Pessary

What is a Pessary?

A pessary is a medical-grade, silicone device that is inserted into the vagina similar to a tampon.

Purpose of a Pessary

A pessary is primarily used as a non-surgical intervention in the treatment of two pelvic health conditions. First, it may be used in the instance of pelvic organ prolapse to support the pelvic organs and minimize their descent. Second, it can be used to treat stress urinary incontinence. In this case, the pessary compresses the urethra (the tube that drains the bladder), thereby decreasing the likelihood of urinary leakage.

How to Use a Pessary

A pessary must be fitted for you by someone trained to do so (gynecologists, specialized nurses, or specialized physiotherapists). There are many different shapes and sizes of pessaries and the best one for you will be chosen based on your anatomy, symptoms, and goals. Depending on your situation and needs, it may be left in for weeks, months, or removed daily. If it is to be removed daily or weekly, you will be taught how to remove, clean and re-insert the device.

Some women wear them all day long and others only for activities where they feel they need a little extra support such as running or aerobics. If it is to be left in for months, you will likely see a nurse or doctor who will remove, clean, and re-insert it for you. Your doctor may prescribe an estrogen cream or other non-hormonal topical to keep your vaginal tissue healthy.

Characteristics of a Successful Pessary

• Your symptoms of pressure, heaviness, and/or bulging are reduced or gone.
• You cannot feel the pessary when it is in place.
• Improved urine and stool evacuation.
• No more urinary incontinence.
• The pessary stays in place and does not fall out with slight bearing down (cough, bowel movement, lift, or exercise).
• Overall improved quality of life.

Intercourse

All except the ring pessary (with or without support) must be removed for penetrative intercourse.

Pregnancy

Pessaries can be used during pregnancy, but you must be monitored and followed by your obstetric care provider.

Menstruation

Only particular pessaries that allow sufficient drainage can be worn during menstruation, but even these must be removed nightly. You must not use both a pessary and a tampon or Diva cup at the same time.

Potential Risks of Pessary Use

A pessary is very safe when users follow the instructions for care and management. However, there are certain risks associated with the use of a pessary. In case of an emergency and you are unable to advise doctors that you wear a pessary, it is a good idea to tell a close friend, family member, or carry a note in your wallet explaining that you wear a pessary.

Risks and Complications Include:

• Increased vaginal secretions.
• Irritation or fissure at the vaginal opening.
• Open sores on the vaginal wall, with or without bleeding.
• Infection.
• Expulsion of the pessary with bearing down (heavy lifting or straining for a bowel movement).
• Difficulty and pain evacuating bowels or emptying bladder.
• Unmasking of stress urinary incontinence (sometimes when the bladder is held in the correct place by the pessary, pre-existing stress urinary incontinence is revealed, and urinary leakage occurs).
• Incarceration: When the pessary gets stuck in the vaginal tissue).
• Migration/fistula: When the pessary moves from the vagina to the bladder or rectum, creating a hole between the organs.
• Increased risk of squamous cell vaginal cancer (with prolonged use and inadequate supervision).

If you experience any of these symptoms, stop using your pessary, notify your physiotherapist, and see your doctor. Medical treatment will be provided based on the reasons for your symptoms. Sometimes your doctor will prescribe a topical estrogen cream in the case of tissue irritation or increased vaginal secretions. You may be advised to stop wearing the pessary temporarily until the tissues have a chance to heal.

Because of these risks, it is imperative for you to adhere to your pessary treatment plan. Often you will visit your physician for a gynecological exam 1-3 months after starting to use a pessary and then every 6-12 months thereafter to monitor the health of your vaginal tissues.

When To Seek Medical Attention if Using a Pessary: 

• You have new or worse pain.
• Vaginal discharge changes in colour or smell, vaginal itchiness, or burning with urination.
• Vaginal bleeding and/or spotting.
• You have trouble voiding your bladder or bowels.
• If you have uncomfortable sensations of pressure or rubbing with continued use of the pessary.

Although pessaries are not a cure and are not an option for every woman, a good fitting pessary can greatly reduce symptoms for many patients, leading to significant increases in quality of life.