Pelvic organ prolapse (POP) is a condition that affects many women, characterized by the descent of pelvic organs due to weakened pelvic floor muscles. This can lead to discomfort, urinary issues, and a range of other symptoms that can significantly impact daily life. Among the various treatment options available, pessaries offer a non-surgical approach to managing POP. These devices are inserted into the vagina to support the pelvic organs, helping to alleviate symptoms. While the effectiveness of pessaries is well-documented, the costs associated with their use often remain unclear. Understanding these costs is crucial for patients and healthcare providers alike, as financial considerations play a significant role in treatment decisions.

What Are Pessaries?

Pessaries are medical devices designed to provide support to pelvic organs that have shifted due to prolapse. They come in various shapes and sizes to accommodate different types and severities of POP. Common types of pessaries include:

• Ring Pessaries: The most widely used, these have a circular shape and are often made of soft, flexible materials. They provide support to the vaginal walls.
• Cube Pessaries: These have a square shape and can be used for more significant support, often beneficial for women with a higher degree of prolapse.
• Gellhorn Pessaries: These have a disc shape with a protruding stem, providing both support and the ability to apply pressure to the vaginal walls.

How They Work

Pessaries work by physically supporting the pelvic organs, helping to keep them in their correct position. When inserted into the vagina, a pessary acts like a scaffold, holding the organs in place and alleviating symptoms such as discomfort, pressure, and urinary issues associated with POP. Pessaries can be adjusted for fit and comfort, allowing for a personalized treatment experience.

Benefits of Using Pessaries for POP

There are several advantages to using pessaries as a treatment option for pelvic organ prolapse:

• Non-Surgical Alternative: For women who prefer to avoid surgery, pessaries offer a viable option that can be effective in managing symptoms without the need for invasive procedures.
• Reversible and Adjustable: Pessaries can be easily inserted and removed, allowing patients to make adjustments based on their comfort levels and lifestyle needs. This flexibility can be particularly beneficial for those who may experience changes in their condition over time.
• Immediate Relief: Many women report immediate relief from symptoms upon inserting a pessary, making it an appealing option for those seeking quick management of their condition.
• Less Recovery Time: Compared to surgical interventions, the use of pessaries generally requires little to no recovery time. This allows patients to return to their normal activities almost immediately.
• Cost-Effective: In many cases, pessaries can be a more affordable option compared to surgical treatments, making them accessible to a wider range of patients.

Cons of Using Pessaries for Pelvic Organ Prolapse

While pessaries can offer many benefits as a non-surgical treatment option for pelvic organ prolapse (POP), they are not without drawbacks. Understanding these cons can help patients make well-informed decisions about their treatment options.

Discomfort and Irritation

• Initial Discomfort: Some women may experience discomfort during the initial insertion of a pessary. It can take time for the body to adjust to having a foreign object in the vagina.
• Irritation or Allergic Reactions: Long-term use of a pessary may lead to vaginal irritation, discharge, or even allergic reactions to the material. It’s important to monitor for signs of irritation and consult a healthcare provider if symptoms persist.

Risk of Vaginal Ulcers

• Pressure Sores: If a pessary does not fit properly or is left in place for too long, it can create pressure points that may lead to vaginal ulcers or sores. Regular follow-up with a healthcare provider is essential to ensure proper fit and function.

Maintenance and Care

• Cleaning Requirements: Pessaries require regular cleaning and maintenance to prevent infections. Patients must follow specific cleaning protocols to ensure hygiene, which can be an added burden.
• Follow-Up Appointments: Regular check-ups are necessary to monitor the condition of the pessary and to make adjustments as needed. This can lead to increased healthcare visits and associated costs.

Limited Efficacy

• Not Suitable for All Cases: Pessaries may not be effective for every woman or every type of prolapse. Some patients may find that their symptoms do not improve or that the pessary does not provide sufficient support.

Emotional and Psychological Factors

• Stigma and Body Image Issues: Some women may feel embarrassed or stigmatized by the need to use a pessary, which can impact their self-esteem and quality of life. This emotional burden should be acknowledged and addressed.
• Adjustment Challenges: Adapting to life with a pessary can be challenging for some women. They may experience anxiety about insertion, removal, or leakage, which can lead to reluctance in using the device consistently.

Potential for Prolapse Progression

• No Cure for Prolapse: While pessaries can manage symptoms, they do not address the underlying cause of prolapse. Some women may find that their condition progresses despite using a pessary, necessitating further treatment options down the line.

