Vaginal Pessaries

Minda Neimark

Pessaries have long been used for the treatment of pelvic floor dysfunction in women. Initial descriptions of a vaginal device entailed intravaginal placement of objects to support genital prolapse and/or administer therapeutic chemicals. Pessaries were originally designed to treat genital prolapse. Application of pessaries for women with stress urinary incontinence (SUI) are rather recent and will be discussed elsewhere. With the high coexistence of genital prolapse and urinary incontinence, it is likely that many women who were fit with a pessary for genital prolapse noted an improvement in their urinary incontinence. In addition, women with exteriorized prolapse may have occult stress incontinence, which is uncovered upon being fit with a vaginal pessary for reduction of the prolapse.

As our population ages, with an increased incidence of pelvic floor dysfunction, alternatives to surgery become more desirable. There are many urogynecologic indications for pessary usage, as mentioned below:

• Patient unable to safely undergo pelvic reconstructive surgery

• Desire to avoid surgery for genital prolapse

• Evaluation of continence mechanism in moderate to severe vaginal prolapse

• Pregnant patient with incompetent cervix/premature delivery/multiple gestation

• Genital prolapse in the neonate

• Low back/pelvic pain secondary to genital prolapse

• Postoperative usage after pelvic reconstructive surgery to prevent recurrence

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