Vaginal Pessary: Types, Care and Risks
The vaginal pessary is a device that has long been used in gynecology. It’s designed to treat pelvic organ prolapse through the vagina. For example, this includes uterine prolapse, bladder prolapse, rectal prolapse, and so on.
These conditions occur when the muscles and ligaments that support these organs weaken. This often happens after giving birth to several children or after undergoing pelvic surgeries. And although the vaginal pessary is a very useful form of treatment, it requires certain considerations before being used. Read on to learn more!
What is a vaginal pessary?
A vaginal pessary is a device that is placed in the vagina. Its function is to support the pelvic organs that prolapse in it. To understand it, it’s important to explain what the pelvic floor is.
The pelvic floor consists of three compartments. The upper one comprises the bladder and the urethra. Both organs can prolapse into the vagina, which is called “cystocele” and “urethrocele”, respectively.
The central compartment consists of the vagina and the uterus. In this case, prolapse of the uterus itself, or even of the vaginal vault, can occur. Finally, the rectum can also prolapse into the vagina, resulting in a “rectocele”.
Prolapse is a very common occurrence in women. The reason is that the pelvic floor can be weakened for many reasons. For example, due to prolonged or instrumental births, pelvic surgeries, multiparity, etc.
Other aspects such as obesity, age, or even genetic predisposition also play a role. A vaginal pessary does not cure prolapse as such; however, they do help to control it and slow down its progression.
They work as if they were support for the vagina itself. Thus, they increase the firmness of the muscles and tissues of the pelvic floor. If used properly, they can be a good treatment option for many women. However, they can also cause complications.
What is a vaginal pessary used for?
A vaginal pessary is a device that allows for the treatment of pelvic organ prolapse without resorting to surgery. According to a publication in Trials , they are used when the symptoms of prolapse are mild. Also in those women who still have the desire to have children or during pregnancy.
The idea of using this element in pregnancy is to try to keep the uterus in a proper position. Sometimes the enlargement of this organ causes it to move into the vagina. This can lead to entrapment of the uterus and complicate pregnancy.
Pessaries are recommended for women who are at high risk for any surgical procedure. For example, if they suffer from chronic diseases, such as heart disease.
On the other hand, they can be used to check whether surgery is indicated or not. Prolapse often leads to urinary incontinence. By placing a pessary, this should disappear.
However, it is possible that the incontinence is caused by other reasons. If so, pessary placement would not fix it. Therefore, it serves to discern which cases of incontinence are operable and which are not. This is called the “pessary test.”
The different types of vaginal pessaries
Most pessaries are made of silicone. The size varies depending on age and vaginal length. Usually, younger women need larger pessaries than older women, for comfort.
According to Mayo Clinic specialists, there are different types of pessaries depending on their shape and characteristics. First, there’s the ring-shaped vaginal pessary. This is the most commonly used in women who suffer from mild prolapse.
On the other hand, there is the doughnut or donut type. These are indicated when the prolapse is more severe. There’s also the incontinence pessary, which is used when there is stress urinary incontinence (when coughing, laughing, or bending over).
Find out more: Anterior Vaginal Prolapse or Cystocele: Causes and Treatment
How is a vaginal pessary inserted?
Before inserting a vaginal pessary, a physical examination of the woman must be performed. According to experts, it’s essential to carry out a gynecological examination in which the type of prolapse is evaluated.
During the examination, the vagina should be measured to decide on the most appropriate size of the element. It should be as accurate as possible and should not be inserted beyond the vagina if it is too large.
When it’s too small, it may come out during urination or defecation. You may need to try several different sizes to find the most suitable vaginal pessary.
To insert it, you should ideally wear gloves or have clean and disinfected hands. The same should apply to the device. In addition, the device should be changed and checked frequently.
It’s advisable that the woman should have a check-up with her gynecologist at least every three to six months. In some cases, the replacement of the pessary can be carried out by the woman herself.
However, there are others that have a special placement or are not designed for long periods. Therefore, it should be the doctor who recommends what is best in each specific case.
