Pessaries: What Are They and When Do You Use Them?
Until surgical methods matured, pessaries were the only form of treating pelvic organ prolapse (POP), such as cystocele, rectocele, uterine prolapse and stress incontinence. A pessary is classically a round ring that is placed into the vagina to reduce the prolapse. It derives from the Greek word pesos, meaning stone. Modern pessaries can take many shapes: rings, cubes, horns, rings with knobs and semi-circle forms.
Since the lifetime risk for a woman in the U.S. for undergoing POP surgery is 11 percent, pessary is often discussed as one of the non-invasive treatment options either for mild-moderate prolapse or in women who may not be good surgical candidates.
Pessaries must be properly fit to the woman’s pelvis and must be comfortable. Often, two or three fittings are necessary in order to see which size is appropriate. Not many practitioners are skilled in fitting pessaries, but usually, a GYN nurse practitioner is the most common health care professional who does the fittings.
Care must be taken when using a pessary. Women who have them inserted must be comfortable removing and placing them by themselves. They must be removed before intercourse. Local estrogen cream is necessary to keep the vaginal tissue from becoming irritated from the pessary. It can be left in during the day and removed at night. Side effects include: discharge, odor, vaginal skin irritation with bleeding, spontaneous expulsion, obstructive urination and discomfort.
Rare cases of vaginal erosion or ulceration can occur if women forget they have a pessary in place. If the woman cannot remove it herself, she must at least visit her practitioner on a frequent basis to have it removed and cleaned.
Link to blog: http://femaleurologyaz.blogspot.com/2009/08/pessaries-what-are-they-and-...
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In normal female pelvic anatomy the vagina is a closed, airless, bi-axial, supportive space. Pessaries are not a perfect answer to prolapse because they keep the vagina slightly open and therefore vulnerable to intraabdominal pressure. This means, for instance, that if a woman has a prolapsed front vaginal wall, constant pessary use can result in worsening symptoms in the back vaginal wall (rectocele). It is not true that estrogen must be used with a pessary. There are other much safer lubricants available that are compatible with pessary use.
Women the world over are learning that prolapse is predominantly a postural problem and when they change the shape of the outer framework from which the pelvic organs are suspended (the spine), they change their symptoms. If a woman has her uterus, which is the hub of the wheel of pelvic organ support, she is much more likely to be able to improve her symptoms by returning to the natural pelvic organ support system. Change your posture, change your prolapse.
Christine Kent, Whole Woman Inc.
August 6, 2009 - 4:23pmThis Comment
Thanks for your comments, although they demonstrate limited knowledge of anatomy. Prolapse is not postural, it is from pelvic floor weakness which is multifactorial. And eventhough other lubricants can be used, most pessaries are used in post-menopausal women who are OLDER and need estrogen IF they're going to place a firm rubber ring in theri vagina INSTEAD of having surgery. Surgilube and Astroglide don't rejuvinate the vagina
August 6, 2009 - 8:35pmI am afraid it is your conventional view of pelvic anatomy that is woefully misconceived. There is no “pelvic floor”, but rather a wall of muscle at the back of the body - just like in quadrupeds. It is the strong lumbar curve that makes human bipedal posture possible. All of the pelvic organs are bi-axial, so that the bulk of their weight is carried toward the front of the body and away from the genital hiatus at the back of the body. Natural female posture keeps pelvic organs properly positioned. By age thirty or so, most women have lost natural spinal curvatures because they have spent their lives in spinal flexion - upholstered furniture, car seats, etc. By returning to natural posture the pelvic organs are slowly repositioned. An anti-inflammatory diet helps the process tremendously by correcting the nutritional matrix of connective tissue. The idea that there is a soft-tissue “hole” at the bottom of the body that “holds up” the organs and therefore must be “strengthened” through kegel exercise is being greatly debunked. Your pessary comments are ridiculous. Prolapse is epidemic in postpartum women and pessaries are utilized by women of all ages, along with the many organic vaginal balms available. Christine Kent, Whole Woman.
August 7, 2009 - 6:18amThanks for your response- but my view is far from conventional AND I am not selling any products.
August 7, 2009 - 6:25amYour surgeries and pessaries are not products?
August 7, 2009 - 6:32amI don't sell pessaries and my site is informational. Surgery, or any other medical recommendation cannot be given over the internet. For a professional opinion and personal time, an appointment can be made. On my site/blog I do not enocurage surgery or pessary use- just what is available and interesting to the public. What I DO NOT do is troll internet sites to leave my name and website so people can buy my books, exercise tools and videos.
August 7, 2009 - 6:53amJust empowering women, sir.
August 7, 2009 - 7:05amI guess since you deleted your last comment, I will delete my response.
August 7, 2009 - 7:52pmThe Moderators of this site have most likely deleted comments that are attacking and inflammatory, and we ask that all users provide personal experiences and health information that is insightful, respectful and empowering.
Differing opinions or research findings can be discussed in such a manner that provides the readers the ability to become more informed, knowledgeable and to create well-constructed and educated questions for their health care providers. There is a fine line in finding the appropriate professional writing techniques that lend themselves to healthy debates vs. telling someone else their "knowledge is limited" or their "comments are ridiculous".
Differing opinions can be discussed, and are welcome, in such a manner as not to attack, degrade or otherwise demean the other person.
August 9, 2009 - 9:17amThanks Alison B- on all my other topic posts none of the other commentors have been "borderline" offensive. I always welcome comments on this blog or my own site- except when direct shots are fired. -Dr. K
August 10, 2009 - 7:59pm