Vaginal prolapse, also known as pelvic organ prolapse (POP), is a medical condition in which the pelvic organs (the uterus, bladder, or rectum) descend from their original position into the vaginal canal and sometimes even protrude out of the vagina. It occurs when the pelvic muscles and ligaments get stretched and weakened due to pregnancy, childbirth, menopause, aging, or other factors.

About 33% of all women globally are prone to experience some degree of vaginal prolapse in their lifetime. Though not fatal, vaginal prolapse can cause severe discomfort, pain, urinary incontinence, difficulty with bowel movements, and sexual dysfunction. It can be managed by pelvic floor exercises, pessaries, hormone therapy, surgery, or a combination of these methods, depending on the severity and type of prolapse. This article will explore what vaginal prolapse pessaries are and how to use them.

What is a Vaginal Prolapse Pessary?

A vaginal pessary is a vaginal support device made of silicon that is inserted into the vagina, typically in case of pelvic organ prolapse. The pessary works by holding up the prolapsed organs, such as the bladder, uterus, or rectum, in their normal position, thus alleviating symptoms such as discomfort, pain, or urinary incontinence caused by the prolapse.

Common types of pessaries includes:

1. Ring: It is a circle-shaped device that can be inserted and removed without a doctor’s help.
2. Gehrung: It is a U-shaped pessary customized to fit its user. It is recommended for more advanced uterine prolapse.
3. Gellhorn: This disk-shaped pessary has a small knob in the middle and is used for severe cases of prolapse.
4. Donut: As the name suggests, this pessary looks like a donut and is more moderate uterine prolapse or mild cystocele.
5. Cube: Cube pessaries are used for treating advanced-stage pelvic organ prolapse. They are compacted down for insertion into the vagina. Once inside, the pessary expands and creates suction to support the pelvic organs. They need to be fitted by a healthcare provider and require regular check-ups to ensure proper positioning and function.

Are You a Candidate for Vaginal Prolapse Pessary?

If you are diagnosed with vaginal prolapse, your healthcare provider may advise you to use vaginal pessary after assessing various factors, including the severity of the prolapse, the type of prolapse, your age and overall health, and your preference for treatment options. Women who are unable or unwilling to undergo surgery or who have medical conditions that make surgery risky may be good candidates for a vaginal prolapse pessary.

 Pessaries can help treat different types of prolapse, such as:

• Cystocele or Urethrocele: (Also called anterior vaginal prolapse.) In this condition, the bladder or urethra bulges into the front vaginal wall.
• Rectocele or enterocele: Also called posterior vaginal prolapse. This type of prolapse involves bulging of the rectum (large intestine) or the small intestine into the back vaginal wall.
• Uterine prolapse: This condition involves the dropping of the uterus down the vaginal canal.
• Apical prolapse: This type of prolapse is characterized by the slipping of the cervix or the upper part of the vagina into the vaginal canal.

Pros and Cons of Vaginal Prolapse Pessary

Pros of Vaginal Prolapse Pessary:

1. Vaginal pessaries can significantly improve a woman's quality of life by relieving discomfort, pain, and incontinence.
2. They are an alternative to surgery for women who are unable or unwilling to undergo surgery.
3. Pessary is a non-invasive treatment option that does not require incisions or anesthesia and can be removed at any time.

Cons of Vaginal Prolapse Pessary:

1. Pessaries can cause discomfort or irritation.
2. Vaginal discharge or odor may increase while using pessaries.
3. Pessaries require regular cleaning and maintenance to reduce the risk of infection at the doctors office.
4. Pessaries can get dislodged or expelled, requiring repositioning or replacement by a health professional.
5. Not all women can be fitted for pessary use.

How to Insert and Remove a Vaginal Prolapse Pessary

Except for ring pessaries, vaginal prolapse pessaries need to be inserted and removed by a healthcare provider. Below are some tips on how to handle pessaries:

• Ensure you wash your hands before and after inserting/removing the pessary.
• You would need to clean the pessary with mild soap and water regularly.
• The pessary needs to be rinsed thoroughly and dried with a clean towel before reinserting.
• Avoid using harsh soaps, detergents, or disinfectants. These can damage the pessary or irritate the vaginal tissue.
• Avoid exposing the pessary to heat or direct sunlight, as this can cause it to warp or degrade.
• Store the pessary in a clean, dry place when not in use.

Care and Maintenance of Vaginal Prolapse Pessary

Taking care of vaginal pessaries is important to preserve their effectiveness. Pessaries are prone to bacterial accumulation if not cleaned regularly. Vaginal secretions and other debris can also accumulate on its surface. An infected pessary can emit a foul odor and can cause discomfort, pain, and vaginal discharge.

Proper care helps prolong the lifespan of the pessary. Ensure you follow all the instructions your healthcare provider gave you to care for the vaginal pessary. Generally, it involves removing and cleaning the pessaries with mild soap and water regularly and reinserting it. You will also need to get yourself checked up regularly by your doctor to monitor the proper fit of the pessary and potential complications or do a vaginal washing. Typically, it is recommended to have the pessary checked and replaced every 3-6 months.

Conclusion

Vaginal prolapse pessaries are very common treatment options for pelvic organ prolapse as they are readily available and low in cost. These devices support the prolapsed organs and help alleviate pain, discomfort, and urinary incontinence. If you are diagnosed with pelvic organ prolapse, you should talk to your healthcare provider to determine if a vaginal pessary is a suitable treatment option for you. Typically, pessaries need to be inserted and removed by a healthcare provider. However, some pessaries (e.g., ring pessaries) can be used without a doctor’s help. You also need to maintain hygiene and take proper follow-up care to prevent infection and other complications. Unfortunately, not all women are able to get fitted for a pessary. Some women’s body simply cannot hold the pessary inside or it causes so much discomfort and side effects, that pessary as a treatment option is not viable. Luckily, there are other treatment options on the market for pelvic organ prolapse if pessary is not one for you.

Supervising Doctor of This Article

Koichi Nagao, MD PhD

Professor, Department of Urology, Toho University Faculty of Medicine
Director of Urinary tract reconstruction center, Toho University Omori Medical Center
Director of Reproduction Center, Toho University Omori Medical Center

Professor Nagao specializes in plastic surgery in the field of reproductive medicine. He completed eight years of plastic surgery training at Showa University before majoring in urology at Toho University. With his meticulous surgical techniques and careful examinations that combines urology and plastic surgery, Professor Nagao became a Board Certified Specialist with multiple associations including the Japanese Urological Association, the Japan Society for Reproductive Medicine, and the Japanese Society for Sexual Medicine.

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