re-insert their pessary before and after sex. Is this something you may consider if offered?

Submitted by 7 x both, 5 x healthcare professionals, 6 x women
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