A vaginal pessary is a removable, dome-shaped device that is inserted into the vagina to support the pelvic organs and treat pelvic organ prolapse. Pessaries come in a variety of shapes and sizes to suit each individual woman's anatomy. They are most commonly made from silicone rubber and are flexible enough to fit comfortably inside the vagina without causing pain or irritation.
Causes and risk factors of pelvic organ prolapse
Pelvic organ prolapse occurs when the muscles and tissues supporting the pelvic organs (bladder, uterus, rectum) become weakened or damaged. This allows the organs to drop down from their normal position and press against the vaginal wall. Some key risk factors that can contribute to pelvic organ prolapse include:
- Childbirth - Vaginal deliveries, especially those involving large babies, instrumental deliveries or lengthy second stages of labor, increase pressure on the pelvic floor muscles.
- Age - As women age, pelvic tissues naturally weaken over time. Estrogen levels also decline after menopause, further reducing tissue elasticity.
- Obesity - Extra weight places additional stress on the pelvic floor, especially during activities like coughing, lifting or straining.
- Chronic conditions - Conditions like chronic coughing from smoking, chronic lung disease or constipation that cause repetitive increases in abdominal pressure over many years can eventually weaken pelvic floor muscles and tissues.
- Genetics - Some women may be genetically predisposed to developing pelvic organ prolapse due to inherent weaknesses in their connective tissues or pelvic floor muscles.
- Previous pelvic surgery - Surgeries involving the uterus (e.g. hysterectomy), bladder (e.g. anti-incontinence procedures) or bowel can disrupt normal pelvic anatomy and blood supply, predisposing to prolapse.
How a vaginal pessary works
A Vaginal Pessary works by fitting securely inside the vagina to support the pelvic organs in their normal positions. Different styles of pessaries are designed to fit against and lift specific organs that have dropped or prolapsed, such as the uterus, bladder or rectum. For example, a ring pessary sits high in the vaginal walls and provides overall lifting support while a cube pessary is contoured to lift the back vaginal wall and rectum.
The pessary must be correctly sized and properly placed by a healthcare professional for maximum support and comfort. With time and experience, many women learn to insert and remove their own pessaries for cleaning or to allow for intercourse, menstrual periods or pelvic exams. Regular follow up is advised to ensure the pessary continues to fit properly as the vagina and pelvic tissues may change subtly over months or years.
Benefits of using a vaginal pessary
For women with mild to moderate pelvic organ prolapse, a vaginal pessary provides an effective non-surgical treatment option with many potential benefits:
- Immediate relief of bothersome bulge, heaviness or pressure symptoms once properly fitted. This allows normal activities and exercise to resume.
- Reversal or prevention of further descent of pelvic organs while the supportive effect lasts. Using a pessary long-term may delay or avoid the need for surgery in some cases.
- Quick, convenient treatment option that does not require anesthesia or recovery time. Pessaries can generally be easily removed for intimacy, hygiene or doctor visits.
- Reversible, low-risk treatment that can be tried short-term to assess symptom relief before considering irreversible surgery.
- May improve urinary, bowel or sexual function by restoring normal pelvic organ position and support. This positively impacts quality of life.
- Relatively inexpensive compared to more invasive surgical repairs. Pessaries have no operating room costs and require limited follow up care.
Potential complications and disadvantages
While Vaginal Pessary are generally very safe, some potential drawbacks can include:
- Discomfort, pain, pressure or tenderness caused by a poorly fitted pessary that requires adjustment. This usually resolves once the correct size is found.
- Increased risk of vaginal infections if hygiene or removal for cleaning is inadequate. Regular pessary care helps prevent this issue.
- Occasional accidental expulsion during activities, especially if the pelvic muscles are very weakened. This risk decreases with time spent wearing the pessary.
- Allergic, inflammatory or erosive reactions to the pessary material in rare cases. Silicone is usually very well-tolerated.
- Pessaries may occasionally cause urinary symptoms like urgency, frequency or incontinence in some women by external compression of the urethra.
- Potential for pessary legs/arms to become embedded in vaginal tissues over many years in some cases, requiring minor surgery for removal.
- Pessary treatment requires long-term care, removal for sex, and regular monitoring visits - it is not a set-it-and-forget-it approach compared to surgery.
Who is a good candidate for a vaginal pessary?
In summary, a vaginal pessary is usually most suitable for women:
- With pelvic organ prolapse stages I-II (mild-moderate), where pelvic organs have dropped down but not completely outside the vagina.
- Seeking a conservative, non-surgical option to improve symptoms before considering repair surgery or as an alternative to surgery.
- Willing and able to properly care for the pessary, removing it regularly for hygiene and sexual intercourse as needed.
- Who hope to maintain or improve quality of life and postpone progression of their prolapse without major intervention.
- Who prefer a reversible, low-risk treatment even if repeated long-term pessary fittings are necessary.
Women with more severe stage III-IV prolapse involving organs outside the vaginal walls are usually not good candidates for pessary management alone and likely need surgical correction. A healthcare professional can help evaluate each woman's individual case and goals of treatment to determine if a pessary is appropriate. Used correctly, vaginal pessaries provide pelvic organ prolapse patients with an excellent conservative option for symptom relief.
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