Learn what you should not do with a pessary and essential tips for its usage. Can you use Vaseline to insert a pessary? How do you handle it? Find answers to these questions and more in this informative article.
A pessary is a medical device used to treat pelvic organ prolapse and stress urinary incontinence. While it is generally safe and effective when used correctly, there are certain things you should avoid doing with a pessary to prevent complications and ensure its efficacy. In this comprehensive guide, we will delve into the dos and don’ts of using a pessary and address common questions and concerns related to its usage. Whether you are new to using a pessary or seeking additional information, this article will provide valuable insights and expert advice to help you make informed decisions.
The information in this blog is provided as an information resource only and should not be used as a substitute for seeking personalized direction from your overseeing physician. Please consult your healthcare team before making any decisions about your pessary treatment plan, which is unique to you and your overall health. PPHC expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this blog.
What is a pessary?
A pessary is a removable silicone device that is inserted into the vagina like a tampon.
Purpose
1. Pelvic organ prolapse: to lift/support the pelvic organs from below and decrease symptoms of heaviness, pressure or bulging.
2. Stress urinary incontinence: to decrease urinary leakage by compressing the urethra (the tube that drains the bladder).
A pessary is a conservative management option that can greatly improve quality of life for those women suffering from symptoms of pelvic organ prolapse or stress urinary incontinence. To learn more about the basics of pessaries, read our previous blog on ‘pessaries for prolapse and urinary incontinence’.
Managing pessaries during a global health pandemic?
Covid-19 has changed almost every area of life over the last few months: how we buy groceries, where we work from, and access to medical care. Virtual medical visits have become the norm as all non-essential medical appointments have been cancelled or postponed. For those who wear pessaries and rely on a nurse, doctor, or physiotherapist to remove, clean, and reinsert their pessary every couple of months, COVID-19 has interrupted this routine care, leaving many women worried about the pessary being inserted for too long, without being cleaned. This blog is meant to provide information and tips about managing a pessary independently, while awaiting an in-person medical appointment. We will cover how to remove and insert three of the most common pessaries, as well as how to sufficiently clean the pessary.
Ring Pessary with Support Insertion and Removal Instructions
Insertion
- Wash your hands
- Position: half squat, one foot on a stool, lying
- Apply lubricant (preferably organic, paraben and glycerin-free, water-based (not silicone)) to vaginal opening and one end of the ring pessary
- Fold ring pessary in half (as an “A” or a “V”)
- Spread the lips of your vagina apart with one hand and insert pessary at the base of the vagina with the other hand
- Gently push the pessary as far back into the vagina as it will go
- Ensure proper positioning once inserted: ¼ turn so largest hole is to the side, back of the pessary slightly higher than the front, front anchored behind the pubic bone
Removal
- Wash your hands. Use a glove on one hand if you find that helps to get a better grip.
- Manipulate ¼ turn so largest hole is facing up to your pubic bone (12 o’clock) with your index finger
- Grab the rim of the pessary with your thumb and index finger, tilt it slightly down and gently pull down and out, folding it with your other hand as you remove it. Instead of using your other hand to fold it as you remove it, you can bend it slightly by pushing your thumb down and using your ring finger to push up on the underside of the pessary as you withdraw it.
- Tip: can bear down to lower the pessary or tie dental floss onto the pessary to aid in removal
- Tip: try removing pessary in standing vs lying
- Tip: if you cannot bend/fold it, turn pessary to a 45* vertical angle so you are not withdrawing it horizontally
Correct Fitting
- No feeling of heaviness, pain, bulge, or the pessary
- Pessary either should not be visible or only slightly visible when labia are separated
- Better urine and stool evacuation
- Better quality of life
Incorrect Fitting
- Pain or difficulty urinating or defecating
- Unusual secretions (odour, color, quantity)
- UTI symptoms
- Itching
- Blood on the pessary or vaginal bleeding
- Discomfort or pain at rest or with effort
- Not sure if it is positioned well (just doesn’t feel right)
Gellhorn Pessary Insertion and Removal Instructions
Insertion
- Wash your hands
- Position: half squat, one foot on a stool, lying
- Apply lubricant (preferably organic, paraben and glycerin-free, water-based (not silicone)) to one end of the disk
- Fold the handle parallel to the disk
- Spread the lips of your vagina apart with one hand and begin to insert the pessary
- Gently push the pessary as deep as it will go, noting that the handle may be seen or felt near the vaginal opening even when correctly in place
Removal
- Wash your hands. Use a glove if you feel that helps get a better grip.
