I’ve been told to see Pelvic Health Physio for pelvic floor exercises and a pessary to help manage my prolapse. A pess-what?!
What is a vaginal pessary?
A vaginal pessary is a soft, removable device that goes in your vagina. It supports areas that are affected by pelvic organ prolapse (POP). Pelvic organ prolapse happens when the bladder, rectum, or uterus drop or bulge down towards the vagina.
A pessary can help manage symptoms associated with prolapse. It can reduce or eliminate the actual bulge and reduce or cure the ache and drag associated with prolapse. It can save the bulged area from becoming sore and ulcerated, or from stretching more. If you have stress incontinence, which causes you to leak urine when you cough, strain, or exercise, a pessary can help you to control this. A pessary might reduce symptoms of bladder urgency. A pessary might allow your bladder to empty properly. Women who have incontinence during pregnancy might find a pessary helpful too.
But I already use a medication pessary prescribed by my doctor, is that the same?
A vaginal support pessary is different to the medication pessary you might be using to apply oestrogen inside the vagina. Common brand names for oestrogen pessaries are Vagifem, which is a tablet form, and Ovestin Ovula, which is a suppository. (Ovestin also comes in a cream form which is applied with a finger or an applicator). This medication can still be used, and in fact is often recommended before commencing the use of a pessary, to improve the health of the vaginal walls.
What does a vaginal pessary look like?
Most are made of silicone – a soft, non-absorbent material. They come in different shapes including: Ring, Cube and Gellhorn. There are many other types of pessary shapes, and most come in up to 10 different sizes.
- Ring Pessary – This circle-shaped device is often the first type of pessary doctors or pelvic health physiotherapists recommend. You can learn to insert and remove it yourself after instruction from your physiotherapist or doctor.
- Cube Pessary – This pessary is compacted down and inserted into the vagina where it uses suction to support the areas affected by prolapse. It is an excellent choice for women who leak when exercsising.
- Gellhorn Pessary – This disk-shaped device with a small knob in the middle is used for more severe prolapse or if simpler shapes get expelled. The strut stops the Gellhorn from tipping and being expelled.
What size pessary will I need?
The size of the pessary can be estimated with a 2-finger internal examination. However, several sizes may need to be trialled before the perfect fit is found. Fitting a pessary can be a bit like trying to find the right style and size of shoe, except we can’t see your foot! Gravity, body weight, straining, lifting, coughing, carrying, and other loads you are subjected to during the day can affect whether the pessary stays in place or slips down.
Does inserting a pessary hurt?
A pessary fitting will be more comfortable if you have used oestrogen for a few weeks beforehand. Most times a pessary insertion does not hurt. Removal can sometimes be a little more uncomfortable, but is rarely painful. Removal is easier if you cough or bear down at the same time. The actual wearing of the pessary should not hurt at all. In fact, you should not feel the pessary at all. If you are aware of its presence, that particular pessary is probably not suitable for you.
Can I have sexual intercourse with a pessary?
Some people find they can have sex with a ring pessary in the vagina. In most cases, we recommend the pessary is removed for sexual activity. This is not a problem for a ring or cube. A Gellhorn is much more difficult to remove yourself, so if you want to remain sexually active, this shape pessary may not be a good option for you.
I have a pessary in now, what next?
We recommend continuing pelvic floor exercises even when you are using a pessary, to ensure the muscles that support the pessary inside the vagina remain strong. Seek support from your pelvic health physiotherapist to ensure you are getting the most benefit out of your pelvic floor exercises.
You will also need to see your doctor or gynaecologist every 3-6 months to 1 year to ensure your vaginal tissues stay healthy with the pessary inside. They will often perform a speculum exam.
You must consult with your health professional if there is any bleeding or if an odour or discharge develops.
You should follow-up with your pelvic health physiotherapist at least every 12 months. The pessaries do have a limited lifespan and need to be renewed every 1-2yrs. The sizing also needs to be checked, especially if you had recently given birth, you lose a significant amount of weight, or you have had surgery since the initial fitting.
If you are looking to consult with a professional pelvic health physio, you may contact us here and we’ll help you get started.