What is a pessary?
A pessary is a removable rubber or plastic device that is inserted into the vagina (birth canal) to provide support in the area of a prolapse. A prolapse takes place when a part of the body droops down or slips out of its normal place. In most cases, pessaries are used when a woman who has a prolapse wants to avoid surgery or has medical problems that make surgery too risky.
What types of pessaries are available?
- Ring pessary – This is the usual choice for first-time use due to the ease with which it can be inserted and removed from the vagina. The ring is lubricated, folded in half, then placed in the vagina where it unfolds. For removal, the pessary is gently pulled and folded in half, or can be attached to a string. Patients can perform insertion and removal without help.
- Gehrung – This pessary is used when a cystocele or rectocele is present along with advanced uterine prolapse. With a cystocele, the bladder (sac that holds urine) drops into the vagina. With a rectocele, the rectum (last part of the colon) bulges into or out of the vagina. The Gehrung pessary is U-shaped and can be molded to fit each patient. However, it is difficult to insert.
- Mar-land – The Mar-land is a flexible silicone pessary used for minor prolapse and to prevent leaking of urine when abdominal muscles are under strain.
- Gellhorn – The Gellhorn pessary is used in advanced stages of prolapse or in patients who are no longer sexually active. Removal and insertion are difficult and cannot be done by the patient alone. The pessary is disk-shaped with a stem in the center. It is folded in half and inserted into the vagina, where it expands and forms suction. Removal usually requires assistance, as the pessary must be rotated, pulled down, and folded.
- Donut – This pessary is used in cases of cystocele or rectocele, as well as uterine prolapse. It is one of the most difficult pessaries to insert and, in particular, to remove.
- Cube – Made of flexible silicone, this pessary is used in advanced stages of prolapse. The cube is compressed and inserted into the vagina, where it forms suction against the edge of the prolapse. Vaginal moisture can be trapped in the folds of the cube, however, leading to bad-smelling discharges. The cube is usually the least favored pessary and should be removed nightly whenever possible.
How is a pessary fitted?
A doctor will do an exam of the vagina to determine the type of prolapse and to take measurements that will help the doctor decide which pessary is best. A pessary that is too small may fall out on its own, or 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 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 with the doctor should take place about every six months. During the visit the pessary will be removed, then cleaned and examined for signs of wear and tear. 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 doctor 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 chafing against the wall of the vagina. In most cases, removal will allow the area to heal. In cases of bleeding, a visit to the doctor is needed.
White-colored discharge from the vagina is common. However, if the discharge becomes colored or smells bad, it could mean a vaginal infection or ulceration. 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.