A Sisterhood of Women: The Process of Co-Creating Recommendations for Improved Pessary Self-Management Support

This work aimed to explore barriers to pessary self-management and co-create strategies to address these.

Participatory Action Research.

In October 2024, eight pessary-using women living in the United Kingdom participated in cooperative inquiry, discussion and co-creation of strategies in two virtual workshops.

Pessary using women who participated in this research identified challenges affecting willingness to self-manage a pessary and proposed solutions to address these and better support women. Pessary practitioners should assess physical capabilities, consider softer, more malleable pessaries, and explore the possibility of a pessary applicator. Peer support was seen as empowering, enabling self-advocacy and improved care; therefore, establishing peer networks was prioritised. Major barriers included difficulty navigating services and limited access to a full range of pessaries, leading some women to buy devices online without medical oversight, creating a two-tier system based on ability to pay. The group called for improved, standardised pessary care, and for self-management to be reframed to avoid women feeling 'fobbed off' through better follow-up, positive language, and compassionate care.

The group identified strategies to address barriers to pessary self-management which require further exploration. Pessary practitioners have a responsibility to listen to these voices and take steps to improve care for women in the future.

To support women's willingness to self-manage their pessary, pessary practitioners should consider and support women to overcome physical and emotional barriers; improve information provision; maximise social support; boost women's perceived self-efficacy; reframe pessary self-management and ensure robust, accessible follow-up is in place. This will ensure pessary-using women are supported to make an informed decision about pessary self-management. This research offers pessary practitioners insight into barriers women perceive to pessary self-management and guidance as to how women can be supported to self-manage their pessary.

Only 21% of women are willing to self-manage their pessary. Therefore, this research aimed to co-create strategies to better support women to self-manage their pessary and overcome barriers to willingness. Women reported individual, societal and service factors which affect willingness to self-manage a pessary. These research findings should be translated into clinical practice and care delivery for pessary using women in both a community and hospital setting.

COREQ (COnsolidated criteria for REporting Qualitative research) Checklist.

Patients and members of the public were involved in research prioritization, study design, data analysis, interpretation of findings and dissemination.

Study not registered.