- Insert one finger above the lip of the disk to break the suction
- Hold the handle with the other hand and slowly pull pessary out while maintaining the suction at a minimum
- Tip: can bear down to lower the pessary in order to help reach above the disk. Turn the disk to a 45* vertical angle so you are not withdrawing it horizontally
Correct Fitting
- No feeling of heaviness, pain, bulge, or the pessary
- Better urine and stool evacuation
- Better quality of life
Incorrect Fitting/Reconsider use of Pessary
- Pain or difficulty urinating or defecating
- Unusual secretions (odour, color, quantity)
- UTI symptoms
- Itching
- Blood on the pessary or vaginal bleeding
- Discomfort or pain at rest or with effort
- Not sure if it is positioned well (just doesn’t feel right)
Cube Pessary Insertion and Removal Instructions
Insertion
- Wash your hands
- Position: half squat, one foot on a stool, lying
- Apply lubricant (preferably organic, paraben and glycerin-free, water-based (not silicone)) to all edges of the cube
- Spread the lips of your vagina apart with one hand and orient the cube so that it enters the base of the vagina by 1 of the 8 corners
- Squeeze the cube as you slowly rotate it into the vagina until it is completely inside
- Push the pessary deeper with 1-2 fingers of one hand while 1 finger of the other hand gently pulls the internal vaginal tissue down towards the vaginal opening
Removal
- Wash your hands. Use a glove if you feel that helps maintain a better grip
- Slide one finger along the vaginal wall
- Break the suction on one or more sides of the cube
- Slowly “unroll” the cube in the direction of the vaginal opening
- Repeat breaking the suction and unrolling until the cube is low enough to grasp with your index finger and thumb and remove fully.
- Note: do NOT remove the cube by pulling on the string. Doing this does not break the suction and can pull the tissues in a downward direction. Additionally, the string can break off, leaving a sharp edge. It is OK, however, to use one hand to apply a small amount of tension on the string as you use your other hand to break the suction and roll the cube out.
Correct Fitting
- No feeling of heaviness, pain, bulge, or the pessary
- Pessary either should not be visible or only slightly visible when labia are separated (string may be hanging outside of the vagina or tucked just inside the vaginal opening)
- Better urine and stool evacuation
- Better quality of life
Incorrect Fitting
- Pain or difficulty urinating or defecating
- Unusual secretions (odour, color, quantity)
- UTI symptoms
- Itching
- Blood on the pessary or vaginal bleeding
- Discomfort or pain at rest or with effort
- Not sure if it is positioned well (just doesn’t feel right)
Cleaning Instructions (adapted from instructions provided by pessary manufacturers):
- Prepare a cleaning solution by mixing a mild, unscented soap (such as Dawn® or equivalent) with warm tap water using the soap manufacturer’s recommended concentration. Do not use anything harsh on the pessary as it may damage it (no rubbing alcohol or boiling of the pessary). Prepare this solution in a container large enough to fully submerge the device.
- Remove pessary as per instructions.
- Run pessary under warm water and dislodge secretions by rubbing the pessary with your fingers.
- Soak the device in the container of prepared soap solution for a minimum of 5 minutes.
- Following the 5-minute soak period, scrub the device for a minimum of 15 seconds with a soft-bristled brush, such as a toothbrush. Scrub device below water line to prevent spraying.
- Following scrub, inspect device for visible soil residue.
- Remove the device from the soap solution and thoroughly rinse under flowing tap water for a minimum of 30 seconds.
- Allow to air dry or dry with a clean, non-shedding towel.
- Store in a dry, safe place (face cloth or pessary box).
- Reinsert as needed as per instructions.
- Your pessary should last 1-5 years if handled with care.
- Make it a habit to inspect your pessary for any cracks before inserting it. If you spot any, replace your pessary immediately, as cracks can harbour infection causing bacteria.
Despite the changes in place to combat COVID-19, if you experience any symptoms out of the ordinary due to use of your pessary, such as pelvic pain, vaginal bleeding, or difficulty emptying your bladder or bowels, don’t hesitate to call your physician’s office to determine if an in-person appointment is necessary.
If you would like further instruction on how to remove your pessary, feel free to give our clinic a call. We’d love to hear from you and help!
Wishing you health and happiness during this unprecedented time.
What Should You Not Do with a Pessary?
Using a pessary comes with certain responsibilities, and avoiding these actions is crucial to maintain your vaginal health and prevent potential complications. Here are the key things you should not do with a pessary:
- Do Not Insert without Medical Guidance: It is essential to consult a healthcare professional before using a pessary. They will assess your condition, recommend the appropriate type and size of pessary, and guide you on proper insertion and removal techniques.
- Avoid Self-Medication: Never attempt to insert a pessary without proper guidance or rely on online tutorials for self-treatment. Incorrect insertion can cause discomfort and worsen your condition.
