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JOGC

Guideline No. 411: Vaginal Pessary Use

Published:November 25, 2020DOI:https://doi.org/10.1016/j.jogc.2020.11.013

      ABSTRACT

      Objective

      To review the use, care, and fitting of pessaries.

      Target population

      Women requiring the use of vaginal pessaries for pelvic organ prolapse and/or stress urinary incontinence. Use may also be indicated for women with certain pregnancy-related clinical scenarios, including incarcerated uterus.

      Options

      Pessaries are an option for women presenting with prolapse and/or stress urinary incontinence. In addition, certain types of pessaries can be considered for patients with cervical insufficiency or incarcerated uterus.

      Outcomes

      Most women with prolapse or stress urinary incontinence can be successfully fitted with a pessary and experience excellent symptom relief, high satisfaction rates, and minimal complications.

      Benefits, harms, and costs

      Women with pelvic organ prolapse and/or stress urinary incontinence may choose to use a pessary to manage their symptoms rather than surgery or while waiting for surgery. Major complications have been seen only when pessaries are neglected. Minor complications such as vaginal discharge, odour, and erosions can usually be successfully treated.

      Evidence

      Medline was searched for relevant articles up to December 2018. This is an update of the SOGC technical update published in 2013, which was the first internationally published guidance on pessary use. Subsequently, an Australian guideline on the use of pessaries for the treatment of prolapse was published later in 2013.

      Validation methods

      The authors rated the quality of evidence and strength of recommendations using the approach of the Canadian Task Force on Preventive Health Care (Appendix A).

      Intended audience

      Gynaecologists, obstetricians, family physicians, physiotherapists, residents, and fellows.

      SUMMARY STATEMENTS

      • 1
        Most women can be successfully fitted with a pessary to treat the symptoms of pelvic organ prolapse or stress urinary incontinence (II-2).
      • 2
        Satisfaction rates for pessary use are very high (I).
      • 3
        Some vaginal pessaries may prevent recurrence of incarcerated uterus (III).
      • 4
        The role of pessaries specifically designed to prevent preterm labour is not yet elucidated (I).
      • 5
        Complications associated with pessary use are usually minor, with vaginal discharge being the most common problem (II-3).
      • 6
        Vaginal erosions can be treated with removal of the pessary and optional vaginal estrogen supplementation (II-2).

      RECOMMENDATION

      • 1
        Pessaries should be considered in all women presenting with bothersome pelvic organ prolapse and/or stress urinary incontinence (I, A).

      Keywords

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