Guideline No. 411: Vaginal Pessary Use

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: RECOMMENDATION.

Keywords: pelvic organ prolapse; pessaries; stress; urinary incontinence; vaginal discharge.