Skip to main content
SpringerLink
Log in

Pessary: A Rediscovered Tool

  • Chapter
  • First Online:
Book cover Management of Pelvic Organ Prolapse

Part of the book series: Urodynamics, Neurourology and Pelvic Floor Dysfunctions ((UNPFD))

  • 928 Accesses

Abstract

Although surgical management of symptomatic pelvic organ prolapse (POP) is often necessary, pessary still remains the most common effective, inexpensive, and safe nonsurgical option to help patients alleviate their symptoms.

Despite the majority of practitioners prescribe pessaries in their clinical practice, a lack of consensus exists whether conservative therapies should always be attempted at first. However thanks to the aging of population worldwide, there has been a renewed interest in the use of conservative treatment for POP.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 69.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Lawrence JM, Luckacz ES, Nager CW, et al. Prevalence and co-occurrence of pelvic floor disorder in community-dwelling women. Obstet Gynecol. 2008;11(3):678–85.

    Article  Google Scholar 

  2. Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;29:4–20.

    Google Scholar 

  3. Oliver R, Thakar R, Sultan AH. The history and usage of the vaginal pessary: a review. Eur J Obstet Gynecol Reprod Biol. 2011;156(2):125–30.

    Article  PubMed  Google Scholar 

  4. Shah SM, Sultan AH, Thakar R. The history and evolution of pessaries for pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(2):170–5.

    Article  PubMed  Google Scholar 

  5. Atrip SD. Pessary use and management for pelvic organ prolapse. Obstet Gynecol Clin N Am. 2009;36:541–63.

    Article  Google Scholar 

  6. Lamers BHC, Broekman BMW, Milani AL. Pessary treatment for pelvic organ prolapse and health-related quality of life: a review. Int Urogynecol J. 2011;22:637–44.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Sevilla C, Wieslander CK, Alas A, et al. The pessary process: Spanish-speaking Latinas’ experience. Int Urogynecol J. 2013;24(6):939–46.

    Article  PubMed  Google Scholar 

  8. Kapoor DS, Thakar R, Sultan AH, et al. Conservative versus surgical management of prolapse: what dictates patient choice? Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(10):1157–61.

    Article  PubMed  Google Scholar 

  9. Serati M, Giarenis I, Meschia M, et al. Role of urodynamics before prolapse surgery. Int Urogynecol J. 2015;26(2):165–8.

    Article  PubMed  Google Scholar 

  10. Visco AG, Brubaker L, Nygaard I, et al. The role of preoperative urodynamic testing in stress-continent women undergoing sacrocolpopexy: the Colpopexy and Urinary Reduction Effort (CARE) randomized surgical trial. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:607–14.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lone F, Thakar R, Sultan AH, et al. A 5-year prospective study of vaginal pessary use for pelvic organ prolapse. Int J Gynaecol Obstet. 2011;114:56–9.

    Article  PubMed  Google Scholar 

  12. Rusavy Z, Bombieri L, Freeman RM. Procidentia in pregnancy: a systematic review and recommendations for practice. Int Urogynecol J. 2015;26(8):1103–9.

    Article  PubMed  Google Scholar 

  13. Lipp A, Shaw C, Glavind K. Mechanical devices for urinary incontinence in women. Cochrane Database Syst Rev. 2014;(12):CD001756. https://doi.org/10.1002/14651858.CD001756.pub6.

  14. Bugge C, Hegen S, Thakar R. Vaginal pessaries for pelvic organ prolapse and urinary incontinence: a multidisciplinary survey of practice. Int Urogynecol J. 2013;24:1017–24.

    Article  PubMed  Google Scholar 

  15. Jeffrey S, Franco A, Fynes M. Vaginal wind: the cube pessary as a solution. Int Urogynecol J. 2008;19:1457.

    Article  Google Scholar 

  16. Thakar R, Stanton S. Management of genital prolapse. BMJ. 2002;324:1258–62.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Pott-Grinstein E, Newcomber JR. Gynecologists’ pattern of prescribing pessaries. J Reprod Med. 2001;46:205–8.

    CAS  PubMed  Google Scholar 

  18. ACOG Committee on Practice Bulletins—Gynecology. ACOG Practice Bulletin No. 85: Pelvic organ prolapse.

    Google Scholar 

  19. Fernando RJ, Thakar R, Sultan AH, et al. Effect of vaginal pessaries on symptoms associated with pelvic organ prolapse. Obstet Gynecol. 2006;108(1):93–9.

