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A review of pessary for prolapse practitioner training

09 May 2019
16 min read
Volume 28 · Issue 9

Abstract

Pelvic organ prolapse is a significant quality of life issue for many women. Prolapse can be managed effectively with a mechanical device called a pessary therefore many women choose this as a conservative treatment option. Despite the extent to which pessaries are used in the UK, there are no clear guidelines regarding the training required for pessary practitioners. This article reviews literature related to pessary practitioner training. Methods: 13 publications were reviewed. Results: eight themes were identified, namely ‘prevalence of pessary training’, ‘type of pessary training’, confidence in pessary care provision’, ‘impact on pessary care’, ‘skills and knowledge required to be a pessary practitioner’, ‘barriers’, ‘speciality of pessary care providers’, and ‘ongoing support’. Conclusion: at present practitioners report a lack of pessary training, which impacts on care. Effective training includes didactic learning of agreed knowledge requirements, practice of clinical skills and ongoing support.

Pelvic organ prolapse is defined as the downward displacement of the uterus and/or different vaginal compartments as well as the bladder or bowel (Haylen et al, 2016). Prolapse is a debilitating condition that can cause bowel and bladder symptoms as well as affecting sexual function, quality of life and body image (Haylen et al, 2016). In the UK, the lifetime risk of a woman requiring a procedure to treat prolapse is 10% (Abdel-Fattah et al, 2011). As some women are not bothered by prolapse and others either do not seek treatment or opt for conservative management, the true prevalence of the condition is unknown (Abdel-Fattah et al, 2011). Women seeking prolapse treatment are likely to be offered surgical or conservative management. Conservative management options include lifestyle advice, pelvic floor muscle retraining, support underwear, oestrogen therapy and pessaries (Dwyer and Kearney, 2018). Of conservative management options, pessaries have been demonstrated to be comparable to prolapse surgery for quality of life, urinary symptoms, vaginal symptoms and sexual function (Lone et al, 2015).

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