A pessary is a gynecological device made of plastic and is placed in the vaginal canal to add support, especially in the case of a prolapsed uterus. A prolapsed uterus occurs when the uterus falls through into the vaginal canal as it loses support from its corresponding ligaments that normally keep it in place. This normally occurs after the strenuous and physically demanding act of labor or after certain invasive procedures of the pelvis which can weaken or damage various pelvic structures. A pessary could also be used to provide support to the rectum (rectocele) or bladder (cystocele).
Pessaries also provide assistance for women who suffer from stress urinary incontinence, which is when urine is accidentally expelled due to coughing, laughing, or sneezing.
There are many sizes of pessaries to choose from. They should be chosen by a professional healthcare practitioner. Usually, several fittings are necessary to find the best size for any particular patient. Having the best possible fit is the most important factor when choosing a pessary and it should also feel comfortable, never painful. Usually, follow up visits are necessary to make sure the fitting and shape of the pessary is ideal for the patient’s specific incontinence needs.
Most pessaries are made of polyvinyl or latex and come in different shapes to cater to every type of anatomy. The most popular shape is round and looks like a diaphragm, except the outer circle is more firm compared to a normal diaphragm and the middle portion of it is open. Other pessary shapes include a cubed form and ‘U’ shapes.
It is crucial to pay attention to the advice given by healthcare practitioners. Most types of pessaries can be worn for several days or even weeks before requiring a good cleansing with water and soap. This also has the added benefit of managing or avoiding any foul smell. Once the pessary has been cleaned, it can be re-inserted for use by the patient herself, or with help from a nurse, physician, or caregiver.
Some women express concern over the possibility of the pessary falling out. While this can happen during exertion, this could indicate that the pessary being used is too small. You should consult with your doctor if this happens to you.
An increase in discharge from the vagina can sometimes be observed along with a stronger odor than usual. The solution in this case is to simply increase the frequency in which you cleanse the pessary.
Another possible side effect is irritation. But estrogen cream is known to help alleviate vaginal irritation induced by pessaries. Vaginal irritation can be the result of an oversized pessary causing friction or mechanical trauma to the vaginal walls, which can result in painful lacerations and ulcers. On top of this, an incorrectly fitted or ill-advised pessary shape can also apply pressure to the urethra, causing urine flow obstruction.
What about intercourse?
Wearing a pessary should not deter you from having sexual intercourse. However, not all pessaries can be used during sex. The most qualified person to advise you whether you could have intercourse while wearing your type of pessary is your healthcare practitioner, so you should consult him/her first, when in doubt.
Doctors and nurses will generally recommend pessaries to pregnant women, to those who are slated to have prolapse surgery and to women for whom prolapse surgery is contraindicated.