Vaginal pessaries and fittings
Vaginal pessaries and fittings
What is a vaginal pessary?
A vaginal pessary is a flexible removable device made of vinyl or silicone that goes inside your vagina. It is used to support a prolapse. Pessaries come in a variety of shapes and sizes. They are comfortable and should not be felt at all. Certain pessaries are removed daily, and others can be left in place for 4-6 months depending on the type of pessary used. You may also be taught to manage a pessary yourself, which includes inserting and removing it.
Why might I need a pessary?
A pessary can help to provide relief from symptoms of a prolapse, allowing you to return to your normal active lifestyle and previous levels of exercise. They can be used if you would prefer to avoid surgery or are awaiting surgery. You may be recommended to try a pessary if you have a prolapse and want to have children or if surgery is not a safe option due to your health. A pessary should be used alongside pelvic floor exercises, and it is important to continue to follow advice on lifestyle management such as weight loss and avoiding constipation.
What can you expect from your appointment?
Your pessary fitting will include:
Discussion about the use of a pessary and its complications, as well as an explanation of the process of fitting a pessary. If you are breastfeeding or post-menopausal you may need to use vaginal oestrogen alongside your pessary. We normally recommend the use of this for 2 weeks nightly prior to fitting.
Full assessment of your pelvic floor issues, including taking a thorough history as well as a whole-body assessment. This will involve assessment of your breathing, alignment, and abdominal engagement, as well as an internal vaginal examination to review the strength and coordination of your pelvic floor muscles and measure your prolapse.
Discussion of which pessary is most suitable for you, considering your symptoms, lifestyle, and the examination findings. Following this your pessary will be fitted.
Fitting the pessary may take several attempts to get the right size for you. A standing examination will be completed once it has been fitted to check that it is in the correct position. Following this, you will be asked to walk around to ensure the pessary feels comfortable and stays in place. If you are more active you may also be asked to run, jump, lift weights or complete movements specific to the exercise you are planning to undertake.
You will need to come back to the clinic 2 weeks after the first fitting to have the pessary checked. This will allow you to ask any questions you may have and resize the pessary if indicated. We can also teach you to self-manage your pessary, showing you how to insert and remove it. Following this, you will then need to return to the clinic after 4-6 months for it to be changed.
What are the complications of having a pessary?
Although a pessary is thought of as a very low risk management option for a prolapse, it is important to be aware of the potential complications of using one and when to seek guidance. If you experience any of the following symptoms or have any concerns regarding your pessary, please contact your physiotherapist.
The symptoms include:
- Odorous vaginal discharge that is suggestive of an infection (an increase in non-odorous discharge is normal).
- Pain or discomfort. This may be linked to the size or type of the pessary which can be altered.
- Difficulty emptying your bladder or bowel since having the pessary inserted.
- Feeling of vaginal irritation which may be due to the pessary rubbing on the surrounding tissue. Often a ‘pessary holiday’ and the use of vaginal oestrogen can resolve these symptoms.
- New onset of vaginal bleeding (please contact your physiotherapist immediately).
Frequently asked questions
Yes, a pessary can fall out. This can happen if it is the wrong size and too small. It can also be pushed out due to straining on the toilet or lifting something heavy. If this happens you can book in to be re-sized for a more appropriate pessary and the physiotherapist will also go through management of intra-abdominal pressure as well as defecation dynamics.
You can clean a pessary in warm soapy water and then leave it out to dry. You do not need to sterilise your pessary. If you have a pessary that can be left in place for 4-6 months and you choose not to remove it, you do not need to clean it during this period.
It is safe to have sex if you have been fitted with a ring pessary. However, some women choose to remove them prior to having sex. You can be taught how to remove and re-insert your pessary by the physiotherapist. Remember, it is not a form of contraception!
Yes, a ring pessary can be used during pregnancy. Some women find that as their pregnancy progresses their symptoms of a prolapse resolve and a pessary is not required. If you become pregnant and have a pessary in place you can continue to use it.
If you already have an IUD in place, then you can have a pessary inserted. They will not, however, be able to insert an IUD if you have a pessary already in place. It will need to be removed and then re-inserted once the IUD has been fitted.
You can continue to use your pessary during your period. Some women choose not to and are taught to remove and re-insert their pessary. If you have a cube pessary you will need to remove it daily. You can use a tampon if you have a ring pessary, as long as it feels comfortable for you.
If you would like to discuss your specific issues with our women’s health physiotherapist before making an appointment for a pessary fitting, please send your details to info@complete-physio.co.uk or call 020 7482 3875 and our clinical specialist will call you back as soon as possible.
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