    Article  PubMed  Google Scholar 

  20. Bash KL. Review of vaginal prolapse pessaries. Obstet Gynecol Surv. 2000;55(7):455–60.

    Article  CAS  PubMed  Google Scholar 

  21. Weber AM, Richter HE. Pelvic organ prolapse. Obstet Gynecol. 2005;106:615–34.

    Article  PubMed  Google Scholar 

  22. Nemeth Z, Nagy S, Ott J. The cube pessary: an underestimated treatment option for pelvic organ prolapse? Subjective 1-year outcomes. Int Urogynecol J. 2013;24:1695–701.

    Article  PubMed  Google Scholar 

  23. Khaja A, Freeman RM. How often should shelf/Gellhorn pessaries changed? A survey of IUGA urogynecologists. Int Urogynecol J. 2014;25:941–6.

    Article  CAS  PubMed  Google Scholar 

  24. Meriwether KV, Komesu YM, Craig E, et al. Sexual function and pessary management among women using a pessary for pelvic floor disorders. J Sex Med. 2015;12:2339–49.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Cundiff GW, Amundsen CL, Bent AE, et al. The PESSRI study: symptom relief outcomes of a randomized crossover trial of the ring and Gellhorn pessaries. Am J Obstet Gynecol. 2007;196(4):405.e1–8.

    Article  Google Scholar 

  26. Cundiff WG, Weidner AC, Visco AG, et al. A survey of pessary use by members of the American Urogynecologic Society. Obstet Gynecol. 2000;95(6 pt 1):931–5.

    CAS  PubMed  Google Scholar 

  27. Wiegersma M, Panman CMCR, Kollen BJ, et al. Pelvic floor muscle training versus watchful waiting or pessary treatment for pelvic organ prolapse (POPPS): design and participant baseline characteristics of two parallel pragmatic randomized controlled trials in primary care. Maturitas. 2014;77:168–73.

    Article  PubMed  Google Scholar 

  28. Nager CW, Richter HE, Nygaard I, et al. Incontinence pessaries: size, POPQ measures, and successful fitting. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(9):1023–8.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Geoffrion R, Zhang T, Lee T, et al. Clinical characteristics associated with unsuccessful pessary fitting outcomes. Female Pelvic Med Reconstr Surg. 2013;19(6):339–45.

    Article  PubMed  Google Scholar 

  30. Culligan PJ. Nonsurgical management of pelvic organ prolapse. Obstet Gynecol. 2012;119(4):852–60.

    Article  PubMed  Google Scholar 

  31. Barber MD, Walters MD, Cundiff GW. Responsiveness of the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) in women under-going vaginal surgery and pessary treatment for pelvic organ prolapse. Am J Obstet Gynecol. 2006;194(5):1492–8.

    Article  PubMed  Google Scholar 

  32. Komesu YM, Rogers RG, Rode MA, et al. Pelvic floor symptom changes in pessary users. Am J Obstet Gynecol. 2007;197:620.e1–6.

    Article  Google Scholar 

  33. Brazell HD, Patel M, O’sullivan DM, et al. The impact of pessary use on bowel symptoms: one-year outcome. Female Pelvic Med Reconstr Surg. 2014;20(2):95–8.

    Article  PubMed  Google Scholar 

  34. Kuhn A, Bapst D, Stadlmayr W, et al. Sexual and organ function in patients with symptomatic prolapse: are pessaries helpful? Fertil Steril. 2009;91(5):1914–8.

    Article  PubMed  Google Scholar 

  35. Clemons JL, Aguilar VC, Tillinghast TA, et al. Patient satisfaction and changes in prolapse and urinary symptoms in women who were successfully fitted with a pessary for pelvic organ prolapse. Am J Obstet Gynecol. 2004;190:1025–9.

    Article  PubMed  Google Scholar 

  36. Donnelly MJ, Powell-Morgan S, Olsen AL, et al. Vaginal pessaries for the management of stress and mixed urinary incontinence. Int Urogynecol J. 2004;15:302–7.

    Google Scholar 

  37. Manchana T, Bunyavejchevin S. Impact on quality of life after ring pessary use for pelvic organ prolapse. Int Urogynecol J. 2012;2:873–7.

    Article  Google Scholar 

  38. Friedman S, Sandhu C, Wang C, et al. Factors influencing long-term pessary use. Int Urogynecol J. 2010;21:673–8.

    Article  PubMed  Google Scholar 

  39. Bugge C, Adams EJ, Gopinath D, et al. Pessaries (mechanical devices) for pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013;(2):CD004010. https://doi.org/10.1002/14651858.CD004010.pub3.

