The Real Deal Regarding Vaginal Pessaries
So, here’s the deal. Some women with prolapse are bothered by the symptoms but don’t want to have surgery because they don’t want the hassle, the expense (depending on how high their deductible is) or they are scared about possible complications. For those women, a vaginal pessary is an option.
These little guys have been around since ancient times. I am not saying that Cleopatra used a pessary, but if she did, it might have been cone-shaped and made out of gold. Her subjects, not being royal, would have to settle for a pomegranate or even half a pomegranate. Throughout history, people have tried to push prolapse back in and hold it in with all sorts of different materials including wax-coated linen or string, bronze, copper, different fruits and even the occasional potato. These devices were often held in place externally with straps and belts of sorts which at times caused lacerations to the labia. Barbaric!!
Thanks to Charles Goodyear, who patented his development of vulcanized rubber, we moved away from some of these home-grown pessary creations and toward our modern version of the pessary, which is made out of silicone. Present day pessaries come in all shapes and sizes, but the most common are shaped like a contraceptive diaphragm (a ring pessary) or something reminiscent of an infant’s pacifier (a Gellhorn pessary).
So do these things work? Yes and no. We try to custom fit pessaries in the office to make them comfortable and to ensure that they stay, but we are not always successful. I have worked with women extensively to find the perfect fit, and they call me on their cell phone from the parking lot to tell me the darn thing popped out.
Some women do great. Those that do best are the women who can take them in and out regularly (not necessarily every day) and clean them, give their vaginal tissues a break while they sleep and then put it back in when they are up and moving around. Of course, I do get the occasional story from a woman who said she tried to bend a ring pessary to get it back in but maybe used a little too much KY Jelly and the little devil popped out of her hand and flew across the room.
Those women who can’t take it in and out themselves for whatever reason can come back into the office every three months, and I remove it, clean it, do an exam to make sure the tissues look healthy and put it back in.
Many women with pessaries who can’t get them in and out themselves are older, and older women tend to have vaginal atrophy. The atrophic vaginal tissue is by definition thin and dry and can be easily injured. The pessary can rub against this delicate tissue and cause an ulceration, like a skinned knee but inside the vagina. Not pleasant. Also, those ulcerations, if left untended can continue to erode into the bladder causing a communication between the bladder and the vagina or the rectum or bowels. So, the point is, pessaries can result in complications if not maintained properly and supervised by a doctor or nurse practitioner.
Pessaries that are not removed and cleaned frequently can cause significant vaginal discharge with odor. Using estrogen cream regularly and some gels or lubricants that have some antibacterial qualities can help.
Patients often ask me my opinion on the use of pessaries. The bottom line is that it can’t hurt to try it. If you like it and it works for you and you don’t mind the maintenance, perfect. If you hate it, it is not a big expense or a risky trial. At least you know, and the information might help with the decision to move on with surgery or not.