What is a pessary?
A pessary is a class IIa or IIb medical device that is inserted into the vagina to resolve problems associated with:
- pelvic organ prolapse;
- urinary and faecal incontinence;
- the risk of premature birth.
Pessaries come in a range of different shapes, sizes and materials. The most common types are the ring, cube and mushroom (or Gellhorn) pessaries, made of medical silicone.
Why should I use a pessary?
Pessaries are a viable alternative to surgery, which not all women want or can undergo. However, in some cases, pessaries can only be used as a temporary solution, while waiting for corrective surgery.
I have a prolapse, what can I do?
Contact your gynaecologist for a thorough consultation. He or she will be able to advise you on the right type of pessary for you. During the consultation, you will assess the degree of prolapse, the organs involved and the size that is best suited to your anatomical characteristics.
However, in mild and asymptomatic cases, it is advisable to do daily exercises, known as Kegel’s exercises, to strengthen the pelvic floor muscles.
I have urinary incontinence, what can I do?
Contact your gynaecologist for a thorough consultation. Urethral ring pessaries and urethral dish pessaries are an ideal solution in the case of urinary incontinence. The “knob”, i.e. the protuberance typical of these models, shifts the transition between bladder and urethra upwards and forwards. The position of the pessary inside the vagina also prevents urine from entering the urethra unintentionally.
I have an increased risk of preterm birth, what can I do?
Contact your gynaecologist for a thorough consultation. Perforated cervical pessaries are designed to prevent preterm births in case of prolapse of the uterine cervix (cervicoisthmic incompetence). The device is inserted into the vagina so as to reduce the pressure on the uterine cervix. The time a pessary is left inside the vagina varies from one case to another. Although the device is usually removed during the 37th or 38th week of pregnancy, certain clinical situations call for earlier removal.
How can I buy a pessary?
Pessaries are prescribed after a thorough gynaecological consultation with a specialist. Contact your doctor to find out more and place an order in our online shop or by calling +39 0521 628482.
Which model of pessary is right for me?
Both the model and the size must be chosen by your specialist!
As a general rule, ring pessaries (conventional ring or perforated dish models) are used for prolapses up to the third degree; in the presence of cystocele and associated urinary incontinence, the most appropriate models are urethral ring pessaries and urethral dish pessaries. However, in the case of prolapses greater than the third degree and cystocele, gynaecologists will opt for other models, such as the mushroom (or Gellhorn) or cube pessaries. When it is necessary to prevent a preterm birth, on the other hand, the most suitable model is the perforated cervical pessary.
What size pessary should I choose?
As with the model, the correct size of pessary will be established by your specialist during an outpatient consultation. To identify the correct size of pessary for the patient, the gynaecologist or obstetrician use a pessary that is smaller than the opening of the vagina and make sure that there is a gap between it and the wall of the vagina (about the width of a finger). The patient must not be able to feel the pessary, and it must not cause any micturition disorders. To make sure the pessary does not come out, patients are usually asked to simulate a few coughs in a supine position and with their legs apart on foot rests, to walk around the consultation room for a few minutes and to check that they have no difficulties urinating once the pessary has been inserted.
What are the benefits of using a pessary?
Women who choose to use a pessary, choose to get back to normal daily life, doing away with discomfort and pain, without anyone noticing. For sexually active and sporty women in particular, there are models of pessary that can be inserted and removed by the patient herself.
Does using a pessary affect the psychological aspects?
Prolapse and urinary incontinence are situations in which a woman’s private life is put to the test. The discouragement and shame they cause can result in isolation, as the woman gives up her daily life and freedom. It is precisely for these reasons that, especially when surgery is not a viable option, pessaries are the only alternative for returning to normality by having a positive influence on the person’s psychological aspects.
What are the risks of using a pessary?
The main risk is the formation of vaginal ulcers that bleed when the device pushes too hard on the vagina, causing chronic irritation of the walls of the vagina.
