Pessary

A pessary is a small plastic or silicone medical device or form of pharmaceutical preparation which is inserted into the vagina or rectum and held in place by the pelvic floor musculature.

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Therapeutic pessaries

Uses

A therapeutic pessary is used to support the uterus, vagina, bladder or rectum. A pessary is most commonly used to treat prolapse of the uterus. It is also used to treat stress urinary incontinence, a retroverted uterus, cystocele and rectocele. Also, in the original form of the Hippocratic Oath the pessary is mentioned as a possible and unethical way to perform an abortion.

The pessary is similar to the outer ring of a diaphragm. It can be placed temporarily or permanently and must be fitted by a physician. Most pessaries can be worn during intercourse.

Care

A physician will provide instruction for the proper care of a pessary. Some patients are instructed to take out, clean with soap and water, and reinsert the pessary every few days or weeks. Others will need to visit the doctor for cleaning.

Side effects and complications

A pessary can cause increased vaginal discharge, vaginal irritation, ulceration, bleeding, and dyspareunia (painful intercourse for the male or female). Cervical cancer is more likely in older women with a prolonged history of pessary use.

Pharmaceutical pessaries

Uses

A pharmaceutical pessary is used as a very effective means of delivery of pharmaceutical substances easily absorbed through the skin of the vagina or rectum, or intended to have action in the locality, for example against inflammation or infection, or on the uterus. An alternative term is suppository, which tends to be used when the primary use is rectal.

Description

The active ingredient(s) will usually be mixed with a suitable oil (such as cocoa butter) which is solid at room temperature to assist insertion, but melts at body temperature, to enable dispersion.

Complications

It can happen that the oil will leak, with the potential to spoil clothing. The oil may also cause rapid deterioration of any latex rubber and can cause problems with contraceptives made of these materials.

Occlusive pessaries

An occlusive pessary is generally used in combination with spermicide as a contraceptive; please refer to cervical cap for more details.