Reviewed on : 12 Nov 2024

Reviewed by : Gateway Editor

Expires : 12 Nov 2026

Female genital prolapse

1. Category: Prior Approval

Prior approval from the Integrated Care Board (ICB) will be required before any treatment proceeds in secondary care unless an alternative contract arrangement has been agreed with the ICB that does not necessitate the requirement of prior approval before treatment

2. Background

This policy is based on the NICE guidelines:

• NG210: Pelvic floor dysfunction: prevention and non-surgical management 2021 – accurate at the point of publication: https://www.nice.org.uk/guidance/ng210
• NG123: Urinary incontinence and pelvic organ prolapse in women: management. 2019 – accurate at the point of publication: https://www.nice.org.uk/guidance/ng123

The ICB does not fund surgical procedures for asymptomatic or mildly symptomatic pelvic organ prolapse

Appropriate conservative management by Primary/Community providers is required before referral for specialist assessment and surgical intervention is considered (unless indication for early referral is present)

Conservative management should include:

• Weight loss if BMI >30
• Treatment for constipation if present to minimise straining
• Management of causes of any cough
• Pelvic floor muscle training
• Ring or other pessary (where appropriate) *

*Please note where a GP does not have the facilities to provide pessary insertion, referral to an appropriate provider of this service is indicated

3. Eligibility Criteria

Referral for specialist assessment is indicated for any of the following:

• Failure of primary/community management in moderate/severe prolapse **with clear documentation that a trial of ring or other pessary has failed
• Prolapse combined with urinary incontinence or faecal incontinence
• Failure of pessary
• Women with symptomatic prolapse (including those combined with urethral sphincter incompetence or faecal incontinence)

** Definition of “moderate” and “severe” by following grading, where Grade 2 is moderate and

Grades 3 and 4 are severe:

• Grade 0 – Normal position
• Grade 1 – descent into vagina not reaching introitus
• Grade 2 – descent just outside the introitus
• Grade 3 – descent outside the introitus – beyond 2 cms
• Grade 4 – Procidentia

For patients who DO NOT meet the eligibility criteria, the ICB will only consider funding the treatment if an Individual Funding Request (IFR) detailing the patient’s clinical presentation is submitted to the ICB

4. Guidance/References

https://www.nice.org.uk/guidance/ng210

https://www.nice.org.uk/guidance/ng123

van der Vaart LR, Vollebregt A, Milani AL, Lagro-Janssen AL, Duijnhoven RG, Roovers J-PWR, van der Vaart CH. Pessary or surgery for a symptomatic pelvic organ prolapse: the PEOPLE study, a multicentre prospective cohort study – Vaart – 2022 – BJOG: An International Journal of Obstetrics & Gynaecology – Wiley Online Library 129: 820–829

van der Vaart LR, Vollebregt A, Milani AL, et al. Effect of Pessary vs Surgery on Patient-Reported Improvement in Patients With Symptomatic Pelvic Organ Prolapse: A Randomized Clinical Trial. JAMA. 2022;328(23):2312–2323. doi:10.1001/jama.2022.22385

Lisa R. van der Vaart, Astrid Vollebregt, Bente Pruijssers, Alfredo L. Milani, Antoine L. Lagro-Janssen, Jan-Paul W.R. Roovers, Carl H. van der Vaart, Female Sexual Functioning in Women with a Symptomatic Pelvic Organ Prolapse; A Multicenter Prospective Comparative Study Between Pessary and Surgery | The Journal of Sexual Medicine | Oxford Academic (oup.com) Volume 19, Issue 2, February 2022, Pages 270–279.

Bø, K., Anglès-Acedo, S. International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training | International Urogynecology Journal (springer.com) 33, 2633–2667 (2022).

Wharton, L., Athey, R. & Jha, S. Do vaginal pessaries used to treat pelvic organ prolapse impact on sexual function? A systematic review and meta-analysis | International Urogynecology Journal (springer.com) , 221–233 (2022).