Vaginal Pessaries: Types and Use
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Try for freeThis 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
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