A pessary is a medical device, often made of plastic, latex or silicone available in various shapes and sizes to suit the needs of the patient. It is inserted into the rectum or the vagina and held in place by the pelvic floor musculature. It’s used for the non-surgical management of a variety of gynecological disorders.
A pessary can be planted temporarily or permanently, a procedure ideally performed by a physician, midwife, or an advanced practice nurse.
Classification of pessaries
Pessaries can be broadly classified into the following few categories:
Therapeutic pessaries: A therapeutic pessary resembles the outer ring of the diaphragm and is used to treat prolapse of the uterus, a retroverted uterus, stress urinary incontinence, cystocele and rectocele. They support the uterus, vagina, bladder, or the rectum as the case may be. In the past, therapeutic pessaries have also been utilized to perform abortions.
Pharmaceutical pessaries: A pharmaceutical pessary functions as an effective tool for delivering pharmaceutical substance for easy absorption through the vaginal or rectal surface.
Occlusive pessaries: Occlusive pessaries are used as contraceptives, often coupled with a spermicide.
Types of pessaries
The type of pessary that is suitable for each patient primarily depends upon the condition being treated.
Some common types of pessaries used in medication are:
Ring pessary: It is used to treat conditions of a mild uterine prolapse. The ring pessary is available in the form of incontinence rings (used to treat stress urinary incontinence) and ring with support (helps in treating mild cystocele).
Incontinence dish: An incontinence dish is used for the treatment of stress urinary incontinence and mild uterine prolapsed. It is also available with support (for treating mild cystocele).
Donut pessary: It is 2 and a half to 3 inches in size and functions to treat a moderate uterine prolapse or a mild cystocele.
Gellhorn: The gellhorn is about 4 inches in size and used to treat a moderate uterine prolapse or a mild cystocele.
Inflatable pessary: It is available in medium as well as large sizes for the treatment of a moderate uterine proplapse.
Cube pessary: It is available in variations of 2 to 4 inches used to treat severe cases of uterine prolapsed, mild conditions of cystocele and rectocele and other types of vaginal vault prolapse.
Gehrung: It is available in sizes ranging from 3 inches to 5 inches used to treat moderate conditions of cystocele, rectocele and uterine prolapsed. It is also available as a knob.
Hodge: It is available in sizes ranging from 2 to 4 inches with support variations to choose from. It is used to treat mild conditions of cystocele.
While pessaries prove to be beneficial in the non-surgical treatment of gynecological disorders, patients fitted with pessaries are at the risk of Active infections of the pelvis or vagina (such as vaginitis or pelvic inflammatory disease) due to the use of the device.
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