Vaginal Pessary: A Revolutionary Non-Surgical Approach to Addressing Pelvic Organ

Vaginal Pessary

A vaginal pessary is a soft, flexible device that is inserted into the vagina to support the pelvic organs. There are different types of pessaries designed for specific pelvic floor conditions. Pessaries provide support without the need for surgery and can help reduce symptoms like pelvic pressure, heaviness, or urinary incontinence.

Types of Pessaries
Ring pessary - This donut-shaped device is one of the most common types. It is flexible and self-supporting to hold the uterus, bladder, or rectum in place. Ring pessaries come in a variety of diameters and widths to provide the right level of support.
Gellhorn pessary - For pelvic organ prolapse conditions, the Gellhorn pessary has longitudinal arms that extend behind the pubic bone for strong anchoring support. Its elongated shape helps support the back wall of the vagina.
Cube pessary - Known as a basic support pessary, the cube has a rectangular shape that is firm yet soft. It is effective for mild prolapse and works well for women just starting pessary therapy.
Gehrung pessary - Similar to the cube but with trapezoidal ends, the Gehrung distributes pressure widely along the vaginal walls. Its slightly wider shape provides intermediate support.
Inflatable pessary - This adjustable pessary uses inflation/deflation of a silicone balloon to custom-fit varying pelvic structures. A medical professional fits and adjusts the device.
How a Pessary Works
When fitted and placed correctly, a Vaginal Pessary fills the vaginal space and applies gentle, consistent pressure to hold pelvic organs in their normal positions. This counteracts the downward pulling forces that cause prolapse conditions. Different pessary designs direct support where needed, like behind the pubic bone or along the vaginal walls.
The pessary material is soft yet durable silicone rubber that flexes with body movements without causing discomfort, pressure sores, or tissue damage. Its open design allows for urine and menstrual flow without obstruction. Pessaries are usually replaced every 6-12 months as the pelvic floor and vaginal tissues change over time.
Benefits of Pessary Therapy
Relief from pelvic pressure and pain: By supporting prolapsed organs, pessaries reduce uncomfortable pelvic heaviness, pressure, and aching.
Improved bladder and bowel function: For prolapse, a pessary restores normal positioning to prevent urine leakage, incomplete emptying, constipation, or difficulty passing stool.
Alternative to surgery: Not all women want or are candidates for surgery. A pessary provides a drug-free option to manage mild to moderate prolapse without risk of surgery's potential side effects or recovery time.
Avoid joint replacement surgeries: Pessaries can help prevent further prolapse progression that risks needing mesh or graft surgeries over time.
Retain sexual function: Mild prolapse may still allow intimacy, while more advanced stages can impact arousal or cause pain. Pessaries preserve anatomy to retain pleasurable sexual activity and function.
Predictable support: Once fitted, a pessary delivers steady, consistent pelvic support in all positions and through varied activities without further interventions.
Who Benefits from Pessary Treatment?
Pessary therapy effectively manages pelvic organ prolapse in most women experiencing:
- Stage I or II prolapse of the uterus, bladder, or rectum where less than half of the organ protrudes into the vagina.
- Stress urinary incontinence alone or with associated pelvic support issues.
- Previous pelvic reconstructive surgery but with recurrent, asymptomatic prolapse.
- A desire to avoid or delay further procedures under certain circumstances like plans to become pregnant.
- Co-existing pelvic floor symptoms such as pressure or heaviness that a pessary can relieve without drugs or surgery.
Women in advanced prolapse stages III/IV usually find greater relief from reconstructive surgeries rather than a pessary alone. Those with infections or other vaginal conditions also fare better with operative treatments until underlying issues resolve.
Getting Fitted for a Pessary
An evaluation with a gynecologist or urogynecologist determines if a patient is a suitable pessary candidate. Exams and tests assess pelvic support levels, adjoining tissues for proper support and retention. A practice fitting selects the best pessary design and size using various types, widths, and diameters.
Women then try the chosen pessary at home, returning in 4-6 weeks for any needed adjustments. With time and practice, most learn independent insertion/removal. Regular follow-ups ensure the pessary continues to fit and function properly as changes occur. Prompt reporting of issues like discomfort or discharge aids quick resolution.
Vaginal therapy provides an excellent conservative solution for mild to moderate pelvic organ prolapse and urinary incontinence. By supporting pelvic structures non-surgically, pessaries safely deliver life-improving relief of troublesome symptoms. With proper fitting and care, pessary treatment allows many women to avoid surgery and maintain pelvic health and active lifestyles long-term.

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