pessary

Introduction

Pessaries are devices made of rubber or silicone materials, or both, designed to reduce pelvic prolapse temporarily & alleviate symptoms of pelvic organ prolapse in females with & without incontinence. Pessaries are available in various sizes & shapes depending on the type & severity of prolapse & the integrity of the perivaginal muscles.

Classification

Types of pessaries

• ring pessary for mild to moderate prolapse
• Gellhorn pessary for moderate to severe prolapse
• cube pessary
  • insufficient vaginal tone to support other pessaries
  • must be removed daily to prevent infections & erosions
• Smith Hodge vaginal pessary

Indications

Pessaries are recommended for women with symptomatic pelvic organ prolapse in two circumstances:

• as a temporary measure for women awaiting surgical correction &
• for treatment of women who are either unable, for medical reasons, or are unwilling to undergo correction of the prolapse.

Contraindications

• vaginal prolapse
• vaginitis
• women without routine access to a health care provider who cannot remove or insert the device
• does not lower rates of preterm delivery

Procedure

• must be fitted
• examine patient after 1 week
• pessaries may be left in place for 2 weeks*
• concurrent use of topical estrogens may prevent complications (see below)
• frequent & regular monitoring

* except cube pessary (must be removed daily)

Complications

can result when the pessary is misused or neglected

• ulceration of vagina
• vaginal infection
• rectovaginal &/or vesicovaginal fistula

Notes

• longer vaginal length predicts successful fitting

More general terms

• device (medical device)