A pessary is a removable medical device inserted into the vagina, designed to provide mechanical support to the pelvic organs. It is a non-surgical option for managing symptoms related to pelvic organ prolapse, which occurs when organs like the bladder or uterus descend from their normal position. Pessaries are also commonly used to treat stress urinary incontinence by supporting the urethra.
Core Physical Characteristics
Most modern pessaries share several core characteristics. They are typically made from soft, medical-grade silicone, a material chosen for its flexibility, durability, and biological inertness within the body. This silicone construction makes the device smooth and non-absorbent, preventing the retention of vaginal fluids or odors. The color is often translucent, white, or light beige, designed to be discreet and easily maintained.
While the material is soft enough to be compressed for insertion and removal, it maintains enough inherent rigidity to provide the necessary structural support. This balance of flexibility and firmness ensures both patient comfort and therapeutic effectiveness. The devices are sized according to the diameter or circumference, ranging significantly to accommodate the diverse anatomy and needs of each patient.
The Spectrum of Shapes and Forms
The appearance of a pessary is highly varied because its shape is specifically matched to the anatomical need and the severity of the condition being treated. Pessaries are broadly classified into two categories: supportive and space-filling. Supportive pessaries are generally used for milder cases of prolapse or for stress incontinence.
The most common type is the Ring pessary, which looks like a thick, flexible bracelet or a simple O-shape, often featuring small drainage holes. The Donut pessary is a similar, but thicker, solid circular shape used when more volume is needed for support. Other supportive shapes include:
- Shaatz pessary, which is a flat disk without a central protrusion.
- Hodge pessary, which is an elongated oval that can be molded into a U-shape for specific anatomical fits.
Space-filling pessaries are reserved for more advanced cases of pelvic organ prolapse that require substantial support. The Cube pessary is a distinct example, having a cubic shape with concave sides that use suction to adhere to the vaginal walls and prevent slippage. This design, which resembles a small, soft die, requires daily removal and cleaning due to its space-occupying function. Another space-filling option is the Gellhorn pessary, which is a flat, circular disk featuring a small knob or stem in the center to stabilize the device high in the vagina.
Distinguishing Pessaries from Other Devices
Unlike an intrauterine device (IUD), which is a small, T-shaped object placed inside the uterus for contraception, a pessary is much larger and sits within the vaginal canal. It is designed for external structural support, not internal hormonal or barrier contraception. A pessary is also distinct from a contraceptive diaphragm, which is a shallow, dome-shaped device used with spermicide to cover the cervix. Menstrual cups are bell-shaped and designed for fluid collection during menstruation. The pessary’s various shapes are built for structural elevation and stabilization of the pelvic organs.
The final look of a pessary is determined by the precise fitting process, which is conducted by a healthcare provider. They measure the size of the vaginal canal and the degree of prolapse to select the correct diameter and shape. A pessary that is too small might easily be expelled, while one that is too large can cause uncomfortable pressure, confirming that the proper fit is as important as the design itself.