  40. Continence Foundation of Australia and International Centre for Allied Health Evidence, University of South Australia. Guidelines for the use of support pessaries in the management of pelvic organ pro-lapse. 2012. http://w3.unisa.edu.au/cahe/Resources/GuidelinesiCAHE/Pessary%20Guidelines.pdf.

  41. Luber KM, Boero S, Choe JY. The demographics of pelvic floor disorders: current observations and future projections. Am J Obstet Gynecol. 2001;184(7):1496–501.

    Article  CAS  PubMed  Google Scholar 

  42. Abdool Z, Thakar R, Sultan AH. Prospective evaluation of outcome of vaginal pessaries versus surgery in women with symptomatic pelvic organ prolapse. Int Urogynecol J. 2011;22:273–8.

    Article  PubMed  Google Scholar 

  43. Mamik MM, Rogers RG, Qualls CR, et al. Goal attainment after treatment in patients with symptomatic pelvic organ prolapse. Am J Obstet Gynecol. 2013;209(488):e1–5.

    Google Scholar 

  44. Ramsay S, Tu LM, Tannenbaum C. Natural history of pessary use in women aged 65-74 versus 75 years and older with pelvic organ prolapse: a 12-year study. Int Urogynecol J. 2016;27(8):1201–7. https://doi.org/10.1007/s00192-016-2970-3.

    Article  PubMed  Google Scholar 

  45. Handa VL, Jones M. Do pessaries prevent the progression of pelvic organ prolapse? Int Urogynecol J Pelvic Floor Dysfunct. 2002;13(6):349–51.

    Article  CAS  PubMed  Google Scholar 

  46. Bo K, Majida M, Ellstrom ME. Does a ring pessary in situ influence the pelvic floor muscle function of women with pelvic organ prolapse when tested in supine? Int Urogynecol J. 2012;23:573–7.

    Article  PubMed  Google Scholar 

  47. Jones K, Yang L, Lowder JL, et al. Effect of pessary use on genital hiatus measurements in women with pelvic organ prolapse. Obstet Gynecol. 2008;112(3):630–6.

    Article  PubMed  Google Scholar 

  48. Gorti M, Hundelist G, Simons A. Evaluation of vaginal pessary management: a UK-based survey. J Obstet Gynaecol. 2009;29(2):129–31.

    Article  CAS  PubMed  Google Scholar 

  49. Hagen S, Sinclair L, Glazener C, et al. A feasibility study for randomized controlled trial with pelvic organ prolapse. ICS Conference, Glasgow, UK. 2001. http://iwcsoffice.org/Abstracts/Publish/106/000616.pdf.

  50. Sullivan SA, Davidson EWR, Bretscneider EM, et al. Patient characteristics associated with treatment choice for pelvic organ prolapse and urinary incontinence. Int Urogynecol J. 2016;27:811–6.

    Article  PubMed  Google Scholar 

  51. Chan SS, Cheung RY, Yiu KW, et al. Symptoms, quality of life and factors affecting women’s treatment decisions regarding pelvic organ prolapse. Int Urogynecol J. 2012;23:1027–33.

    Article  PubMed  Google Scholar 

  52. Brincat C, Kenton K, Pat Fitzgerald M, et al. Sexual activity predicts continued pessary use. Am J Obstet Gynecol. 2004;191(1):198–200.

    Article  PubMed  Google Scholar 

  53. Korbly NB, Kassis NC, Good MM, et al. Patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapsed. Am J Obstet Gynecol. 2013;209(5):470e1–6.

    Article  Google Scholar 

  54. Detollenaere RJ, denBoon J, Stekelenburg J, et al. Sacrospinous hysteropexy versus vaginal hysterectomy with suspension of the uterosacral ligaments in women with uterine prolapse stage 2 or higher: multicentre randomised non-inferiority trial. BMJ. 2015;351:h3717. https://doi.org/10.1136/bmj.h3717.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Rahmanou P, Price N Jackson SR. Laparoscopic hysteropexy versus vaginal hysterectomy for the treatment of uterovaginal prolapse: a prospective randomized pilot study. Int Urogynecol J. 2015;26(11):1687–94.

    Article  PubMed  Google Scholar 

  56. Clemons JL, Aguillar VC, Tillinghast TA, et al. Risk factors associated with an unsuccessful pessary fitting trial in women with pelvic organ prolapse. Am J Obstet Gynecol. 2004;190(2):345–50.