Possible risks and side effects
Despite their benefits, these devices are not without risks and complications. As a study published in Clinical and Research in Gynecology and Obstetrics explains, pessaries can cause injury to the vaginal wall.
In turn, this can cause pain and bleeding. The vaginal wall can progressively wear away, causing abnormal communication to form between the vagina and the rectum. This is called “rectovaginal fistula”. They can even appear between the bladder and the vagina (vesicovaginal fistulas).
Being a foreign body in the vagina, it’s likely to increase the secretion in this area. Likewise, the risk of infections is increased. For example, by Actinomyces. The inflammatory process can lead to cellular alterations with malignant potential.
In some cases, although very infrequently, the vaginal pessary has been associated with peritonitis and other intestinal complications. It has also been seen to become impacted in the vagina.
Here’s another informative article for you: Things Taken into Account Regarding Urine Abnormalities
Care and recommendations
Wearing a vaginal pessary requires certain aspects to be taken into account. First of all, a woman will probably have to try several different types and sizes until she finds the right one. In addition, they often have to remove, clean, and reinsert the pessary themselves.
However, if there are difficulties in carrying out these maneuvers, they can be done in a doctor’s office. On the other hand, depending on the type of vaginal pessary used, it may be necessary to leave it in place during sexual intercourse.
This can interfere with the comfort and how to choose the most appropriate method of contraception. If complications arise, such as sores or wear and tear of the vaginal wall, the recommendation is to remove the device. Ideally, it is best to remain without it for two to three weeks.
In addition, estrogens and lubricants are often prescribed for application to the area. Estrogens help the vaginal epithelium to remain strong and reconstitute itself. They can be administered in the form of creams, rings, or pills.
When it comes to cleaning the vaginal pessary, follow all the instructions of the doctor and the brand. This reduces the risk of vaginal infections.
What to remember
A vaginal pessary is a device used to treat pelvic organ prolapse. For example, this may occur when the uterus, bladder, or rectum presses through the vagina. It’s a good treatment option in women for whom surgery is contraindicated. They are available in different sizes and types.
However, they can cause injury, discomfort, and other complications. Therefore, a doctor’s instructions should always be followed. It’s also important to have frequent gynecological check-ups.
All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.
- Hagen S, Kearney R, Goodman K, Melone L, Elders A, Manoukian S, Agur W, Best C, Breeman S, Dembinsky M, Dwyer L, Forrest M, Graham M, Guerrero K, Hemming C, Khunda A, Mason H, McClurg D, Norrie J, Karachalia-Sandri A, Thakar R, Bugge C. Clinical and cost-effectiveness of vaginal pessary self-management compared to clinic-based care for pelvic organ prolapse: protocol for the TOPSY randomised controlled trial. Trials. 2020 Oct 8;21(1):837. doi: 10.1186/s13063-020-04738-9. PMID: 33032644; PMCID: PMC7542756.
- Pesario vaginal para prolapso de órgano pélvico. (n.d.). Retrieved June 7, 2021, from https://www.yourpelvicfloor.org/media/vaginal-pessary-for-pelvic-organ-prolapse-spanish.pdf.
- Tipos de pesarios – Mayo Clinic. (n.d.). Retrieved June 7, 2021, from https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/multimedia/pessary-use/img-20006056.
- Lopez-Olmos, J. (2013). Lesiones vaginales por pesario. Estudio de casos y revisión de la literatura. Clinica e Investigacion En Ginecologia y Obstetricia, 40(4), 146–153. https://doi.org/10.1016/j.gine.2012.04.001.
- Luyer, M. D. P., Reijn, V., Plasschaert, H., & De Feiter, P. W. (2007). Caecal rupture due to a dislocated vaginal pessary with fatal outcome in a patient with rectal diverticulosis. In Scandinavian Journal of Gastroenterology (Vol. 42, Issue 8, pp. 1021–1022). Informa UK Limited. https://doi.org/10.1080/00365520601137298
- Pesarios vaginales | Cigna. (n.d.). Retrieved June 7, 2021, from https://www.cigna.com/es-us/individuals-families/health-wellness/hw/temas-de-salud/pesarios-vaginales-tv1613.