What is a vaginal pessary?
A vaginal pessary is a device that is placed inside the vagina to manage pelvic organ prolapse. It is fitted in the office and it reduces the prolapse back into the vagina. The pessary can provide symptomatic relief as well as preventing progression of the prolapse. It is removable and needs to be checked 4-6 monthly to monitor for potential pressure issue on the vaginal wall. It can be used as a short, medium or long term therapy. Not everyone will be able to use a pessary as it is dependent on a person’s anatomy.
Types of pessaries
There are many different types and sizes of pessaries to accommodate different types of prolapse and anatomy. The most commonly used pessary is the ring pessary. One may need to trial different sizes to find the most suitable one. Small pessaries will fall out and larger pessaries will be uncomfortable and can cause pressure problems. Some pessaries provide additional support to the urethra to help with stress urinary incontinence.
What problems can you have with the use of a vaginal pessary?
The most common annoyance is the vaginal discharge that some people experience. Most pessaries are made out of PVC or silicon which are inert materials. The vaginal discharge is from the minor irritation due to the presence of the pessary itself and rarely from an actual infection. It is not uncommon to get some light vaginal spotting. When there is heavier bleeding, it is important to rule out other potentially serious causes of vaginal bleeding. If the pessary has been neglected over a long period of time without regular checks, rarely, the pessary can be trapped in the vagina.
Use of vaginal Oestrogen therapy with pessary
Vaginal skin becomes thin with age, just like the skin on the back of our hands and other parts of our body. Oestrogen in the form of a cream or vaginal pessary provides hormonal support to the vaginal skin to improve its health. This minimises irritation from the pessary use. The dose of oestrogen in the cream is minute and is usually quite safe to use long term. If you have a history of breast cancer, this treatment should be discussed with the doctor looking after your breast cancer treatment.
Self-managing the pessary
Vaginal pessaries can be checked by your gynaecologist or a physiotherapist who specialises in female pelvic health. One can also be taught how to remove and reinsert the pessary to self-manage the pessary. The pessary can then be left out during sexual intercourse or at night when it is not necessary to minimise pressure effect. Pessaries made of silicon material are softer and are easier to remove and reinsert, making it the pessary of choice for self-managing.
Pessary and Sex
With the majority of pessaries, sexual intercourse is possible with them in place. However, there are larger pessaries that take up more space (such as the cube, doughnut and gellhorn pessaries) therefore sexual intercourse would not be possible without removing them.