In some cases, it is possible the pessary may cut into both the bladder and the rectum. It is therefore essential to have regular gynaecology check-ups to monitor the action of the inserted pessary and, in the case of an ulcer, to remove it promptly before it can cause infections. The doctor will only be able to decide whether to insert another pessary once the ulcer has healed.
In addition, if the pessary is too small, the uterine prolapse may get worse with a general weakening of the pelvic floor and complications such as cystocele and rectocele.
How can I clean my pessary?
To clean your pessary, simply rinse it under running water using neutral soap and a soft brush. Once washed, place it on a sanitised surface, away from dust and direct sunlight.
Can I use the same pessary my whole life?
No, your pessary will have to be replaced periodically by your gynaecologist.
What lifestyle must I adopt while using a pessary? Will it place restrictions on my daily life?
Using a pessary does not restrict a woman’s daily life, rather it guarantees its continuity by avoiding discomfort, prolapse pain and incontinence urine loss. No one, except your partner, will know you are wearing one!
Can I have sex while using a pessary? If so, will my partner be able to feel it. Will it affect my sex life?
Yes, there are types of pessary, for example cube and mushroom pessaries, that, once they have been removed by the woman, allow normal sexual activities.
Will I be able to self-manage my pessary?
During your gynaecologist’s consultation, he/she will assess your self-management abilities and your personal needs and choose the most appropriate model of pessary for you.
What type of intimate hygiene must I adopt when using a pessary?
Daily intimate hygiene with a neutral intimate wash is recommended, as well as weekly use of a vaginal lavage if your specialist confirms it is appropriate.
How many gynaecologist’s appointments must I have when using a pessary?
The frequency of gynaecology consultations is established by the gynaecologist or obstetrician, depending on the patient’s individual needs and characteristics. It is generally recommended to have at least one every six months.
What is prolapse?
Prolapse is when one or more pelvic structures drop downwards and sometimes bulge out of the vaginal. It may affect, to different extents and in different combinations:
- the uterus, hysterocele;
- the bladder, cystocele;
- the rectum, rectocele;
- the intestinal loops, enterocele;
- the vaginal cuff following hysterectomy (removal of the uterus).
What is uterine prolapse?
Uterine prolapse consists in the descent of the uterus from its position in the lesser pelvis into the vaginal canal.
There are 4 degrees of uterine prolapse:
- 1st degree: the uterus sags into the vaginal canal;
- 2nd degree: the uterus protrudes from the pudendal cleft;
- 3rd degree: the uterus reaches the mouth of the vagina, bulging out of the pudendal cleft;
- 4th degree: the uterus is completely outside the vaginal canal.
How do I know if I have a prolapse?
Prolapse is associated with a sense of pelvic heaviness and vaginal encumbrance that in the more severe cases translates into the uterus coming out of the vagina or the onset of symptoms (for example urinary incontinence, cystitis, problems emptying the bladder, constipation and bleeding) associated with the abnormal function of the organs involved.
Discomfort during sexual intercourse and a sensation of movement of viscera in the groin after changes of position or while walking are also typical of prolapse.
Women with mild prolapse may have no symptoms at all.
What diagnosis is required in the case of prolapse?
Uterine prolapse is diagnosed during a normal gynaecology consultation.
If disorders associated with micturition and bladder emptying come to light during the talk, the specialist may recommend an urology consultation.
During the clinical interview, the gynaecologist will look at the patient’s individual situation (births, menopause, oestrogen deficits) and risk factors (obesity, chronic constipation, medical conditions).
What causes prolapse?
The disorder is caused by a total or partial weakening of the pelvic floor responsible for supporting the pelvic organs.
Although childbirth and the menopause are among the main factors that result in a sagging of the pelvic floor, it may also be caused by chronic constipation, pelvic injuries, chronic bronchitis, lack of exercise and familial factors.
In cases of uterine prolapse, are pessaries a definitive solution on a par with surgery?
No, pessaries do not definitively solve prolapse in the same way as surgery; however, they do allow the repositioning of the prolapsed pelvic organs.