PESSARY

A pessary is a device that is inserted into the vagina. Depending on the type used, its function can vary from correcting physical disorders of the uterus and preventing pregnancy to curing vaginal infections.

The term pessary describes a device worn in the vagina. It can be mechanical, used to correct womb displacements of the womb or to aid contraception, or it can be a soluble vaginal suppository.

MECHANICAL PESSARIES

Many women have abnormal displacements of the womb of which they are unaware. It is only when these displacements cause unpleasant symptoms that treatment is required. One form of treatment may involve the use of a solid vaginal pessary. Only two types are now commonly used - the Hodge pessary and the ring pessary.

THE HODGE PESSARY

This is a solid plastic device used to correct the position of the extroverted uterus - that is, a womb that tilts backwards instead of forwards.

About 20 per cent of women have wombs that tilt backwards but, fortunately, most never require treatment. In some cases, however, the retro version womb does not lie in a good position for sperm to enter it after sexual intercourse. And, if conception is to be achieved, a Hodge pessary may need to be inserted to tilt the womb forwards. This type of pessary is also used where the extroverted womb causes a woman to have difficulty in passing urine during the third month of pregnancy. In either case, the pessary will be removed once the woman is pregnant, or once the urinary problems have been overcome.

THE RING PESSARY

Made out of polythene or rubber, this device is used to stop the vagina and/or the womb from relapsing (dropping down). They can be worn for many years if used to treat a prolepses and are changed every four to six months. Because of the inconvenience of having to insert a new pessary every few months and the possibility of sores developing in the vagina, this treatment is reserved for the elderly, the unfit or those who are particularly anxious to avoid an operation. In other cases an operation is advised either to remove the womb or to stitch it back into the correct position.

Mechanical pessaries are inserted by a doctor or nurse. And, as this is usually painless, it is often done in a clinic without the necessity for any form of anesthetic. Neither the Hodge nor the ring pessary should cause any discomfort to the woman if it fitted correctly.

The cap or diaphragm is another form of mechanical pessary that is inserted into the vagina. It is used as a contraceptive and works by holding cream or jelly over the neck of the womb which kills sperm and so prevents the egg being fertilized. It is not strong enough, however, to correct displacements of the womb.

VAGINAL SUPPOSITORIES

Certain drugs can be made up into a tablet form which will melt at body temperature. Such tablets are used as vaginal pessaries. In this way the drug is slowly released into the vagina as the tablet melts. These pessaries can be used to treat local vaginal conditions, such as infections, but some drugs can also be absorbed from this site into the blood circulation. For example, naturally occurring progesterone is destroyed before reaching the bloodstream if it is taken by mouth, but it can be absorbed from the rectum or vagina in order to treat cases of pre-menstrual tension.

It is usually necessary to insert pessaries into the vagina for several consecutive days; your doctor will tell you the exact length of the curse of treatment. Although it is rather messy, some pessary treatments need to be continued during menstruation. Again, your doctor will advise you about this.

A pessary may be inserted into the vagina in the same way that a tampon is inserted. Some pessaries are supplied with a plastic applicator to make insertion easier. In both cases the pessary should be inserted high in the vagina.

As there may be leakage from the pessary, it is a good idea to wear disposable pants or a sanitary towel during a course of treatment.