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Do You Need a Pessary?

The use of vaginal pessaries to support pelvic organ prolapse dates back centuries and was written about in the Egyptian Papyri, the world’s oldest documented medical literature. Over a century later, Hippocrates and his disciples are attributed with soaking pomegranates halves with wine or vinegar and placing them in the vagina to support the internal structures. Historically, pessaries have provided a low-cost and safer alternative surgery and in modern times they can be used for women for whom surgery is either not possible or desired.

In this article Grace Carey explains what a pessary is, how they work, and why you may need one.

What is Pelvic Organ Prolapse?

Pelvic organ prolapse occurs when pelvic floor ligaments, tissues, muscles and nerves that support the pelvic organs (uterus, bladder, rectum) become weak or damaged and cause one or more pelvic organs to descend into or out of the vagina.

Prolapse affects up to 50% of women at some point in their life time and is usually occurs after pregnancy, although can occur from other causes.

Awareness of a bulge or lump protruding from the vagina is the most common prolapse symptom. Women with prolapse may also experience a dragging sensation in the pelvis or low back ache. Prolapse may also interfere with bladder emptying or bowel evacuation and cause difficulty with sexual intercourse.

What is a Pessary?

A pessary is a medical device that is inserted into the vagina to support pelvic organ prolapse and, less commonly, urinary incontinence.

A pessary may be used in the short term, such as in the weeks or months leading up to pelvic organ surgery or for someone who requires surgery but has not yet completed their family. Pessaries can also be used in the long term for milder prolapses or those who do not wish to undergo surgery.

Pessaries are usually worn full time and may be used during exercise. They may be useful for women who have been prescribed pelvic floor muscle training as they can offer immediate feedback as something to squeeze down on.

How is a Pessary Fitted?

A pessary is fitted by a medical professional who will teach the user how to insert and remove as well as discuss how to clean it and when to see a doctor with regard to potential symptoms.

Some medical professionals will use a fitting set to gauge size before selecting the appropriate size.

Incorrectly fitted pessaries can fall out and may cause ulceration or excessive discharge.

How Long Can a Pessary Be Worn For?

The recommended time a pessary can remain in the body varies depending on who you speak to. Many pessary manufacturers stipulate that the pessary be removed once a day for cleaning, however many medical professionals recommend they be removed once a week for cleaning and some also recommend that the user should sleep without it one night a week.

Many pessaries are contraindicated for sexual intercourse and should be removed prior to sex.

When a pessary is used in an older patient who wishes to avoid surgery or who is possibly not a good surgical candidate, their treating medical professional may remove and change it for them once every three to six months.

For women who are happy to self care (i.e. can insert, remove and clean the pessary comfortably and frequently) it is also recommended that they should replace the pessary every three to six months. This might involve a scheduled appointment with the treating medical professional or some clinicians might be happy to send a pessary of the correct size to a patient they have previously fitted.

What Kind of Pessary Do I Need?

Pessaries come in a range of shapes, sizes and materials. Over the years they have been made from many different materials including glass, metal and wood but thankfully modern pessaries are typically made from flexible rubber, polymers and silicone. Being made of softer materials, pessaries can be compressed for insertion and easily removed.

The kind of pessary fitted will depend on the symptoms and treating medical practitioner. The shapes of pessaries vary greatly including cubes, rings and doughnuts.