Pessary 101

“A good pessary can be a beautiful thing.”

This might not be a quote that ends up on a personalized coffee mug, but Dr. Pamela J. Levin, urogynecologist at Penn Medicine, knows what she’s talking about. And women with incontinence or uterine prolapses who have benefited from pessaries would agree with her.

So, what is a pessary?

A pessary is a silicone device that is inserted into the vagina, which helps support the uterus, vagina, bladder or rectum. It’s most often used to treat prolapse of the uterus, but also can help relieve urinary incontinence, according to the American Academy of Family Physicians (AAFP).

“Pessaries aren’t just for grandma—a lot of young people use them as well,” Dr. Levin says. “Many of my patients use them between pregnancies.” she says.

Most people know that incontinence is when you leak urine when you cough, exercise, or strain, the AAFP says. While it often occurs in women over 50, it might also occur during pregnancy, after childbirth, or because of various diseases.

Uterine prolapse is also common. It happens when the muscles and ligaments that support the uterus are too weak, causing it to droop or sag into the vaginal canal, the AAFP says. It can occur after you give birth or with age, especially if you have a genetic predisposition for a loss of support in the pelvic floor.

Benefits

When patients come in with uterine prolapse or incontinence, Dr. Levin likes to offer them a “buffet” of options”. Pessaries are often recommended as a non-invasive treatment for women dealing with bladder and pelvic floor disorders.

Pessaries are also a low maintenance option. It can be worn for weeks to months at a time, but it will need to be removed and cleaned with soap and water at least once every 3 months, the AAFP says.

Some women can clean and reinsert them themselves, but others prefer their doctor manages it for them. Regardless, most doctors want to see patients for regular checks to ensure no irritation and continued good fit.

As Dr. Levin notes, many women remove pessaries during sex. “It’s not necessary to take it out, but often patients find this it is more comfortable to remove a pessary when being sexually active,” she says.

Pessaries vs. surgery

Challenges

“Pessaries have very few side effects,” says Dr. Levin. “Occasionally, some women experience vaginal irritation from them.”

Some also experience extra vaginal discharge, according to a January 2015 study in The American Journal of Obstetrics and Gynecology.

Fit can also be a challenge. The AAFP notes that while pessaries cannot go anywhere inside of the body since the vagina is a closed organ, they can fall out, which is usually a sign that the pessary is too small.

If you have any of these problems, talk to your doctor about relief for your symptoms, or other treatment options.

A new treatment, a new life

A pessary might sound like a strange treatment, but it can boost your quality of life.

“Patients are often surprised and very satisfied,” says Dr. Levin. “Before getting pessaries, many women don’t realize that there is something that could help them. Once they get them, they see that they can live their lives free of uncomfortable symptoms of uterine prolapse or incontinence.”

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