A vaginal pessary is a removable, capsule-shaped device made of silicone, vinyl, or rubber that is inserted into the vagina to support or lift the pelvic organs. Pessaries come in many different sizes and shapes to accommodate the individual needs of each patient. The goal of a pessary is to help support the pelvic organs, including the bladder, uterus, and rectum, from falling into or protruding out of the vaginal opening.
Types of Pessaries
There are different types and styles of pessaries that may be utilized depending on the type and severity of the prolapse. Some common pessary options include:
- Ring pessary: This donut-shaped device provides support around the vaginal walls. It is one of the most commonly used pessary styles.
- Shelf pessary: With a flat, sloping shelf design, this pessary supports the pelvic organs from below.
- Gehrung pessary: Featuring inward-curved sides, a Gehrung pessary fits high in the vagina to support the uterus or rectum.
- Gellhorn pessary: For more significant prolapses, a Gellhorn pessary has a stem that extends beyond the vagina for extra support.
Fitting and Maintaining a Pessary
When fitted properly by a healthcare provider, a Vaginal Pessary should be comfortable enough to forget that it is there. However, regular cleaning and removal is needed. After fitting, most women will need to remove the pessary every one to three months for cleaning and to check for any sores or irritation. Reinsertion of a clean pessary is usually simple. Over-the-counter recovery gels or creams can help with any minor discomfort.
Who Can Benefit From Pessary Treatment?
Pessaries provide an effective non-surgical option for women experiencing mild to moderate cases of pelvic organ prolapse. Specifically, vaginal pessaries may help with:
- Cystocele: When the bladder bulges into the vagina.
- Rectocele: When the rectum protrudes into the vaginal area.
- Uterine prolapse: When the uterus drops from its normal position.
- Vaginal vault prolapse: Occurs after hysterectomy, causing the top of the vagina to drop.
For many women, a properly fitted pessary eliminates symptoms like a sensation of pelvic heaviness, pressure, or bulging. Pessaries are also often recommended postpartum or after weight loss to allow tissue time to heal on its own.
Managing Expectations and Potential Issues
While most women adapt well to pessary use over time, some initial discomfort is normal. Minor issues like increased vaginal discharge, irritation, or an uncomfortable sensation may occur initially but usually improve within a few weeks. For a small percentage of women, a pessary simply may not be comfortable long-term regardless of fit or type.
It is also important to remember that pessaries only treat the symptoms of pelvic organ prolapse, not the underlying structural issues. For severe prolapses, pessaries may not provide adequate support on their own. Surgery would be considered a better option. Overall, with routine healthcare provider follow-up and care, vaginal pessaries provide an effective, non-invasive treatment alternative for many women.
The Risks and Benefits of Surgical Alternatives
For those where a pessary does not relieve symptoms or when the prolapse is severe, surgical repair may be recommended. Common surgical options include:
- Sacrocolpopexy: A mesh or tissue graft is utilized to provide additional support to the top of the vagina and lift the pelvic organs. This option has higher success rates but requires an abdominal incision.
- Vaginal mesh or biological graft procedures: Mesh or graft materials are placed vaginally to repair weakened tissues. Risks include exposure or rejection of the mesh material.
- Sacrospinous ligament fixation: Sutures are placed anchoring the top of the vagina to the sacrospinous ligaments behind the ischial spines.
Surgery aims to provide a more permanent repair, it also carries increased risks such as injury to nearby organs, infection, mesh complications, or having to repeat the procedure. For many women facing pelvic organ prolapse, a vaginal pessary provides an excellent first-line approach worth trying.
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