Answers about pessary use to relieve symptoms of pelvic organ prolapse
Millions of women around the world have pelvic organ prolapse. However, the number of women who are talking about it is much less! That’s likely the reason why there is so much confusion and so little understanding about the various treatments for this common disorder.
While prolapse is not life-threatening, that doesn’t mean any woman should simply suffer with the discomfort and reduced quality of life that it can cause. One method to help relieve your symptoms is a pessary, which may provide temporary support of prolapse or pelvic floor organs.
Because pessaries don’t get a lot of press (and most women are hesitant to boldly introduce the topic over a cup of coffee), we’ve prepared the following questions and answers to address your concerns.
What exactly is a pessary?
A pessary is a soft, removable prosthetic device that is custom-fitted and inserted into the vagina during a standard office visit to your doctor, often a urogynecologist. After insertion, the pessary supports the areas of your pelvis that have been affected by prolapse.
Pessaries are latex-free, come in various shapes and sizes, and are safe to use. Your doctor will determine which type to use to help with your specific degree or type of prolapse. After a short training session, most women can competently remove the pessary and reinsert it by themselves.
Is a pessary the primary option for supporting prolapse?
The most suitable option for supporting prolapse depends largely on the level of discomfort and severity of the prolapse. Using a pessary is one way to experience relief. Other ways to cope include:
- If it isn’t too bothersome, many women choose to do nothing.
- For mild cases of prolapse with manageable symptoms, helpful therapies include pelvic floor muscle exercises, dietary changes, and physical therapy.
- If the prolapse is more disruptive, traditional options include wearing a pessary or having surgery.
A new device for use in vaginal surgery is EnPlace™, an innovative and minimally invasive approach for pelvic floor ligament fixation, which recently received FDA clearance for pelvic floor ligament fixation. In comparison to a pessary, EnPlace™ offers a more permanent way to support prolapse.(Learn more about EnPlace at femselect.com)
What are the different kinds of pessaries?
The two main types of pessaries are categorized as support and space-filling. Both kinds are usually made from medical-grade silicone, which is highly durable and nonabsorbent. The frequency of when your pessary must be changed or replaced depends on the type, and your doctor will provide personalized instructions.
What is the fitting process?
It’s essential to stress that you must visit a trained and experienced medical professional to fit your pessary, because if it is fitted improperly – not only will it fail to improve your symptoms, but it can also cause vaginal damage.
What happens? First, a collapsed pessary is inserted into the vagina and placed just beneath the cervix. A few sizes and shapes may need to be tried before the perfect fit is found. Then, your doctor may inflate it using a bulb (depending on the type). Once it is snug in place, you should not notice it at all. Because the fitting and insertion process is not too uncomfortable, no anesthesia is usually required.
Before you head home, your doctor will teach you how to insert, remove and clean the pessary on your own. About a week later, you’ll need to return for a follow-up exam to confirm that the fit is still tight and healthy. Future check-ups will be needed throughout the next months, in addition to a comprehensive annual exam.
Can a pessary cure prolapse?
No. Unfortunately, a pessary is not a cure or repair for pelvic organ prolapse. However, it can alleviate your symptoms and enable you to return to enjoying your regular lifestyle – exercising, taking care of your family, and working normally, for example.
How long is a pessary worn for?
It depends on why you’re wearing it. A pessary can be worn temporarily until you have surgery to treat the prolapse, or it can be worn long-term if you don’t want (or cannot have) surgery. Keep in mind that while a pessary is a safe long-term treatment, it does need to be replaced every three to six months – either by yourself or by your doctor.
What are the advantages of using a pessary?
A pessary lifts your pelvic organs, thereby reducing the symptoms of prolapse. The benefits of this specific therapy include:
- It is less invasive than surgery
- It has significantly lower risks than surgery
- It is relatively inexpensive
What are the downsides of using a pessary?
Every medical treatment has its pros and cons. With pessaries, the most common possible side effects are: vaginal discharge – often foul-smelling, vaginal irritation, urinary tract infections, and stress-incontinence (leaking a small amount of urine during exercise or sneezing). Because pessaries are removable, these side effects can usually be resolved quickly upon consultation with your doctor.
While serious complications from a pessary are rare, many women become frustrated with these annoying side effects and they discontinue wearing it after about two years, on average.
Can a pessary be worn during sexual intercourse?
With most types of support pessaries, you can have intercourse with it in place – although some women prefer removing it. Note – a properly fitted pessary should not be felt by either partner.
Can a pessary fall out?
If it’s not fit correctly or if you strain excessively, a pessary can fall out. But no worries… it can’t end up anywhere else in your body or “get lost” inside you.
Is it hard to care for a pessary?
With clear instructions from your doctor, you should be able to remove, clean, and replace most types of pessaries efficiently by yourself–although some kinds may require a visit to your doctor every few months for cleaning. To clean the pessary at home, use mild soap and water and rinse it off well before reinserting it. This maintenance routine will need to be done either daily or weekly. To reduce the risk of vaginal irritation, your doctor may also prescribe an estrogen cream to apply while the pessary is out.