Pessary Management

Enquire about pessaries at clinics@health-tearoha.co.nz 

What is a prolapse?  

Prolapse of the uterus (womb) and/or walls of the vagina (with the bladder or bowel sitting behind them) is a common condition affecting up to 50% of people with a vagina. It is commonly referred to as pelvic organ prolapse (POP) or just a prolapse. Prolapses usually occur due to weakness of the supporting structures (muscles, ligaments, etc.) of the vagina. Weakening of the supports can occur during childbirth, or because of chronic heavy lifting or straining, or as part of the ageing process (menopause being a common time to start feeling the prolapse).  

Prolapses can feel like a heaviness or dragging sensation, or “just not feeling right” in the vagina or vulva area. You might see something coming down if you strain. You can also experience an increased need to pee or difficulty emptying your bladder, difficulty emptying the bowel, you might start to leak (incontinence), and intercourse might become uncomfortable. 

The good news is that the majority of prolapses can be treated and you can live a normal, healthy, functional life. There are a variety of treatment options for prolapses including conservative treatment like a pessary or surgery. Over 75% of people who are fitted with a pessary find that they no longer need to consider surgery to manage their symptoms. 

What is a pessary?  

A pessary is a removeable medical device that acts like a scaffold within your vagina. By providing this support, your prolapse symptoms can be reduced or eliminated completely. There are different types of pessaries, mostly made from soft, non-absorbent, non-leaking silicone. They come in different sizes and shapes – that is why we must individually measure and fit them for you. 

Who is suitable for using a pessary?  

Most people with a vagina are medically suitable for pessaries. However, there are some who should not have a pessary fitted. You are not suitable for pessary fitting if you have pelvic inflammatory disease, active infections in the vagina or pelvic area, allergies to silicone, vaginal or cervical cancer, previous radiotherapy in the pelvic region, or undiagnosed vaginal bleeding. If you have had surgical mesh inserted with previous pelvic surgery, you will need to be referred by us to a gynaecologist to determine if you are suitable for pessary fitting and they will coordinate your pessary management. 

What appointments do I need if I’m using a pessary?  

Initial assessment [Normal consult fee] 

This involves discussing your symptoms of concern and includes an internal examination and measuring for pessary (if appropriate). If a pessary is deemed suitable, this will be ordered at this appointment, there is no additional charge for this. 

Pessary Fitting Appointment [FREE] 

Once your pessary has arrived, we will contact you to book an appointment to fit the pessary. Due to the unique nature of vaginas, the fitting process is by ‘trial and error’ and may take a number of appointments before the correct size and type of pessary is found for you. In the clinic we ask you to perform several activities (sitting, standing, jumping, squatting, bending, coughing, straining, and emptying your bladder) with the pessary in place before we finalise the best pessary for you. We want to find the best pessary that stays inside your vagina and reduces or eliminates your symptoms. 

Your clinician will provide you with all the information you need at this appointment for management moving forward, including how to remove and replace pessary (if required) and appointment for follow up checks. 

Pessary Check/Change [FREE] 

After the initial appointment to fit the pessary, you need to return for a follow up appointment within 2 – 6 weeks. This is to ensure the pessary is sitting correctly, that you are having fewer symptoms, and so we can check with a speculum that the pessary is causing no issues to your vaginal tissues. When we do this check, we will remove and reinsert the pessary. After this first follow up appointment, the frequency of appointments needed depends on if you are self-managing the pessary or if you are relying on your clinician to manage it. The type of pessary you are using may also influence the timing of these follow up appointments. 

If you are self-managing the pessary, you will be required have a review with your clinician for pessary and vaginal checking every 12 months. If you are relying on your clinician to manage your pessary, you need a review every 3 months. 

Already have a pessary fitted? 

We may be able to take over the management of your pessary.  This would mean you would not need to travel to Waikato Hospital to be seen in the pessary clinic.  Please contact us to discuss, we will need details of the type of pessary you are using.  

ACC 

If you have experienced an injury while giving birth on or after 1 October 2022, you may be eligible to make a claim for prolapse and appointments related to the management of this, including a pessary. Please discuss this with your clinician if you think you may be eligible.