Pessary

What is a pessary?

A pessary a nonsurgical device to help with pelvic organ prolapse (when one or more organs in the pelvis slip down from their normal position and bulge into the vagina) or with urinary incontinence (when urine leaks). The pessary is fitted to you and supports the weakened tissue in the vagina.

Pessaries are typically made of silicone or latex and come in different shapes and sizes but there are generally 2 types:

• Support: These lift up prolapsed parts of the vagina. They are the most common and user-friendly pessaries. Examples include a ring or Gehrung pessary.
• Space-occupying: These fill space in the vagina to support areas of prolapse. They are often useful for more advanced prolapse. Examples include the Gellhorn or donut pessary.

How is a pessary fitted?

First, your doctor will do a physical exam of your vagina to decide what size pessary might work best. They also will check for any sores, tears or breakdown of vaginal skin that could lead to bleeding or infection. The recommended shape or style of pessary depends on the condition being treated and the patient. You will need to try several sizes to see what fits you best. A good fit must meet 2 requirements:

• The pessary must be comfortable – that is, small enough to not cause pain or discomfort but large enough to not fall out.
• You should be able to pee and poop. A pessary that is too large can makes these difficult.

You will be asked to perform some activities such as walking around, bending down and peeing to make sure the pessary fits and is comfortable.

How do I take care of the pessary?

Some patients can remove and clean their pessary at home and others come into the office for the physician to remove and clean it. If you care for your pessary at home, we recommend taking it out and cleaning it daily. Wash it with mild soap and water, rinse and let it dry completely before reinserting. You can keep it in longer but no more than 3 months.

If you care for your pessary at home, you will need to come back to the office for an examination and fit check in 2 weeks and then 3 months. After that, you will need to be seen 2 or 3 times a year.

If you can’t remove and reinsert your pessary, you will need to come back to the office for cleaning and an exam every 3 month. If you develop bleeding or infection before your appointment, please call us at once.

Using a vaginal estrogen cream can help make the vagina walls thicker and healthier. This helps prevent injury in women who have gone through menopause.

What are the risks of a pessary?

Pessaries are typically very safe with very few complications, especially if they fit correctly. However, there are a few possible risks:

• Erosions/ulcerations: Because the pessary is against the vaginal wall, it could rus and cause a sore to form. Using certain vaginal creams can help prevent or treat these, but if one forms, the pessary needs to be removed and stay out until the vagina heals.
• Pain: Sometimes the pessary can move or change position and cause pain. You (or our office) can remove the pessary and reposition it.
• Vaginal discharge: Women often experience some vaginal discharge with continued use of a pessary. Although this does not indicate an infection, it can bother some patients.

Can I have sex with the pessary in place?

You can’t have sex with a space-occupying pessary in place, so it would have to be removed. And although sex is sometimes possible with a support pessary, we recommend removing it, too. Please let your doctor know if you are sexually active and ask what they recommend for your specific situation.

Will my insurance company cover a pessary?

Our office will help you obtain prior authorization if your insurance policy requires it. If you have further questions, contact your insurance carrier to determine the details regarding your coverage.