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Pessaries: What Are They and When Do You Use Them?

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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-when-do-you.html

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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 - 4:23pm
EmpowHER Guest
Anonymous (reply to Moonspinner)

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 - 8:35pm
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