27 May 2021 Author : Isabel Grilo What is a vaginal pessary? Vaginal pessaries are removable devices that are placed in the vagina to relieve symptoms associated with pelvic organ prolapse . They are made of silicone, or other soft and non-absorbent inert material. They have different shapes and sizes. Some can be used for several months, others must be removed and cleaned daily. There are two main types of pessaries: Support pessaries , which are used in prolapses of varying severity and stress urinary incontinence; Space-filling pessaries , which are used in more severe prolapses. The most used pessary is the ring pessary that is a support pessary. It is suitable for about 70% of women, is well tolerated, simple to apply and removes by the gynecologist, in consultation. In what situations can a vaginal pessary be used? The main indications for using the vaginal pessary in the treatment of pelvic organ prolapse are: High surgical risk due to other health problems; Preference for non-surgical treatment; Need to postpone surgery to correct prolapse; Prolapse of pelvic organs during pregnancy; Desire for a future pregnancy. Placement and use of the pessary The use of a pessary implies a previous gynecological medical evaluation to evaluate the prolapse, exclude the existence of lesions and to determine the most appropriate pessary. When the pessary is not the right size and is too big, it can cause vaginal pressure. If it is too small, it can be expelled with an effort. Often, a new medical evaluation may be required shortly after the pessary is placed for the first time to ensure it is the right device or to try an alternative when the first option does not have the expected results. In menopausal women, the lack of estrogens makes the vaginal mucosa more sensitive to injuries. Thus, local estrogens with the use of the pessary are often prescribed. In the case of the ring pessary, which is usually the preferred one, it is generally advisable to have it changed and the vaginal cavity disinfected every 3-6 months . The ideal is to have two pessaries to alternate. The alternatives to using a pessary are the pelvic floor strengthening exercises and the surgical treatment of pelvic organ prolapse. Advantages of the vaginal pessary The vaginal pessary has several advantages: It can be used in the long term; It avoids a surgery; It is an inexpensive solution; It is usually well tolerated and safe; Does not imply limitations in daily activities; Depending on the type of pessary, it is possible to have sex without having to withdraw it. Since some pessaries do not allow sexual intercourse, this issue should be discussed with the doctor when choosing the most appropriate pessary. Possible complications of the vaginal pessary Prolonged contact of the device with the walls of the vagina can cause bleeding and / or ulceration, giving rise to a pink or bloody discharge. If this happens, medical care should be sought. You may have remove the pessary until you can treat an infection and / or cure the lesions. If the pessary is not the right size, it can cause pain or discomfort. Sources Clemons JL. Vaginal pessaries: indications, devices and approach to selection. www.uptodate.com International Urogynecological Association. Vaginal pessary for pelvic organ prolapse. www.iuga.org/ Meet the obstetrics-gynecology team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
