thumb|right|Gold-plated stem pessary ([[intrauterine device|interuterine device) from 1920]]
A pessary is a prosthetic device inserted into the vagina for structural and pharmaceutical purposes. It is most commonly used to treat stress urinary incontinence to stop urinary leakage and to treat pelvic organ prolapse to maintain the location of organs in the pelvic region. It can also be used to administer medications locally in the vagina or as a method of contraception.
Pessaries come in different shapes and sizes, so it is important that individuals be fitted for them by health care professionals to avoid any complications. Some side effects may occur if pessaries are not sized properly or regularly maintained, but with the appropriate care, pessaries are generally safe and well tolerated. The term 'pessary' itself is derived from the Ancient Greek word , meaning round stone used for games.
Pessaries are even mentioned in the oldest surviving copy of the Greek medical text, the Hippocratic Oath, as something that physicians should never administer for the purposes of an abortion: "Similarly I will not give to a woman a pessary to cause abortion."
The earliest documented pessaries were natural products. For example, Greek physicians Hippocrates and Soranus described inserting half of a pomegranate into the vagina to treat prolapse.
Some signs and symptoms include feeling pressure in the pelvic area, lower back pain, painful intercourse, urinary incontinence, a feeling that something is out of place, constipation, or bleeding from the vagina.
The pressure causes opening of the sphincter muscles which usually help prevent urine leakage. Stress urinary incontinence is a common medical problem, especially in women; about 1 in 3 women are affected by this condition at some point in their lives.
Other
Some additional uses for pessaries are for an incarcerated uterus, prevention of preterm birth and an incompetent cervix. In early pregnancy the uterus can be displaced, which can lead to pain and rectal and urinary complications. This can lead to a preterm birth or even a miscarriage. Pessaries can be used to correctly position the cervix, increasing the success of pregnancy.
It is used to treat prolapse of uterine, vaginal wall (vaginal vault), bladder (cystocele), rectum (rectocele), or small bowel (enterocele). It is also used to treat stress urinary incontinence.
There are different types of pessaries but most of them are made out of silicone—a harmless and durable material. Pessaries are mainly categorized into two types, supporting pessaries and space-occupying pessaries.
Support pessary
Ring with support pessaries are the supporting type.. A clinical trial has shown that Reia pessaries are equally supportive as ring and Gellhorn pessaries. Reia pessaries have also been found to be less painful to insert and remove than other pessaries.
Space-occupying pessary
Donut pessaries are considered space-occupying pessaries.
Lever pessary
Hodge pessaries are a type of lever pessary. Although these can be used for mild cystocele and stress urinary incontinence, they are not commonly used. Smith, and Risser pessaries are other types of lever pessaries and they differ in shape.
Pessaries can also be used in a similar way to help induce labor for women who have overdue expected delivery dates or who experience premature rupture of membranes. Prostaglandins are usually the medication used in these kinds of pessaries in order to relax the cervix and promote contractions.
According to Pliny the Elder, pessaries were used as birth control in ancient times.
Occlusive pessaries
Occlusive pessaries are most commonly used for contraception. Also known as a contraceptive cap, they work similar to a diaphragm as a barrier form of contraception. They are inserted into the vagina and block sperm from entering the uterus through the cervix. The cap must be used in conjunction with a spermicide in order to be effective in preventing pregnancy. When used correctly the cap is thought to be 92–96% effective. These caps are reusable but come in different sizes. It is recommended for anyone attempting this form of contraception to be fitted for the correct size by a trained health care professional.
Stem pessary
The stem pessary, a type of occlusive pessary, was an early form of the cervical cap. Shaped like a dome, it covered the cervix, and a central rod or "stem" entered the uterus through the external orifice of the uterus, also known as the cervical canal or the os, to hold it in place.
Side effects and complications
thumb|Pessary covered in [[phosphate after being left in the vagina for an extended time]]
When pessaries are used correctly, they are tolerated well for pelvic organ prolapse or stress urinary incontinence. However, pessaries are still a foreign device that is inserted into the vagina, so side effects can occur. Some more common side effects include vaginal discharge and odor. These symptoms can be treated with the appropriate medications.
More serious side effects include fistula formation between the vagina and rectum or the vagina and bladder, or erosion, or thinning, of the vaginal wall.
For individuals with pessaries that are not fitted for them, herniations of the cervix and uterus can occur through the opening of the pessary. This can lead to tissue necrosis in the cervix and uterus.