Cost Breakdown of Pessaries for Pelvic Organ Prolapse

Initial Purchase Costs

The initial cost of a pessary can vary significantly based on the type and material. Here’s a general overview of what to expect:

• Price Range of Different Types:

• Ring Pessaries: Typically range from $50 to $100. These are the most common type and are often made from silicone or rubber.
• Cube Pessaries: Usually priced between $75 and $150, these offer more support and may be recommended for more severe cases.
• Gellhorn Pessaries: These can cost between $100 and $200, depending on the specific design and material.

• Factors Influencing Cost:

• Material: Pessaries made from higher-quality materials or those designed for increased comfort may come at a premium.
• Design: More complex designs that offer enhanced support can also lead to higher prices.

Additional Costs

In addition to the initial purchase price, patients should be aware of other potential costs associated with using a pessary:

• Fitting Appointments:

• The first fitting with a healthcare provider can cost between $100 and $300. Proper fitting is crucial for comfort and effectiveness, and it may take several attempts to find the right size and type.

• Follow-Up Visits:

• Regular follow-up appointments are essential to monitor the condition and make any necessary adjustments. These visits can range from $50 to $150 per appointment, depending on the provider and location.

• Cleaning and Maintenance Supplies:

• Patients will need specific cleaning supplies to maintain the pessary’s hygiene, which may add an extra $10 to $20 per month. This includes mild soaps and other cleaning solutions recommended by healthcare providers.

Pessary Total Cost Considerations

When calculating the total cost of using a pessary, it’s important to consider both initial and ongoing expenses. Here’s a hypothetical breakdown over the first year:

• Initial Purchase Cost: $100 (average for a ring pessary)
• Fitting Appointment: $200 (one-time cost)
• Follow-Up Visits: $100 (assuming one follow-up visit every six months)
• Cleaning Supplies: $240 (assuming $20 per month)

Estimated Total Cost for Year One: $640

This total can vary based on individual circumstances, including the type of pessary chosen, the frequency of follow-ups, and any additional treatments or complications that may arise.

Insurance Coverage for Pessaries

Insurance coverage for pessaries can vary widely based on the specific policy, provider, and geographical location. Some key points to consider include:

• Type of Insurance:

• Employer-sponsored plans, individual health plans, and government programs (such as Medicare and Medicaid) may have different policies regarding coverage for pessaries.
• It's essential to review the specific terms and conditions of your plan to understand what is included.

• Medical Necessity:

• Many insurance providers classify pessaries as durable medical equipment (DME) and may cover them if deemed medically necessary. Documentation from healthcare providers that supports the use of a pessary for POP can enhance the chances of coverage.

Variability in Coverage

Coverage for pessaries can vary significantly even within the same insurance company. Key factors influencing coverage include:

• Geographical Location:

• Regional differences in healthcare practices and insurance policies may affect whether pessaries are covered and to what extent.

• Plan Specifics:

• Some plans may cover the cost of the pessary itself but not the fitting or follow-up appointments, while others may include these expenses as part of their coverage. It’s crucial to review the specifics of your plan.

• Out-of-Pocket Expenses:

• Even with insurance coverage, patients may still face out-of-pocket expenses such as deductibles, co-pays, or coinsurance. Understanding these potential costs is essential for effective budgeting.

Recommendations for Navigating Insurance Claims

To maximize the likelihood of coverage for pessaries, patients should consider the following steps:

• Consult with Healthcare Providers:

• Discuss insurance coverage with your healthcare provider. They can provide documentation that supports the medical necessity of using a pessary and may assist with the claims process.

• Contact Insurance Providers:

• Reach out to your insurance company to inquire about specific coverage details for pessaries. This can help clarify any questions regarding costs, co-pays, and coverage limitations.

• Keep Detailed Records:

• Maintain detailed records of all medical appointments, receipts, and correspondence with your insurance provider. This documentation can be helpful if there are any disputes regarding coverage.

• Appeal Denied Claims:

• If a claim is denied, don’t hesitate to appeal the decision. Many insurance companies have formal processes for appealing denied claims, and providing additional documentation from your healthcare provider can strengthen your case.

Comparing Pessaries to Other Treatments for Pelvic Organ Prolapse

When considering treatment options for pelvic organ prolapse (POP), it’s essential to weigh the benefits and drawbacks of using pessaries against other available treatments, such as surgical interventions and lifestyle modifications. Each option has its own set of advantages, challenges, and costs.

Surgical Options for POP

Surgery is often considered a definitive treatment for POP, and it may be recommended for women with more severe symptoms or those who do not find relief with non-surgical options like pessaries.

