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?
Evidence	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 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4479661/
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

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