Atrium Health Navicent Women's Care Urogynecology & Pelvic Surgery

Pessary

What is a pessary?

A pessary a non-surgical management option for pelvic organ prolapse. It is a device that is fitted for your vagina that when in place, serves to support the weakened tissue in the vagina.

Pessaries come in different shapes and sizes, but are mainly categorized into two types. Depending on the type prolapse, many times we can find a pessary that will work for you.

• Support type pessaries: These pessaries are used to support the areas of prolapse in the vagina. These are typically the most common and user friendly pessaries. Some common examples include a ring or gehrung pessary.

• Space-occupying pessaries: These pessaries are used to fill the space in the vagina, effectively support the areas of prolapse. These types of pessaries are often useful in advanced staged prolapse. Some examples include the gellhorn or donut pessary

How is a pessary fitted?

Pessaries are fitted after an examination of the vagina is performed to get the approximate dimensions of the vaginal vault. In addition, it is important to inspect the vagina for any lesions, erosions, or other breaks in the skin as this can lead to bleeding and infection. Afterwards, a series of pessaries of different sizes will be tried to ensures that you have a good fit. You will be asked to perform some activities in order to ensure proper fit and comfort such as walk around, bend down, and empty your bladder. In order to be a good fit, two criteria must be met.

• The pessary must be comfortable. Ideally the pessary is small enough to be comfortable, but large enough to not fall out
• The pessary should allow for normal bladder and bowel function. A pessary that is too large can cause difficulty with bowel movements or with voiding.

How do I maintain the pessary?

Patients will vary with regards to the frequency they remove and clean their pessary. Some patients will choose to remove and their pessary on a daily basis, while others will leave the pessary in place until their next office visit for the physician to remove and clean. In addition, using a cream such as Trimo-san with your pessary will help maintain the vaginal tissues. In women who are in menopause, vaginal estrogen creams are often used as well to help with maintaining the vaginal tissues. Ultimately, you will need to follow-up with our office every 3-6 months to have the pessary cleaned and to evaluate the vagina for any signs of erosions. If you develop bleeding or infection earlier than your scheduled visit, please contact the office.

What are the risks of a pessary?

Pessaries are typically very safe with very few complications. This is especially the case in a pessary that is fitted properly. However, there are a few issues with pessaries that patients should be aware of.

• Erosions/ulcerations: Because the pessaries rests on the vaginal epithelium, this can cause ulcerations to form. Use of premarin or Trimo-san cream can help with maintaining the vaginal epithelium. If this occurs, the pessary will need to remain out until the vagina has healed
• Pain: Occasionally, the pessary can move or change position causing pain. If this is the case, remove the pessary and replace it in the correct orientation. If you are unable to reposition the pessary, call the office to schedule an appointment.
• Vaginal discharge: Women often experience some vaginal discharge with continued use of a pessary. While this does not indicate an infection, it can be bothersome to some patients.

Can I have sex with the pessary in place?

In general, the recommendation is to remove the pessary prior to intercourse. Some patients are able to have intercourse with a ring type pessary in place, however your partner may feel the pessary as well. With the space-filling pessary, intercourse will not be possible with the pessary in place. Please let Dr. Kow know if you are sexually active if you are considering a pessary.

Will my insurance company cover a pessary?

Most insurance policies will cover pessary. Our office will help you with obtaining prior authorization if your insurance policy requires it. If you have further questions, contact your insurance carrier to determine the details regarding your coverage.