Let’s Talk About Pessary
Never heard of a pessary? That’s okay!
A pessary is a silicon device inserted into the vagina to treat pelvic organ prolapse and urinary incontinence. Pessaries have actually been used for hundreds of years, were made of all kinds of different materials, and used for many different reasons.
You may benefit from a pessary if you experience:
- Urge urinary incontinence (you feel the urge to urinate and have no time to make it to the bathroom).
- Stress urinary incontinence (you leak urine when you laugh, cough, or sneeze).
- Pelvic organ prolapse, which can include cystocele, rectocele, a combination, and in varying stages of progression.
Urinary incontinence is pretty easy to understand, but many patients assume that their symptoms of pelvic organ prolapse are normal parts of aging. This can include feeling pelvic pressure, having to splint to have bowel movements, or actually having to manually reduce (or push back in) a prolapse.
If you are having any of these symptoms, it’s time to ask your healthcare provider about your options. If caught early, we can implement pelvic floor physical therapy, some patients will ultimately need a pessary, and others benefit from surgical intervention of varying degrees. These symptoms are NOT normal parts of aging.
So if you have talked to your provider about a pessary, what should you expect next?
- You will likely be started on vaginal estrogen to add lubrication and elasticity to the vaginal walls. Vaginal estrogen helps keep a normal pH balance, reducing risk of vaginal and bladder infections. It also treats vaginal dryness, irritation, and can reduce pain with intercourse. You would likely use vaginal estrogen for a few weeks to prepare for the fitting of a pessary device. There are so many sizes and shapes, it can take a few tries to find the right fit, and we want that process to be as comfortable as possible.
- You’ll complete your pessary fitting, finding the right size and shape for you.
- Your provider may instruct you on how to insert and remove the device yourself. Some patients do this easily, especially if they previously used a diaphragm as birth control and were able to remove it and insert it easily. Other patients will be managed completely by their provider. Some devices are difficult to remove on your own, or can be difficult to remove if you have arthritis in your hands, back or shoulder injuries, etc. If your provider is managing your pessary they will see you every 1 to 3 months to remove the device, clean it, do a good exam, and re-insert the device.
Some other questions about pessaries:
- Can you have sex with a pessary in place? It depends on the device, and if the patient (or partner) is capable of removing it before sex and re-inserting it after.
- Can’t I buy a pessary online? Yes, you can actually. There are more and more devices being advertised online, but if have vaginal dryness or are concerned about your ability to insert and remove it easily, I would talk to your healthcare provider first. (You don’t want to end up in the ER for help removing a pessary from Amazon).
- Do I really need a pessary? That is up to you and your healthcare provider to decide. But it can greatly improve your quality of life, decrease pain, and make daily activities much more comfortable.
If you would like to know more about pessaries feel free to reach out! Or you can check out the book below, which was actually written by one the doctors I worked with for the last 4 years. And of course, reach out to your healthcare provider to determine if it’s right for you!
https://www.amazon.com/Vaginal-Pessaries-Teresa-Tam/dp/1138394408
