Vaginal pessaries for pelvic organ prolapse

What is pelvic organ prolapse (POP)?

This refers to a drooping of the uterus, bladder or rectum beyond the vagina. It is more common in older women. The main cause of this is weakened pelvic floor muscles from damage sustained during pregnancy and childbirth, weakening from ageing and menopause and obesity. Read more about it here.

What is a vaginal pessary?

This is a soft, removable device that is inserted in your vagina to support your prolapsed pelvic organs and hence provide relief of your symptoms of POP. This is temporary as if the pessary is removed, POP will recur. Vaginal pessaries come in many different shapes and sizes. The most commonly used one is the ring pessary, which needs to be removed, washed and replaced by your gynaecologist every 3-4 months or so.

How is a vaginal pessary inserted?

A vaginal pessary can be fitted after a vaginal examination by your gynaecologist in the clinic. Sizing sometimes requires trial and error as every woman’s vagina, degree of prolapse, activity levels and toileting habits are different – much like trying on new shoes! Pessaries that are too small may drop out easily on physical activity or while on the toilet bowl passing urine or motion (particularly if you have a habit of straining). Pessaries that are too large may cause discomfort and rub excessively against the vaginal walls causing ulcerations, bleeding and infection. 

What are the advantages of a vaginal pessary?

• Relieves the symptoms of POP 
• Can be fitted in the clinic
• Does not interfere with daily activities 
• Can defer surgery if one is not keen/ ready for it
• Does not involve surgical or anaesthesia risks

What are the disadvantages of a vaginal pessary?

• Temporary; POP recurs if pessary is removed 
• Needs regular follow-up for removal, washing and reinsertion
• May experience increase in vaginal discharge
• Risk of ulceration, bleeding and infection 
• May interfere with sex (depending on pessary shape). It is possible to have sex as per normal with a ring pessary.

What are the alternatives of a vaginal pessary?

• Kegel (pelvic floor) exercises
  These strengthen and maintain the tone of pelvic floor muscles, which can help to improve the symptoms of POP.

• Surgery
  This is suitable for more severe forms of POP and is a definitive treatment option.

Anything else I need to know?

With menopausal changes causing thin and dry vaginal skin (vaginal atrophy) and the presence of a vaginal pessary, it is important to use topical vaginal estrogen creams and tablets regularly to reduce the risk of ulceration and bleeding.

Photo credit: Madhero88 / Wikimedia Commons