• Types of Surgical Procedures:

• Pelvic Floor Repair: Procedures may include vaginal or abdominal techniques to repair the pelvic floor and support the affected organs.
• Hysterectomy: In some cases, removal of the uterus may be necessary, especially if it is contributing to prolapse symptoms.

• Cost Comparison:

• Surgical procedures can be significantly more expensive than pessaries, often ranging from $5,000 to $20,000, depending on the complexity and type of surgery.
• Additionally, there may be costs associated with hospitalization, anesthesia, and post-operative care.

• Recovery Time:

• Recovery from surgery can take several weeks, with restrictions on physical activity during the healing process. This can lead to a longer time away from daily activities.

• Long-Term Efficacy:

• Surgical options may offer a permanent solution for prolapse but carry risks of complications, including recurrence of prolapse or surgical complications.

Lifestyle Modifications and Other Non-Surgical Treatments

In addition to pessaries, some women may find relief through lifestyle changes or other non-surgical interventions.

• Pelvic Floor Exercises:

• Kegel Exercises: Strengthening the pelvic floor muscles can help support pelvic organs and may alleviate mild symptoms of POP.
• Physical Therapy: Specialized pelvic floor therapy can provide targeted support and education on managing symptoms.

• Weight Management:

• Maintaining a healthy weight can reduce pressure on the pelvic floor and help prevent worsening of prolapse symptoms.

• Cost Comparison:

• Lifestyle modifications may have minimal direct costs, primarily related to potential fees for physical therapy or fitness classes.

• Long-Term Management:

• These approaches can be effective for managing mild cases of POP but may not provide the necessary support for moderate to severe cases. They also require ongoing commitment and effort.

Support Devices for Pelvic Organ Prolapse

Types of Support Devices

• External Support Devices:

• Support Garments: Specialized garments, such as pelvic support belts or shorts, can help reduce pressure on the pelvic floor and provide additional support during physical activities.
• Biofeedback Devices: These devices assist in pelvic floor muscle training, offering feedback on muscle contractions to enhance pelvic floor strength and coordination.

Benefits of Support Devices

• Enhanced Comfort:

• Many women find that support devices can provide immediate relief from discomfort associated with prolapse. By distributing weight and pressure more evenly, these devices can make daily activities more manageable.

• Non-Invasive Options:

• Like pessaries, most support devices are non-invasive and reversible, allowing women to explore these options without the need for surgical intervention.

• Integration with Other Treatments:

• Support devices can be used in conjunction with other treatments, such as pelvic floor exercises or lifestyle modifications, to enhance overall management of POP.

Limitations of Support Devices

• Variable Efficacy:

• Not all support devices will work for every individual. Some women may find that external supports provide insufficient relief or that vaginal devices are uncomfortable or difficult to use.

• Learning Curve:

• Using certain support devices may require guidance from healthcare providers. Proper fitting and usage are crucial for effectiveness, and some women may feel overwhelmed by the learning process.

• Maintenance Requirements:

• Similar to pessaries, support devices often require regular cleaning and maintenance, adding to the overall commitment of managing POP.

FemiCushion for pelvic Organ Prolapse

The FemiCushion is a supportive device designed to help manage different types of pelvic organ prolapse, including bladder prolapse, from the comfort of home. It features a cushion that provides targeted support to the affected organ, relieving discomfort and alleviating symptoms. By applying gentle and consistent pressure, the device supports the uterus and helps reduce issues related to prolapse. Many women who have used the FemiCushion report being able to return to an active lifestyle, allowing them to move freely without worrying about pain or discomfort from their prolapse. This support device is particularly recommended for women with stages 1 to 3 of prolapse who prefer to avoid surgery or the use of a pessary.

A study conducted at Showa University Northern Yokohama Hospital, published in The Journal of Obstetrics and Gynecology Research, examined the effectiveness of FemiCushion in treating pelvic organ prolapse (POP) using magnetic resonance imaging (MRI). The research involved twelve participants aged 56 to 84, all suffering from severe stages 3 or 4 of POP.

Key findings from the study include:

• FemiCushion was highly effective in repositioning prolapsed pelvic organs.
• The device demonstrated results comparable to those of a pessary but with fewer risks, such as vaginal erosion and bleeding.
• FemiCushion not only lifted the prolapsed organs but also supported the perineal body and closed the hiatuses.
• Users with severe POP experienced a significant reduction in prolapse severity after using FemiCushion.
• Improvements in POP were noted even after just one month of use.

These findings highlight FemiCushion's potential as a non-invasive alternative to pessaries for managing POP, offering similar benefits while minimizing associated risks. The study suggests promising advancements in the treatment of severe pelvic organ prolapse.

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.