Introduction
The vaginal pessary is a device that can be easily bent, shaped, and adaptable and provides support to the tissues within the pelvic region. It is commonly employed as a therapeutic intervention for the management of pelvic organ prolapse. However, it also offers several other advantages. A potential drawback associated with the use of a pessary is the possibility of experiencing discomfort or pain, which could potentially disrupt sexual intercourse.
What Are the Uses of Vaginal Pessaries?
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The pessary is a frequently utilized medical device designed to provide support to the pelvic floor and address various disorders, such as urinary incontinence.
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Although pessaries are mostly utilized for these intended applications, they also can administer drugs through the intravaginal route. The cervical cap, which is utilized as a contraceptive method, can be classified as a form of pessary from a technical standpoint.
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Prolapse is characterized by displacing a bodily organ or structure from its usual anatomical location, resulting in its protrusion into a neighboring structure. A pelvic organ prolapse refers to the condition in which the pelvic organs, particularly the bladder, protrude through the vaginal opening.
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For a significant number of women, the utilization of a pessary proves to be a more favorable alternative to surgical intervention in the management of pelvic organ prolapse. Considering the elevated rates of recurrence associated with surgical interventions for pelvic organ prolapse, pessaries present a favorable alternative for the majority of women.
What Are the Various Classifications?
The design of the pessary may exhibit variability depending on the specific ailment being addressed. The following items are the most frequently encountered:
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Uterine prolapse is a medical condition characterized by the descent of the uterus from its normal anatomical position, resulting in the protrusion of the organ into the vaginal canal.
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Cystocele, alternatively referred to as anterior prolapse, manifests when the bladder descends from its anatomically expected location, resulting in the formation of a protrusion within the vaginal canal.
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Rectocele is a medical condition characterized by the weakening of the tissue that separates the rectum and vagina, resulting in the protrusion of the rectum against the posterior wall of the vagina.
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Enterocele is a medical condition characterized by the weakening of the upper vaginal wall, resulting in the protrusion of the small bowel into the vaginal cavity.
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There exists a strong association between pelvic organ prolapse and urinary incontinence, as evidenced by around 40 percent of women diagnosed with prolapse also experiencing stress incontinence, characterized by the involuntary release of urine during activities such as coughing, sneezing, or engaging in heavy lifting.
What Are the Side Effects?
While using a pessary can be productive, it is full of drawbacks. When utilized suitably, the associated dangers are usually few. However, they may encompass the following:
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The individual experiences vaginal discomfort and pain.
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The occurrence of bleeding from the vaginal area.
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Constipation is a common gastrointestinal disorder characterized by infrequent bowel movements or difficulty passing stools.
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Pessaries have the potential to disrupt sexual intercourse and may potentially contribute to stress urine incontinence, especially when the device is not properly fitted.
What Are the Complications of Pessaries?
The most prevalent issues connected with the use of a pessary encompass:
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The device undergoes deformation or experiences a loss of its original shape.
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The occurrence of vaginal bleeding and the experience of pain.
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Vaginal discharge is a common physiological occurrence in women that involves the release of fluid from the vagina.
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Typically, the management of these issues involves the administration of antibiotics or the application of estrogen cream. The healthcare provider may advise the temporary discontinuation of pessary usage.
Additional potential problems may involve damaged vaginal tissues, rendering them susceptible to infection. The symptoms may encompass:
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An unpleasant and malodorous discharge with characteristics reminiscent of fish.
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The occurrence of pruritus and discomfort in the vaginal region.
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Urinary retention.
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The sensation of burning is experienced during urination.
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The presence of cloudy or bloody urine.
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The individual experiences a recurring or heightened need to avoid urine.
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Individuals may experience sensations of pressure or discomfort in the posterior region or the lower abdominal area.
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The individual is experiencing symptoms of fever and chills.
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Most illnesses arise from prolonged retention of a pessary, exceeding five years, or inadequate sanitation practices between successive usage. The likelihood of experiencing adverse outcomes is also heightened when individuals disregard indicators of vaginal discomfort or neglect to seek regular medical supervision.
What Are the Various Methods for the Insertion of a Pessary?
Most pessaries can be removed and reinserted by the patient in a home setting. A healthcare professional may insert a pessary, then remove, clean, and reinsert it at intervals of three to six months.
The insertion of a pessary typically necessitates the use of a suitable lubricant to facilitate the process. Postmenopausal women may receive recommendations to utilize estrogen cream as a therapeutic measure to alleviate vaginal dryness and enhance the thickness of the vaginal wall.
The healthcare provider will provide instructions on the proper technique for inserting the pessary. However, the general operation typically adheres to consistent criteria.
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Ring Pessaries: It is a folding process before implantation. Subsequently, the folded edge is lubricated and introduced into the vaginal aperture. After properly positioning, the ring is expanded and gently inserted into the posterior fornix, a spacious cavity behind the cervix. Subsequently, the ring is gently rotated to guarantee a secure and tight fit.
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Cube Pessaries: Before implantation, cube pessaries are compressed firmly. They are inserted into the vaginal canal at its most profound location and, after that, discharge. The resultant suction force maintains the device's position. In contrast to several alternative devices, cube pessaries necessitate overnight removal to prevent vaginal discomfort.
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Gehrung Pessaries: Theyare additionally configured folded, rendering the curved arch flat. Subsequently, the pessary's heels are greased and introduced into the designated area. Upon being opened, the posterior arch will assume a position within the anterior fornix located anteriorly to the cervix, while the anterior arch will rest on the cartilaginous structure situated between the pubic bones, commonly referred to as the symphysis pubis.
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Shaatz Pessaries: They exhibit rigidity and require vertical insertion. Subsequently, they are rotated into a transverse orientation within the vaginal canal.
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Gellhorn Pessaries: They are arranged in a folded configuration where one side of the base comes into contact with the stem. Subsequently, the pessary is placed into the vagina with the base end leading. Once extended, the stem should then be positioned securely into the vaginal introitus, providing a stable anchor for the device.
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Inflatable Pessaries: They are introduced in a deflated state, with the pump stem protruding from the vaginal opening. Subsequently, a compact pump is attached to the stem and compressed three to five times to achieve inflation. Once filled, a ball bearing will effectively prevent air escape. The stem may then be positioned externally, protruding from the vaginal canal, or it may be discreetly concealed within the vaginal orifice. Similar to cube pessaries, inflatable pessaries necessitate daily removal and cleaning.
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Lever Pessaries: They are often folded in half, resulting in the convergence of the curved end with the flattened end. Following the application of lubricant, the pessary is introduced into the vaginal canal and appropriately positioned such that the curved bar is situated posteriorly to the pelvis and the horizontal end is positioned posteriorly to the symphysis pubis.
Removing a pessary generally entails a straightforward reversal of the preceding processes. In most pessaries, it is possible to engage the index finger beneath the rim to dislodge the device delicately. Deflation keys or release valves are necessary for the deflation of inflatable pessaries.
Conclusion
The insertion of a pessary into the vaginal canal serves the purpose of providing support to pelvic tissues, including the bladder, uterus, and rectum, preventing their protrusion into the vaginal cavity. Pelvic organ prolapse can be effectively treated by utilizing a diverse range of forms and sizes of medical devices, which offer a non-invasive approach. Pessary is a medical device that administers medication through the vaginal tissue. In most cases, individuals can independently insert and remove a pessary in the confines of their residence. It is advisable to consult a medical professional if one encounters pain, abnormal discharge, or malodor symptoms. The effectiveness of this particular kind of contraception is rather low compared to other methods, such as hormonal contraceptives and intravaginal devices like the diaphragm, resulting in a major decline in its usage.
