A vaginal pessary is a removable plastic device placed into the vagina to help to support areas of pelvic organ prolapse. The pessary is most often used to reduce prolapse of the uterus. A pessary can also help to support a cystocele (when your bladder droops down into your vagina) or a rectocele (when the wall of your rectum bulges into the bottom of your vagina).
There are several types of pessaries that can be used, the most common one being a ring pessary. There are other types such as the Gelhorn or shelf pessary, which are used in more severe or recurrent prolapse cases.
Pessaries are used as a non-surgical approach to the treatment of pelvic organ prolapse.
They can be used in women who have other serious chronic health problems, such as heart or lung disease, that make a surgical procedure more dangerous. Pessaries can be used when the symptoms of pelvic organ prolapse are mild or when future pregnancies are planned.
Pessaries are sometimes used to see what the effect of surgery for pelvic organ prolapse will be on urinary symptoms. This is called a pessary test. If you have a problem with incontinence with a pessary inserted, a separate surgical operation to fix the incontinence problem may be done at the same time as the prolapse surgery.
Pessaries do not cure pelvic organ prolapse but help to manage the progression of the prolapse. Symptoms improve in many women who use a pessary, and for some women the symptoms go away.
Your health professional will fit your pessary to hold the pelvic organs in position without causing discomfort. Pessaries come in a variety of sizes and should be fitted carefully. You may need to experiment with different kinds of pessaries to find one that feels right for you. The pessary must be changed every four to six months.
Most women say that the experience of removing/inserting the ring is not as bad as they had imagined. You will probably feel some discomfort but not too much pain.
You may notice more vaginal discharge than normal. Your vaginal discharge may also develop an odour. Vaginal irritation is another possible side effect. Women who are past the menopause may need to use oestrogen cream to help relieve the irritation.
Vaginal erosions and ulcers that can cause some vaginal bleeding are reported in around one in six women. Other common side effects include stress urinary incontinence, interference with sexual intercourse and difficulty with bowel movements. Urinary tract infections have been reported by one woman in nine, and bacterial inflammation of the vagina in up to one in three pessary users.
Complications can be minimised by having a pessary that fits correctly and does not put too much pressure on the wall of the vagina. Your pessary should be checked frequently by your health professional until both of you are satisfied with the fit.
Ring pessaries are popular because they do not block the vagina and are therefore compatible with sexual intercourse. They need to be replaced every six months, but otherwise should not be felt or prove bothersome, thus not preventing any activity the woman wishes to undertake.
Alternatives to the ring device include the shelf, Gellhorn and cube pessaries or variations. These devices block the vagina and are therefore not compatible with sexual activity, with the exception of the cube pessary, which has a mechanism for insertion and removal by the patient herself, meaning it can be taken out and re-inserted before and after sex.
The advantage of vaginal pessary devices is that they confer much less risk than surgery and can be inserted and replaced in the outpatient setting without the need for anaesthetic of any kind.
The disadvantage of these devices is that they may fail. This means that they may be displaced from the vagina by the prolapse, despite trying different sizes or different devices. This method is also an ongoing treatment, requiring repeated appointment attendance, which for some women may not be practical. The final drawback of vaginal pessary devices is that they can produce a vaginal discharge which some women do not like.