Pessary Use for Prolapse – Making it Woman-Centred and Evidence-Based

Prolapse is a common condition with symptoms of vaginal bulge and bladder and bowel problems affecting up to a third of women. Prolapse is an embarrassing and stigmatised condition that impacts on a woman’s quality of life. Treatment options for prolapse include a pessary device placed in the vagina to support the descending walls. There is a lack of high quality evidence for pessaries although they are widely used in the initial management of prolapse. This PhD aimed to determine the current evidence and priorities for future research for pessary use to improve the extent to which pessaries are evidence-based and woman-centred. To meet the project aims a mixed research study was conducted that comprised a systematic scoping review (n=412), an evidence review of high quality studies (n=24) and a James Lind Alliance Priority Setting partnership to identify the shared future research needs for women with experience of prolapse and healthcare professionals. The results from the review and priority setting phases of the study were integrated using a mapping method (REMQIP) developed for this doctoral project to highlight the gaps in research and evidence in relation to the established priorities. The results indicate that although there is a lack of randomised controlled trials, there is a sufficiency of consistent evidence to suggest that pessary use for prolapse, particularly the ring pessary, is an acceptable, effective and low risk option for any woman with symptomatic prolapse. This research has shown that there are significant gaps in evidence knowledge and research in relation to the top ten shared priorities, notably with respect to the effect of pessaries on psychological wellbeing and sexual activity. The inclusion of the experiences of women in research has been minimal to date. The conclusions that can be drawn from this research are that the identified shared priorities for future pessary research may be answered by studies that address the complexity of pessary provision for women. Improved recording of pessary related clinical data in the NHS may follow the adoption of a UK Guideline being developed as a consequence of this PhD project that in turn may improve intervention reporting.