Vaginal Support Pessaries

Indications for Use and Fitting Strategies

Shanna Atnip and Katharine O'Dell

Disclosures

Urol Nurs. 2012;32(3):114-125. 

In This Article

Abstract and Introduction

Abstract

Flexible silicone vaginal support pessaries offer a low-risk, effective option for treatment of symptoms of pelvic organ prolapse. This first article in a three-part series summarizes clinical recommendations and current evidence related to pessary indications, choice, and fitting.

Introduction

Pelvic floor disorders are common in women, and as the population ages, these disorders may be seen more frequently by health care providers (Nygaard et al., 2008). When pelvic symptoms are associated with loss of structural support of the pelvic organs and vagina, vaginal support pessaries offer an important option for relief (American College of Obstetricians & Gynecologists [ACOG], 2007).

Historically, vaginal pessaries have been used to manage pelvic floor relaxation and were made from a variety of materials, including fruit, metal, porcelain, rubber, and acrylic (Shah, Sultan, & Thakar, 2006). Modern pessaries are made from silicone, acrylic, latex, or rubber. Flexible, medical-grade silicone pessaries are the primary subject of this article and series because they offer many advantages over other materials. For example, flexible, medical-grade pessaries are pliable, long-lasting, non-absorbent (related to odor and secretions), biologically inert, non-allergenic, non-carcinogenic, and washable, and can generally be sterilized using an autoclave, boiling water, or a cold sterilization product (Cooper Surgical, 2008; Personalmed, 2012).

Support pessaries are experiencing a renaissance and are currently recommended as a first-line, low-risk treatment option for a variety of prolapse-related symptoms (ACOG, 2007; Clemons, Aquilar, Sokol, Jackson, & Myers, 2004). However, to provide satisfactory care, health care providers must effectively evaluate pelvic symptoms and related health attitudes; assess vaginal size, shape, and support; select a comfortable and effective pessary; and provide health education and appropriate follow up. This article addresses basic information essential to prescribing pessaries to women, including an overview of current patterns of clinical use, a review of existing evidence, and suggestions for ongoing research.

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