Pelvic organ prolapse (POP) is a common condition with prevalence rates between 25 to 65 percent. Roughly, 200,000 women have pelvic organ prolapse surgery in the United States. A vaginal pessary may be an alternative to surgery for some women.
A vaginal pessary is a custom made, removable device that is placed into the vagina. A vaginal pessary is a device that is designed to support the areas affected by pelvic organ prolapse.
The pessary is placed high inside the vagina. When placed correctly, a woman will not be able to feel it. Once the pessary is put into place, all normal activity can resume. A woman should be able to become more active as her prolapse is supported and she feels more comfortable. If it seems that a pessary is not working, it can be removed quickly and easily.
These pessaries are available in several materials including plastic, rubber or a silicone-based material. Several common kinds of pessaries include the doughnut camera, Gellhorn camera and inflatable camera.
Why Pessaries are Used
A pessary is used as a nonsurgical approach to treat pelvic organ prolapse. Many times, physicians use pessaries to treat uterine prolapse in women during pregnancy. The pessary holds her uterus in the proper position. Without a pessary, her uterus could fall into her vaginal canal.
A pessary is also utilized if the symptoms of pelvic organ prolapse occur before a woman’s childbearing years are complete or the symptoms of POP are mild. Pessaries are also used in women who suffer from other chronic health problems, such as lung or heart disease, which makes surgical intervention more dangerous for them.
Physicians sometimes use a pessary as a means to determine if surgery for POP is feasible to help relieve urinary symptoms associated with this condition. For those who suffer incontinence while their pessary is inserted, the surgeon may choose to fix the incontinence problem while he is performing a prolapse surgery.
Conditions Treated with a Vaginal Pessary
A pessary can also be used to treat other gynecological conditions, such as an incorrectly positioned uterus.
Proper Placement is Essential
Pessaries are available in various sizes. The woman’s health care professional will place her pessary in a position to hold her pelvic organs in place without causing her any discomfort. The health care professional does this fitting in his office and no anesthetic is necessary.
It may take several tries before a woman to finds the pessary that is comfortable for her. A woman needs to have her pessary checked regularly by her health care professional until both she and her physician are satisfied with the way it fits.
Once a woman has her pessary fitted by her health care professional, he will teach her how to take her pessary out, clean it and then reinsert it. Her cleaning schedule will be determined by the kind of POP that she has and the brand of pessary she is using. Some women have difficulty removing and replacing their pessaries. These women can visit their physician’s office regularly for assistance with this procedure. Women need to change their pessary every three to six months.
How Well a Pessary Works
Vaginal pessaries are just as successful as surgery in alleviating the symptoms related to prolapse. While a pessary will not cure POP, it is used to control and slow down the progression of the prolapse. The pessary adds vaginal support and tightens the muscles and tissues of the pelvis. Many women who use a pessary notice improvement in their symptoms. Some women no longer have any symptoms related to their POP after the insertion of their pessary.
Risk Factors of Wearing a Pessary
The possible complications include:
- Open Sores Inside the Vagina – On rare occasions, a pessary can cause pressure on certain areas within the vagina, leading to open sores.
- Rectocele Formation – This condition occurs when the rectum bulges against the vaginal wall
- Vaginal Wall Degradation – In severe cases a fistula (opening) can form between a woman’s vagina and rectum
The best way to minimize the chance of complications is to ensure that a pessary does not put excessive pressure on the vaginal wall and that it fits correctly.
Following the health care professional’s cleaning instructions will also reduce the chance of complications.
Post Menopausal Women
Sometimes women who have already gone through menopause will be given estrogen to assist with any irritation that the pessary may cause. This estrogen may be in the form of a ring, cream or tablets.
What to Consider
A pessary is often an effective tool in the management of pelvic organ prolapse without surgical intervention.
Pessaries may be a great choice for:
- Young women who are still interested in having children
- If surgery is risky due to chronic health conditions
- If a woman does not want to have surgery for any other reasons
A pessary is not recommended for a woman who has had a hysterectomy because her vaginal walls are not held in place by her cervix and uterus. Women that suffer severe prolapse after undergoing a hysterectomy might have problems keeping the pessary in the right place.
Sexual Intercourse After Pessary Insertion
Sexual intercourse is possible following pessary insertion; however, a diaphragm cannot be inserted. A diaphragm is a device that is placed in the vagina as a barrier method to avoid becoming pregnant. Women who have yet to undergo menopause should speak to their health care provider about other forms of birth control.