The Downside of a Pessary
“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.
There are sometimes mild side effects from pessary use, such as vaginal irritation, foul-smelling discharge, and urinary tract infections. However, because the pessary is removable, any side effects experienced can usually be corrected quickly.
How long can I use a pessary for? Pessaries are a safe long-term treatment for prolapse but they do need to be changed every three to six months. Some women will be able to do this at home themselves but others will need to go to a hospital or a clinic to have this done for them.
Pessaries are quite safe, although in some patients they seem to be associated with recurring bladder infections.
The most common side effects of pessary use are a foul smell, vaginal discharge, bleeding, pain and constipation [43].
A question we often see online is “Can I Pee After Inserting Canesten Pessary?”. The answer is Canesten Pessary's do not stop you from weeing, so you can wee after inserting the pessary.
If you've had no contractions after 6 hours, you may be offered another tablet or gel. If you have a controlled-release pessary inserted into your vagina, it can take 24 hours to work. If you are not having contractions after 24 hours, you may be offered another dose.
As an invasive device, similar to a vaginal tampon or contraceptive diaphragm, the pessary may have increased a woman's risk of vaginal infections, possibly including toxic shock syndrome, especially during the 19th century when prolapsus uteri was a common diagnosis among young women.
In a prospective, self-controlled clinical trial published in Investigative and Clinical Urology in March 2022, Mayo Clinic investigators found that both pessary use and surgery for pelvic organ prolapse improved symptoms. However, patients deemed the degree of improvement more significant for surgery.
Many types of pessaries can be left in place within the vagina during intercourse. However, some women prefer to remove theirs beforehand. Often, this is their partner's preference, although many partners don't even notice it.
Pessaries and internal cream work best at night. If you're using the external cream and you forget to put it on, use it as soon as possible and continue putting it on 2 to 3 times a day as usual.
Remember to push the pessary back as far as you can get it. You cannot push it in too far.
When you choose a pessary for the right patient, evidence shows that about 75 percent of these patients will report improvement in their prolapse symptoms.
Pessary use may prevent worsening of the prolapse. Success rates, defined as continued pessary use in women who have a pessary fitted, range from 56 to 89% at 2–3 months3, 4, 5, and 56– 68% at 6– 12 months after insertion. Many women continue to use a pessary for life.
Women who can insert and remove the pessary on their own can remove it for cleaning weekly or even nightly. Follow-up visits should take place every six to 12 months. During the visit the pessary will be removed and cleaned.
Infectious complications of these devices, attributable in some instances to poor routine maintenance, are uncommonly reported. We present 2 cases of genitourinary sepsis associated with unsuspected pessary use and discuss the spectrum of complications reported with these appliances.
A properly fitted pessary should not cause any pain - if it does then we will need to change the size. We may also fit a different sized pessary if it falls out or you can't pass urine with it in place. Once you feel comfortable with your pessary you can go home.
Removing the Pessary
Find the rim of the pessary just under the pubic bone at the front of your vagina. Locate the notch or opening and hook your finger under or over the rim. Tilt the pessary slightly, to about a 30 degree angle, and gently pull down and out of the vagina.
For some women, their prolapse gets worse over time. For others, their prolapse will stay the same with conservative treatment options. Prolapse generally does not improve without surgery, but symptoms can be managed with less invasive treatment options.
Once the pessary is in place you should not be able to feel it. If you feel any discomfort it may be that you need a different size of pessary. You may sometimes feel or see part of the pessary you will do yourself no harm by gently pushing it back into place.
They are inserted into the vagina with the aim of providing the pelvic organs with support. So although pessaries don't treat the cause of the prolapse, they can keep the affected organs in their natural position. Doctors also think that using a pessary might help to strengthen the pelvic floor muscles.
Before you get a pessary, your doctor will need to diagnose the severity of the prolapse, provided that's the condition you're experiencing. The doctor will take measurements to fit the pessary so that you get the device that fits you best in the right shape for your condition.
A prolapse is not life threatening, but it can cause pain and discomfort. Symptoms can usually be improved with pelvic floor exercises and lifestyle changes, but sometimes medical treatment is needed.
The ring pessary with support is the most commonly used support pessary. The Gellhorn pessary is the most commonly used space-filling pessary.