Intended for healthcare professionals

Practice Uncertainties

Does self-management of vaginal pessaries improve care for women with pelvic organ prolapse?

BMJ 2021; 372 doi: (Published 19 February 2021) Cite this as: BMJ 2021;372:n310
  1. Carol Bugge, associate professor1,
  2. Melanie Dembinsky, research fellow1,
  3. Rohna Kearney, consultant urogynaecologist and honorary senior lecturer23,
  4. Suzanne Hagen, professor of health services research4
  1. 1Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
  2. 2Warrell Unit, St Mary’s Hospital, Manchester University NHS Trust, Manchester Academic Health Science Centre, Manchester, UK
  3. 3Division of Developmental Biology and Medicine, School of Medical Sciences, University of Manchester, Manchester, UK
  4. 4Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
  1. Correspondence to C Bugge carol.bugge{at}

What you need to know

  • Self-management of vaginal pessary for pelvic organ prolapse may enable patient autonomy over when to remove and insert the pessary (for example, to remove before intercourse) and may reduce the number of clinic appointments

  • Limited evidence from small observational studies suggests that self-management may improve the length of time a woman uses a pessary for, her satisfaction, and her quality of life, without increasing complication rates, but it is difficult to generalise from this evidence

  • During the covid-19 pandemic, reassure women who may need a pessary change that a delay of a few months is acceptable as long as they are not experiencing any problems such as vaginal bleeding, discharge, or pain

Pelvic organ prolapse is common in women over the age of 50 and negatively affects their quality of life.1 Management includes lifestyle modification, pelvic floor muscle training, vaginal pessary, or surgery.2 Pessaries may be preferred by women as an alternative to surgery or while they await surgery. In an observational study in the UK (680 women), two thirds of women initially preferred conservative management with pessaries. Women were more likely to consider surgery if they were bothered by severe symptoms affecting bowel emptying, sexual function, and quality of life.3

A pessary is inserted into the vagina to hold up the vaginal walls and pelvic organs and to relieve symptoms of prolapse (figure 1 shows types of pessary). Two types of pessary are commonly used: support pessaries—such as rings—and space occupying pessaries—such as Gellhorn or shelf pessaries. Pessaries can be inserted by general practitioners, specialist nurses, specialist physiotherapists, or gynaecologists. Guidance from the National Institute for Health and Care Excellence (NICE) recommends removing and replacing the pessary at least every six months to prevent and detect complications such as vaginal ulceration.2 NICE guidance does not …

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