Pessary: ​​what it is, what it is for, types and when to use it

The pessary is a removable device that can be inserted into the vaginal canal to support the walls of that location, and is mainly indicated in cases of genital prolapse and urinary incontinence.

This gynecological device can have different formats that provide greater or less support in the region in which it is placed, and should be indicated according to the gynecologist’s guidance, after carrying out a gynecological examination.

Pessaries do not cause side effects, however, when it is too large or small in relation to the size of the vaginal canal, there may be a feeling of discomfort and pressure in the area or when the pessary comes out when carrying out daily activities, and it is important to communicate to the doctor.

What is it for

The pessary is a device that serves to support the walls of the vagina or the uterus, and is mainly indicated in cases of genital prolapse. Genital prolapse is a condition in which the uterus, bladder or rectum descends, for example, into the vaginal canal, which is a consequence of weakening of the muscles and ligaments that support these organs. See more about uterine prolapse.

When to use

The use of a pessary is recommended by the gynecologist in the following situations:

• Vaginal, uterine and/or bladder prolapse;
• Urinary incontinence;
• Short cervix during pregnancy.

Furthermore, the pessary may be recommended by the doctor when one wishes to postpone a gynecological surgical procedure or when surgery is contraindicated.

Types of pessary

The pessary is a silicone device, made of non-absorbable material and can have different types according to its shape, and must be recommended by the gynecologist according to the objective of the treatment and size of the vagina. The main types of pessary are:

• Ringwhich has a round shape and is the most used type of pessary, as it is easier to insert and remove and is useful in the initial and advanced stages of prolapse;
• Donutwhich is round and has a hole in the middle, similar to a ring, and can be indicated in cases of small or large vaginal prolapse;
• Gellhornwhich has a rounded shape and a rod in the center, which helps support the tissues, being indicated in more advanced cases of prolapse;
• Cube, may be indicated in cases of more serious genital prolapse, as it causes generalized suction of the vagina, however it must be removed more frequently for cleaning, which can be complicated. Therefore, this type of pessary is usually the last option to be considered.

Make an appointment with a gynecologist to find out which pessary is best:

Can I have sexual intercourse using the pessary?

Some types of pessary can interfere with sexual intercourse, such as the donut, cube and gellhorn pessary, because they occupy a large part of the vaginal canal. Therefore, to have sexual intercourse, it is recommended that they be removed and then reinserted. On the other hand, in the case of a ring pessary, there is no need to remove it unless it causes discomfort.

Therefore, it is important that the gynecologist is consulted so that they can give some guidance on sexual intercourse during the period of pessary use.

How to put on the pessary

The pessary must initially be placed in the gynecologist’s office after the vaginal examination to check the size of the vagina and characteristics of the change to determine the best type of pessary. Next, the woman must be in the gynecological position and the doctor places the pessary, which adapts to the anatomy of the region.

After placing the pessary, it is important that the woman follows the doctor’s instructions, as some types of pessary need to be removed and cleaned daily, while others only need to be removed once a week or every 1 to 3 months, depending on with the guidance of the gynecologist.

Possible side effects

The side effects of the pessary are related to the size of the pessary and the vagina, which may cause discomfort, pain, a feeling of pressure in the area, increased vaginal discharge or discharge when urinating or carrying out daily activities, for example. In these cases, it is important to return to the gynecologist to check the possibility of changing the type of pessary.

In rare cases, there may also be the formation of adhesions on the wall of the vagina and ulcers, which can cause bloody vaginal discharge. In this case, it is important to go to the gynecologist so that an evaluation can be carried out and treatment can be started, which can be done by removing the pessary and using medication, in some cases.