- Do Not Ignore Discomfort: If you experience any discomfort, pain, or unusual symptoms while using a pessary, seek medical advice promptly. Ignoring discomfort may lead to complications and compromise the effectiveness of the treatment.
- Avoid Prolonged Wear without Cleaning: Regularly clean and maintain your pessary as advised by your healthcare provider. Prolonged wear without proper cleaning can lead to infections and other complications.
- Do Not Ignore Signs of Infection: If you notice any signs of infection, such as foul-smelling discharge or itching, remove the pessary and contact your healthcare provider immediately.
- Avoid Using Vaseline: While lubrication may be necessary during insertion, avoid using Vaseline or petroleum-based products, as they can weaken the pessary material and compromise its integrity.
Can I Use Vaseline to Insert a Pessary?
No, it is not recommended to use Vaseline or petroleum-based products for pessary insertion. These substances can break down the pessary material, reducing its effectiveness and potentially causing it to lose its shape or integrity. Instead, use water-based lubricants as recommended by your healthcare professional. These lubricants are safer for both you and the pessary.
How Do You Handle a Pessary?
Handling a pessary requires proper hygiene and care to ensure its effectiveness and longevity. Here are some essential tips on how to handle a pessary:
- Always wash your hands thoroughly with soap and water before inserting or removing the pessary.
- Follow your healthcare provider’s instructions for insertion and removal techniques.
- If the pessary has a knob or string for removal, make sure it is easily accessible to you.
- Avoid using sharp objects or tools to remove the pessary, as this can damage the device and harm your vaginal tissues.
How Far Up Do You Push a Pessary?
The placement of the pessary is crucial for its efficacy. Generally, the pessary should be positioned high enough to support the prolapsed organs but should not cause discomfort or pressure. The exact placement may vary based on the type and size of the pessary and your individual condition. Your healthcare provider will guide you on proper insertion to ensure optimal placement.
How Do You Know If Pessary Is Inserted Correctly?
Ensuring the correct placement of the pessary is essential for its effectiveness. Here are some indicators that the pessary is inserted correctly:
- You should not feel any discomfort or pain after insertion.
- The pessary should stay in place during daily activities, including walking, sitting, and standing.
- You should not experience any urinary or fecal incontinence while wearing the pessary.
- Regular follow-up visits with your healthcare provider can help confirm proper placement and address any concerns you may have.
Should I Be Able to Touch My Pessary?
Ideally, you should not be able to feel the pessary once it is correctly inserted. If you experience discomfort or can feel the pessary, it may not be placed optimally, or it might not be the right size for you. In such cases, consult your healthcare provider for adjustments or a different type of pessary.
How Long Does a Pessary Take to Dissolve?
Pessaries are not designed to dissolve inside the body. Instead, they are made from medical-grade materials intended for long-term use. The duration of pessary use varies based on individual needs and the type of pessary recommended by your healthcare provider.
What Is the Most Common Complication of a Pessary?
The most common complication associated with pessary use is vaginal discharge or irritation. However, these issues can often be managed with proper cleaning and care. If you experience any persistent discomfort or unusual symptoms, consult your healthcare provider for appropriate guidance.
What Infection Is Caused by a Pessary?
The prolonged use of a pessary without regular cleaning can lead to bacterial or fungal infections. Vaginal discharge with an unpleasant odor, itching, or redness may indicate an infection. Promptly remove the pessary and seek medical advice if you suspect an infection.
How Long Can You Keep a Pessary In Without Cleaning It?
It is essential to follow your healthcare provider’s recommendations for pessary maintenance and cleaning. Typically, pessaries should be removed and cleaned every one to two weeks, depending on the type and material. Avoid wearing a pessary for extended periods without cleaning, as this can increase the risk of infections.
How Long Can a Pessary Last?
The lifespan of a pessary varies depending on factors such as the material, frequency of use, and individual body chemistry. Some pessaries can last up to several months, while others may need replacement more frequently. Regular follow-up visits with your healthcare provider will help assess the condition of the pessary and determine if a replacement is needed.
Can Pessaries Cure Yeast Infection?
Pessaries are not a cure for yeast infections. However, they may help manage symptoms of pelvic organ prolapse or stress urinary incontinence, which can be exacerbated by infections. If you suspect a yeast infection, consult your healthcare provider for appropriate treatment.
Is It Normal to Have Discharge When You Have a Pessary?
A certain amount of vaginal discharge is normal and common while using a pessary. However, if the discharge is excessive, foul-smelling, or accompanied by itching, it may indicate an infection. In such cases, seek medical advice promptly.