Pessary Fitting and Management
A pessary is a removable rubber or plastic device that is inserted into the vagina (birth canal) to provide support in the area of a prolapse. A prolapse takes place when a part of the body droops down or slips out of its normal place. In most cases, pessaries are used when a woman who has a prolapse wants to avoid surgery or has medical problems that make surgery too risky.
Dr. Dooley will do an exam of the vagina to determine the type of prolapse and to take measurements that will help the doctor decide which pessary is best. A pessary that is too small may fall out on its own, or while passing urine or during a bowel movement. A pessary that is too large can apply too much pressure and feel uncomfortable. A good fitting may require two or three attempts.
Women who can insert and remove the pessary on their own can remove it for cleaning weekly or even nightly. Follow-up visits with the doctor should take place about every six months. During the visit the pessary will be removed, then cleaned and examined for signs of wear and tear. The vagina will be examined to make sure the pessary is not scraping or bruising the skin.
In cases where the pessary cannot be removed by the patient, follow-up doctor visits usually occur every two to three months.
Pain or discomfort means the pessary is not fitting correctly and should be replaced with a different size. A pink or bloody discharge could mean the pessary is chafing against the wall of the vagina. In most cases, removal will allow the area to heal. In cases of bleeding, a visit to the doctor is needed.
White-colored discharge from the vagina is common. However, if the discharge becomes colored or smells bad, it could mean a vaginal infection or ulceration. Using an estrogen cream can improve the health of the vaginal skin, which gets thinner with age.
It is possible to have sexual intercourse when a ring pessary is in place. However, the donut, cube, and Gellhorn types fill the vagina and must be removed before sex.