What is a Pessary?
A pessary is a medical device that is used in the non-surgical management of a number of gynecological conditions. It is a device that is inserted into the vagina or rectum to support the vagina, uterus, bladder and rectum when the muscles and structures that hold them up are weakened or defective. It is usually made of plastic, latex or silicone and comes in a variety of styles and shapes. These different styles and shapes are suited to different purposes and uses. The choice of pessary usually depends on the particular gynecological problem. Incontinence pessaries are used for urinary incontinence, ring pessaries are used for uterine prolapse or vaginal prolapse, and so on.
Uses of Pessaries
Pessaries are used in support defects of the pelvic organs such as the vagina, uterus and rectum. These defects include:
1. Vaginal prolapse
2. Uterine prolapse
3. Retroverted uterus
4. Urinary incontinence
5. Cystocele (herniation of the bladder into the vagina)
6. Rectocele (herniation of the rectum into the vagina)
7. Enterocele (herniation of the intestines into the vagina)
8. In preoperative preparation
9. Contraception
Types of Pessaries
Pessaries can be therapeutic (as treatment for the above mentioned conditions) and occlusive (used with a spermicide as a contraceptive).
1. Ring pessaries
2. Gellhorn pessary
3. Donut pessary
4. Inflatable pessary
5. Shaatz pessary
6. Gehrung pessary
7. Cube pessaries
8. Hodge pessary
9. Incontinence pessaries
How to Insert a Pessary
A pessary size is chosen that fits the woman and does not fall out easily (this is done by trial and error). The doctor inserts the pessary and then ensures that the patient learns how to remove and reinsert it herself. If the patient cannot learn the procedure, the doctor can always do this at regularly scheduled examinations. After inserting the pessary, the patient is asked to stand, sit, squat, and strain muscles that might cause the device to fall out to ensure that it will not become dislodged. She is also asked to try to urinate to see if the pessary interferes with urination. The pessary can be worn for weeks to months before it has to be removed.
Tips on Dealing with a Pessary
1. Follow the instructions and directions given by the doctor.
2. Learn to remove and reinsert it properly on your own.
3. Remove the pessary and clean it with ordinary soap and water every few weeks (usually 3 weeks). Do not clean the pessary with any other washing liquids.
4. On removal, inspect the pessary for cracks or breaks. If there are any it should be replaced.
5. Always inspect the vagina for allergic reactions, injuries or infections.
6. Do not reinsert the pessary if there is a sore or infection in the vagina.
7. Treat minor complications using the remedies indicated below. All serious complications should be brought to the attention of a doctor.
8. Attend regularly scheduled visits to the doctor to have the pessary removed and cleaned and the vagina examined.
9. You may or may not be able to have sexual intercourse when you have a pessary inserted. Find out from your doctor about this and whether you can be fitted with a pessary that allows sex.
Complications of Using a Pessary (and Treatments)
1. Use of pessaries can cause injuries and ulceration in women with thin vaginal mucosa such as postmenopausal women. Treatment with an estrogen cream before pessary insertion can prevent this.
2. Pessaries can cause vaginal discharge and odor. These can be treated by douching with dilute vinegar or using an acidic vaginal gel.
3. If a pessary is improperly inserted, it may damage surrounding structures.
4. Pessaries also cause irritation and itching due to allergy. This can also be relieved by douching with dilute vinegar or hydrogen peroxide or changing the pessary.
5. Sometimes the pessary may become embedded in vaginal mucosa and can be difficult to remove. This is treated by using an estrogen cream. It may require surgical intervention.
See More: Side Effects of Using Pessaries
