What is a pessary?
A pessary is a removable device that is inserted into the vagina (birth canal) to provide support in the area of a prolapse. In most cases, a pessary is used when a woman who has a prolapse wants to avoid surgery or has medical problems that make surgery too risky.
What is prolapse?
Prolapse of the uterus (womb) or vaginal walls happen when there are weaknesses in the supporting structures of the pelvis. These supporting structures are called the pelvic floor muscles. They hold the organs in your pelvis in place and give them stability. Over time, however, they can grow weak and begin to loosen. When a prolapse happens, the organs sag and drop out of place and can cause several uncomfortable symptoms.
The weaknesses that cause prolapse can be related be several factors, including:
- Pregnancy and vaginal childbirth.
- Heavy lifting.
- Frequent straining.
If your prolapse is causing symptoms, you may need treatment.
What types of pessaries are available?
Different types and sizes of pessaries are available. Most pessaries are made of silicone which is a soft, non-absorbent material. Some pessaries can be removed and replaced by the patient while others require a healthcare provider to remove and reinsert the pessary. As long as the pessary is fitting properly, it can be used for years. At times, a pessary may become discolored, this is normal and does not mean that the pessary needs to be replaced.
Specific types of pessaries include:
- Ring pessary.
- Gehrung pessary.
- Mar-land pessary.
- Gellhorn pessary.
- Donut pessary.
- Cube pessary.
The different types of pessaries can serve different purposes. They are different shapes and sizes, and they range from devices you can insert yourself to ones your healthcare provider will need to help you insert. Your healthcare provider will tell you about the different types of pessaries and discus the best option for you.
How is a pessary fitted?
A healthcare provider will do an exam of the vagina to determine which pessary is best. A pessary that is too small may fall out on its own while passing urine or during a bowel movement. A pessary that is too large can apply too much pressure and feel uncomfortable. A good fitting may require two or three fitting attempts.
How is a pessary maintained?
Women who can insert and remove the pessary on their own can remove it for cleaning weekly or even nightly. Follow-up visits should take place every six to 12 months. During the visit the pessary will be removed and cleaned. The vagina will be examined to make sure the pessary is not scraping or bruising the skin.
In cases where the pessary cannot be removed by the patient, follow-up visits usually occur every two to three months.
Are there any complications from using a pessary?
Pain or discomfort means the pessary is not fitting correctly and should be replaced with a different size. A pink or bloody discharge could mean the pessary is rubbing against the wall of the vagina. In most cases, removal will allow the area to heal. In cases of bleeding, a visit to a nurse or doctor is needed.
White-colored discharge from the vagina is common with pessary use. Using an estrogen cream can improve the health of the vaginal skin, which gets thinner with age.
It is possible to have sexual intercourse when a ring pessary is in place. However, the donut, cube, and Gellhorn types fill the vagina and must be removed before sex.