Contraindications of using a pessary
There are few contraindications to the use of a pessary. Active infections of the pelvis or vagina, such as vaginitis or pelvic inflammatory disease, preclude the use of a pessary until the infection has been resolved. Patients who are noncompliant or unlikely to follow up should not be fitted for a pessary. Most pessaries are made of silicone; some are made of latex. An allergy to the product would also be a contraindication.
Ref: ANTHONY J. VIERA, LT, MC, USNR, Naval Hospital Guam, Dededo, Guam, MARGARET LARKINS-PETTIGREW, LCDR, MC, USNR, Naval Hospital Jacksonville, Jacksonville, Florida, Am Fam Physician. 2000 May 1;61(9):2719-2726.
Ref: ANTHONY J. VIERA, LT, MC, USNR, Naval Hospital Guam, Dededo, Guam, MARGARET LARKINS-PETTIGREW, LCDR, MC, USNR, Naval Hospital Jacksonville, Jacksonville, Florida, Am Fam Physician. 2000 May 1;61(9):2719-2726.
complications of the pessary
As with anything inserted into the body, the pessary is still a foreign object and some women may find that their body will automatically try to expel the pessary.
The pessary has been used for century's in one shape or material. The pessary remains one of the safest devices in the conservative management of incontinence and pelvic organ prolapse. However, it can still present with side effects.
The most common complaint from women is that they find an increase in vaginal discharge or that they are experiencing a different odour.
Some doctors prescribe the use of Trimo-San with the pessary to help relieve minor irritations or itching. Many women who have used Trimo-San during sex complain of a thick white lumpy discharge, this is nothing to worry.
Postmenopausal women with thin vaginal mucosa are more susceptible to vaginal ulceration with use of a pessary. Treatment with oestrogen cream can make the vaginal mucosa more resistant to erosion and should be used before or concurrently with the fitting of the pessary in such patients. (1,2)
It is so important to ensure that the patient is able to self manage and be compliant. There have been cases (very very few) of women who have left the pessary in for longer than should be. One lady I spoke to left her Gellhorn in for over a year and when I asked her why she said she was too frightened to see her doctor as it hurt so much when she had a previous Gellhorn changed. The longest on record is a lady left hers in for over 30 years and this caused her no end of problems, but as soon as it was removed and the infection cleared she was fine.
If the pessary is left in for longer than it should be this neglect can cause the pessary to become embedded in the vaginal mucosa and can be very difficult to remove and painful for the patient. Some have been prescribed an Oestrogen cream to help with decreasing inflammation and promoting epithelial maturation. (3)
It is very rare that the pessary be removed surgically. (4)
If the pessary (ring, oval, cerclarge, dish) is of inaccurate fitting, the cervix and lower part of the uterus can herniate through the centre of the ring and become incarcerated. If this is not treated it could lead to strangulation of the cervix leading to necrosis of the cervix and uterus. (4)
While it is observed in rare cases that certain changes in the vaginal cells may lead to inflammation there has never been any link between vaginal or cervical cancer and a pessary.
The pessary has been used for century's in one shape or material. The pessary remains one of the safest devices in the conservative management of incontinence and pelvic organ prolapse. However, it can still present with side effects.
The most common complaint from women is that they find an increase in vaginal discharge or that they are experiencing a different odour.
Some doctors prescribe the use of Trimo-San with the pessary to help relieve minor irritations or itching. Many women who have used Trimo-San during sex complain of a thick white lumpy discharge, this is nothing to worry.
Postmenopausal women with thin vaginal mucosa are more susceptible to vaginal ulceration with use of a pessary. Treatment with oestrogen cream can make the vaginal mucosa more resistant to erosion and should be used before or concurrently with the fitting of the pessary in such patients. (1,2)
It is so important to ensure that the patient is able to self manage and be compliant. There have been cases (very very few) of women who have left the pessary in for longer than should be. One lady I spoke to left her Gellhorn in for over a year and when I asked her why she said she was too frightened to see her doctor as it hurt so much when she had a previous Gellhorn changed. The longest on record is a lady left hers in for over 30 years and this caused her no end of problems, but as soon as it was removed and the infection cleared she was fine.
If the pessary is left in for longer than it should be this neglect can cause the pessary to become embedded in the vaginal mucosa and can be very difficult to remove and painful for the patient. Some have been prescribed an Oestrogen cream to help with decreasing inflammation and promoting epithelial maturation. (3)
It is very rare that the pessary be removed surgically. (4)
If the pessary (ring, oval, cerclarge, dish) is of inaccurate fitting, the cervix and lower part of the uterus can herniate through the centre of the ring and become incarcerated. If this is not treated it could lead to strangulation of the cervix leading to necrosis of the cervix and uterus. (4)
While it is observed in rare cases that certain changes in the vaginal cells may lead to inflammation there has never been any link between vaginal or cervical cancer and a pessary.
References:
- Brubacker L. The vaginal pessary. In: Friedman AJ, ed. American Urogynecologic Society Quarterly Report. 1991;9(3).
- Deger RB, Menzin AW, Mikuta JJ. The vaginal pessary: past and present. Postgrad Obstet Gynecol. 1993;13(18):1–8.
- Poma PA. Management of incarcerated vaginal pessaries. J Am Geriatr Soc. 1981;29:325–7
- Miller DS. Contemporary use of the pessary. In: Sciarra JJ, ed. Gynecology and obstetrics. Revised 1997 ed. Philadelphia: Lippencott-Raven, 1997:1–12.