    Article  PubMed  Google Scholar 

  57. Yamada T, Matsubara S. Rectocele, but not cystocele, may predict unsuccessful pessary fitting. J Obstet Gynaecol. 2011;31(5):441–2.

    Article  CAS  PubMed  Google Scholar 

  58. Markle D, Skoczylas L, Goldsmith C, et al. Patients characteristics associated with successful pessary fitting. Female Pelvic Med Reconstr Surg. 2011;17(5):249–52.

    PubMed  Google Scholar 

  59. Mutone MF, Terry C, Hale DS, et al. Factors which influence the short term success of pessary management of pelvic organ prolapse. Obstet Gynecol. 2005;193:89–94.

    Google Scholar 

  60. Hanson LM, Schultz J, Flood CG, et al. Vaginal pessaries in managing women with pelvic organ prolapsed and urinary incontinence: patient characteristics and factors contributing to success. Int Urogynecol J. 2006;17:155–9.

    Article  CAS  Google Scholar 

  61. Fitchett JR, Bhatta S, Sherpa TY, et al. Non-surgical interventions for pelvic organ prolapsed in rural Nepal: a prospective monitoring and evaluation study. JSRM Open. 2015;6(12):2054270415608117. https://doi.org/10.1177/2054270415608117. eCollection 2015.

    Article  Google Scholar 

  62. Alnaif B, Drutz HB. Bacterial vaginosis increases in pessary users. Int Urogynecol J. 2000;11:219–23.

    Article  CAS  Google Scholar 

  63. Arias BE, Ridgeway B, Barber MD. Complications of neglected vaginal pessaries: case presentation and literature review. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(8):1173–8.

    Article  PubMed  Google Scholar 

  64. Penrose KJ, Tsokos N. Delayed vesicovaginal fistula after ring pessary usage. Int Urogynecol J. 2014;25:291–3.

    Article  PubMed  Google Scholar 

  65. Walker KF, Dasgupta J, Cust MP. A neglected shelf pessary resulting in a urethrovaginal fistula. Int Urogynecol J. 2011;22:1133–4.

    Google Scholar 

  66. Ambereen DF. Ureterovaginal fistula due to a cube pessary despite routine follow-up: but what is “routine”? J Obstet Gynaecol Res. 2014;40:2162–5.

    Article  Google Scholar 

  67. Ho MP. Unilateral acute pyelonephritis associated with neglected pessary. J Am Geriatr Soc. 2011;59:1962–3.

    Article  PubMed  Google Scholar 

  68. Christ ML, Haja J. Cytological changes associated with vaginal pessary use with special reference to the presence of actinomyces. Acta Cytol. 1973;22(3):146–9.

    Google Scholar 

  69. Schraub S, Sun XS, Maingon PH, et al. Cervical and vaginal cancer associated with pessary use. Cancer. 1992;69:2505–9.

    Article  CAS  PubMed  Google Scholar 

  70. Martin C, Hong L, Siddighi S. What is hiding behind the pessary? Int Urogynecol J. 2013;24:873–5.

    Article  PubMed  Google Scholar 

  71. Jain A, Majoko F, Freites O. How innocent is the vaginal pessary? Two cases of vaginal cancer associated with the pessary use. J Obstet Gynaecol. 2006;26(8):829–30.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Regional Hospital of Lugano, EOC, Lugano, Switzerland

    Elena Cattoni & Linda Leidi-Bulla

  2. Department of Gynecology and Obstetrics, Ospedale Giuseppe Fornaroli, Magenta, Italy

    Paola Sorice

Authors
  1. Elena Cattoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paola Sorice
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Linda Leidi-Bulla
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elena Cattoni .

Editor information

Editors and Affiliations

  1. Department of Urology, Careggi University Hospital, Florence, Italy

    Vincenzo Li Marzi

  2. Urogynecology Unit, University of Insubria, Varese, Italy

    Maurizio Serati

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Cattoni, E., Sorice, P., Leidi-Bulla, L. (2018). Pessary: A Rediscovered Tool. In: Li Marzi, V., Serati, M. (eds) Management of Pelvic Organ Prolapse. Urodynamics, Neurourology and Pelvic Floor Dysfunctions. Springer, Cham. https://doi.org/10.1007/978-3-319-59195-7_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-59195-7_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-59194-0

  • Online ISBN: 978-3-319-59195-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation