Vaginal Pessaries: Types and Use

This post was written with Consensus AI Academic Search Engine – please read our Disclaimer at the end of this article. Vaginal pessaries are medical devices inserted into the vagina to support pelvic organs and manage conditions such as pelvic organ prolapse (POP) and urinary incontinence. They are often recommended for women who prefer non-surgical treatment options or are not suitable candidates for surgery. This article explores the different types of vaginal pessaries, their uses, and the associated care and complications.

Types of Vaginal Pessaries

There are several types of vaginal pessaries, each designed to address specific conditions and anatomical needs:

Ring Pessary

The ring pessary is one of the most commonly used types. It is flexible and easy to insert and remove, making it suitable for women with mild to moderate POP and stress urinary incontinence1 9.

Gellhorn Pessary

The Gellhorn pessary is typically used for more severe cases of POP. It has a stem that provides additional support, making it suitable for women with advanced prolapse stages1 9.

Incontinence Dish Pessary

This type of pessary is designed specifically to manage urinary incontinence. It has a dish-like shape that supports the urethra and bladder neck, helping to prevent urine leakage1 9.

Use and Management

The use of vaginal pessaries requires regular follow-up and care to prevent complications such as vaginal epithelial abnormalities and bacterial vaginosis (BV).

Follow-Up Intervals

A randomized controlled trial found that extending the interval between pessary care visits from 12 weeks to 24 weeks is noninferior in terms of the incidence of vaginal epithelial abnormalities. This suggests that less frequent follow-up visits may be sufficient for many women, reducing the burden of frequent medical appointments1 9.

Self-Management

Self-management of vaginal pessaries, where women are taught to remove, clean, and reinsert the pessary themselves, has been shown to improve quality of life and may be a cost-effective alternative to clinic-based care4.

Use of Vaginal Estrogen

Topical vaginal estrogen is often prescribed to prevent vaginal irritation and erosion associated with pessary use. Studies have shown that while estrogen use does not significantly reduce erosion rates, it does decrease the prevalence of BV and improve urinary symptoms2 3.

Complications and Their Management

While vaginal pessaries are generally safe, they can be associated with certain complications:

Vaginal Epithelial Abnormalities

The most common complication is vaginal epithelial erosion. Factors such as the duration of pessary use and a history of prior epithelial abnormalities increase the risk of developing these issues1 9.

Bacterial Vaginosis

BV is another common issue among pessary users. The use of hydroxyquinoline-based gels like TrimoSan has not been shown to significantly reduce BV prevalence, suggesting that other preventive measures may be needed5.

Vaginal Atrophy

For postmenopausal women, low-dose estriol pessaries have been effective in treating vaginal atrophy, improving vaginal pH, and reducing symptoms such as dryness and irritation6.

Conclusion

Vaginal pessaries are a versatile and effective non-surgical option for managing pelvic organ prolapse and urinary incontinence. Different types of pessaries cater to varying degrees of prolapse and incontinence, and their use requires regular follow-up and care to prevent complications. Self-management and the use of vaginal estrogen can further enhance the effectiveness and comfort of pessary use.

Disclaimer

The content presented in this blog is generated by Consensus, an AI-powered academic search engine, and is based on publicly available scientific literature. While every effort is made to provide accurate, up-to-date, and well-researched information, the content is intended for informational and educational purposes only. It does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional before making any decisions regarding medical conditions, treatments, or medications. The AI system’s analysis may not cover all perspectives, emerging research, or individual cases, and it is not a substitute for professional expertise. Neither the blog publisher nor the developers of the AI-powered search engine are responsible for any actions taken based on the information provided in this content. Use of this information is at your own risk. Citations to the original scientific studies are included for reference, but these studies should be reviewed in full and interpreted with the guidance of a healthcare or research professional.

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