What is a Vaginal Pessary?
A pessary is a small plastic device inserted into the vagina to support the prolapse and return it to its correct position.
The most commonly used pessary is a “ring pessary” which is shaped like a ring or donut and is placed in the vagina to hold the prolapse in place. Pessaries come in many different shapes and sizes. The type and size of pessary used is individualised to each woman. It may take more than one pessary fitting to determine the correct pessary type and size for the individual. The pessary fitting is performed in the consulting rooms by Dr. McKertich and no anaesthetic is required.
The pessary sits inside the vagina either around the cervix (neck of the uterus or womb) or at the top of the vagina (after a hysterectomy).
After a successful pessary fitting a woman should not have a sensation of a bulge or lump in the vagina and should not be aware of the presence of the pessary. There are no restrictions on activities with the pessary in position. Most pessaries (such as a ring pessary) can be left in position with sexual intercourse and neither the woman nor her partner are usually aware of the presence of the pessary. If desired, a woman can be taught to remove and replace the pessary herself.
How long can a Vaginal Pessary be used to treat Prolapse?
If the pessary is successful in supporting the prolapse and relieving prolapse symptoms, it can be an excellent long-term treatment for prolapse.
Some women decide to have a ring pessary as a permanent measure to treat their prolapse due to other health problems or personal preference.
Some women use the pessary as an interim measure to treat prolapse as they wish to defer having surgery for reasons such as a desire to have further children or inconvenient timing to have surgery.
What follow up is required in Women who have Pessary to treat Pelvic Organ Prolapse?
All women with a long term pessary require regular follow up to ensure that they are not developing complications or problems related to the pessary. Regular checks are performed by a doctor every 4 to 6 months with removal and cleaning of the pessary and inspection of the vaginal tissues before the pessary is replaced. The interval between pessary checks can be extended by the doctor depending on the individual patient and the healthiness of the tissues at the time of the pessary check up.
What to expect with a Pessary to treat Vaginal Prolapse
All women with a pessary to treat vaginal prolapse will notice some increase in vaginal discharge. It is also necessary to use a vaginal lubricant or moisturiser when a vaginal pessary for prolapse is used. In post menopausal women vaginal oestrogen is used in the form of vaginal Ovestin® cream or Vagifem Low® pessaries. This is not the same as “systemic” hormone replacement therapy (i.e. hormone replacement tablets or skin patches), which is designed to raise blood levels of oestrogen.
Vaginal pessaries of oestrogen (e.g. Vagifem Low® or Ovestin® cream which are inserted internally into the vagina using a special applicator) are designed to act as vaginal moisturisers to improve the health of the vaginal tissues and reduce potential complications of a pessary for prolapse.
Alternatives to vaginal oestrogen include non-hormonal vaginal moisturisers such as Replens® cream or Aci-Jel®.
Are there any complications of using a Pessary long term?
Potential complications of long-term vaginal pessary use to treat pelvic organ prolapse include:
- Ulcers can occur in the vagina due to the pessary which can be prevented by use of vaginal oestrogen (i.e. Vagifem Low® pessaries or Ovestin® cream)
- Vaginal bleeding – usually mild
- Vaginal infection
- Treated by temporary removal of the pessary and use of antibiotics and vaginal oestrogen
- Potentially increased rate of urinary tract infection
- But treatment of the prolapse and improved bladder function with the pessary may help to reduce problems with urinary tract infection due to poor bladder emptying
- Extremely rare complications such as damage to organs adjacent to the pessary - have been reported when pessary care is neglected i.e. failure to use regular vaginal oestrogen and attend for regular follow up and review of the pessary
The potential problems from having a vaginal pessary are minimal if the appropriate precautions are taken and ongoing review and check ups are performed.