A pessary is a medical device, typically made of silicone, that is inserted into the vagina to provide support to the pelvic organs or for other therapeutic functions. These devices are used as a non-surgical treatment for conditions such as pelvic organ prolapse, where organs like the uterus or bladder descend from their normal position. They are also sometimes used to help manage stress urinary incontinence by supporting the urethra. The availability of these devices, whether requiring a prescription or being sold over the counter, is a common question.
Understanding Pessary Availability
Pessaries used for pelvic support are regulated as Class II medical devices by the Food and Drug Administration (FDA) in the United States. This classification indicates that the devices require special controls to ensure their safety and effectiveness. Due to this regulatory status, supportive pessaries are not available for purchase over the counter.
The requirement for a prescription stems from the specialized nature of the device and the potential for harm if used improperly. A healthcare provider must first diagnose the underlying condition before a pessary can be considered. Attempting to self-diagnose and insert an improperly sized pessary could lead to complications like vaginal wall erosion, ulceration, or infection.
The fitting of a pessary requires professional expertise to accurately measure the vagina’s length and width. An ill-fitting device will either fall out or cause discomfort and potential tissue damage. This need for precise sizing and medical supervision makes the devices unsuitable for general retail sale.
Medical and Contraceptive Pessary Differences
The term “pessary” can refer to devices with distinct medical purposes. Support pessaries are designed to physically hold up pelvic organs, typically made from medical-grade silicone in various shapes like rings, cubes, or Gellhorn styles. These devices are intended for long-term use and require periodic cleaning and re-evaluation by a clinician.
In contrast, barrier contraceptive devices, such as diaphragms and cervical caps, are also technically a type of pessary but function by blocking sperm entry to the cervix. While some older references might use the term “contraceptive pessary,” the devices are functionally different from support devices. Diaphragms and cervical caps have generally required a fitting by a healthcare provider to ensure they cover the cervix completely.
Some vaginal preparations, such as those containing hormones like estradiol to treat vaginal atrophy, are also sometimes called pessaries but are actually medicinal tablets inserted into the vagina. These hormonal preparations are medications and strictly require a prescription. Devices or medications inserted deep into the vagina for a therapeutic purpose usually necessitate medical oversight to confirm the correct indication, dosage, or fit.
Steps for Obtaining a Prescribed Pessary
Since supportive pessaries are not available over the counter, the first step in obtaining one is consulting a healthcare provider, such as a gynecologist, urogynecologist, or nurse practitioner specializing in women’s health. The provider will conduct a thorough pelvic examination to assess the condition, which informs the selection of the most appropriate pessary style. The examination often involves measuring the distance from the pubic bone to the back of the vagina to estimate the required size.
The process of finding the right fit is often one of trial and error, as the correct size cannot always be determined on the first attempt. The provider will insert a trial size and then ask the patient to perform activities like coughing or bearing down to test if the device stays in place without causing discomfort. A correctly fitted pessary should relieve symptoms and not be noticeable during normal activities.
Once a comfortable and effective pessary is found, the patient is instructed on the care regimen, which may include learning how to insert, remove, and clean the device at home. For patients who cannot manage the device themselves, follow-up appointments are scheduled for the provider to remove, clean, and reinsert the pessary, typically every few months. Regular follow-up is necessary to monitor the vaginal tissue for any signs of irritation or erosion and to ensure the pessary maintains its effectiveness.