A pessary is a soft, non-absorbent silicone medical device inserted into the vagina to provide structural support to the pelvic organs. This non-surgical treatment manages symptoms of pelvic organ prolapse, such as when the bladder, uterus, or rectum descend into the vaginal canal. Pessaries are also an effective option for treating stress urinary incontinence, which involves involuntary urine leakage during physical activities. This article clarifies the regulatory status of these devices and outlines the necessary professional steps required to safely acquire and use a pessary.
The Prescription Status of Pessaries
Traditional, medical-grade pessaries are not available over the counter in the United States, the United Kingdom, or most developed healthcare systems. These devices are classified as medical instruments requiring a healthcare provider’s prescription and professional fitting. This regulation protects the patient from potential harm, as improper use or sizing carries genuine health risks. The classification ensures the patient receives a thorough pelvic examination and diagnosis before the device is used. While most therapeutic pessaries are prescription-only, a few specific products designed for stress incontinence are sometimes marketed as over-the-counter options. These are usually simpler, single-use supports aimed solely at urethral positioning, distinct from the reusable medical pessaries used for complex prolapse management.
The Necessity of Professional Sizing and Fitting
The requirement for a prescription stems directly from the fitting process. A pessary must be tailored to the patient’s unique anatomy and the specific condition being treated, which is determined through a physical examination. The healthcare provider assesses the length and width of the vaginal canal and the severity of the organ prolapse to determine the correct size and shape.
Pessaries come in many shapes, including the common ring, the space-filling Gellhorn or cube, and the U-shaped Gehrung. Each shape suits different clinical needs. For example, a simple ring pessary is often suitable for mild to moderate prolapse and stress incontinence, while a cube or Gellhorn is reserved for more severe cases. Choosing the wrong shape or size can lead to significant complications.
If a pessary is too small, it will fail to provide adequate support and may be easily expelled from the vagina during normal activities. Conversely, a device that is too large can cause intense discomfort, tissue erosion, ulceration, and vaginal bleeding due to excessive pressure.
The fitting process is often a careful trial-and-error procedure requiring multiple in-office attempts. The goal is to find a device that stays securely in place while remaining completely unnoticeable to the patient. A correctly fitted pessary should not interfere with urination or defecation, requiring functional testing immediately after placement.
Steps to Obtain and Manage a Pessary
The process of obtaining a pessary begins with an initial consultation with a specialized healthcare provider, such as an obstetrician-gynecologist (OB/GYN) or a urogynecologist. During this appointment, the provider performs a comprehensive pelvic examination to accurately diagnose the condition. This determines if a pessary is the most appropriate treatment and helps decide on the best type of support.
Fitting and Confirmation
The provider begins the trial fitting process using sizing rings or devices to find the optimal fit. Once a size and shape are selected, the device is inserted. The patient is then asked to perform maneuvers like walking, squatting, or coughing to confirm the pessary remains stable and comfortable. The patient must also be able to empty their bladder completely with the device in place.
Long-Term Management
Successful long-term use requires regular care. If the patient can self-manage, they are instructed to clean the device daily or weekly using mild soap and water. For patients who cannot self-manage, the provider must remove, clean, and reinsert the device during regular office visits, usually scheduled every three to six months.
Patients must monitor for signs that the device is causing issues. These symptoms may indicate an infection or tissue irritation:
- New or increasing pain.
- Foul-smelling discharge.
- Vaginal bleeding.
- Signs of tissue irritation.
The provider may prescribe a low-dose vaginal estrogen cream for postmenopausal patients to maintain the health of the vaginal tissue. Regular follow-up appointments are mandatory to monitor the tissue and ensure the pessary continues to fit correctly.