Insertion and Removal of a Vaginal Pessary

Insertion and Removal of a Vaginal Pessary

This leaflet is written to answer some of the frequently asked questions about vaginal
pessaries and to provide you with information.

Following your appointment with your Consultant or Specialist Nurse it was decided that
a vaginal pessary may be the best treatment for your vaginal wall or uterine prolapse.

What is a prolapse?
Sometimes the pelvic floor muscles and ligaments become weak and are no longer able
to support the pelvic organs such as bladder, bowels and uterus (womb), this is called
pelvic organ prolapse. Childbirth, ageing, menopause, long term cough and long term
constipation can weaken the pelvic floor resulting in a prolapse, this is not a life
threatening condition but can cause some significant discomfort.

What is a vaginal pessary?
A vaginal pessary is a device that is inserted into the vagina to hold the vaginal walls in
place and support a prolapsed womb, supporting tissues that have become weak.

Types of pessaries
There are different types of pessaries they are made of silicone, latex or vinyl and are
available in different shapes and sizes. It is not always possible to choose the correct
size or shape straight away and your Consultant or Specialist Nurse may need to try a
different size or shape until the correct one is found to give you the most benefit. When
your pessary fits comfortably you will be seen for further follow up in hospital or your
Doctors Surgery.

• Ring pessary – a round flexible ring that come in various sizes (often white in
  colour) and is usually managed by your GP
• Shelf pessary – A hard plastic device that may be used when a ring pessary is not
  suitable (can be black or purple)
• Pink Milex pessary – Similar to shelf pessaries, variable shapes are available,
  these are softer and can be used when a ring pessary is not suitable (Pale pink in
  colour)

*the images used in this leaflet were supplied by mediplus

Why did the Doctor or Specialist Nurse suggest a pessary?
The use of a pessary may be suggested to alleviate or relieve your symptoms of
prolapse if:

• You are unfit for surgery
• You have decided not to have surgery
• You need a temporary method to manage your prolapse while you are waiting for
  surgery
• You are pregnant or would like to have more children

Does the insertion/removal of the pessary hurt?
You may feel some discomfort during the insertion or removal but this should soon
resolve.

Will I be able to feel the pessary once it is in place?
Once the pessary is in place you should not be able to feel it. If you feel any discomfort
it may be that you need a different size of pessary.

Are there any risks or side effects of having a vaginal pessary?
It is highly unlikely that a pessary will cause serious risks as long as regular checks and
changes are performed as recommended below. Some women may have vaginal
dryness, discharge, irritation, erosions or bleeding. These can often be treated with local
oestrogen cream or antibiotics. The pessary may be removed while you are receiving
treatment and left out for a short period of time.

Will my pessary fall out?
After the insertion of a pessary you will be asked to cough, walk around the clinic and
pass urine before you leave to ensure that the pessary is fitting properly. If the pessary
falls out while passing urine, having a bowel movement or been active it may be that
you require a different size or style. Your Consultant or Specialist Nurse will be able to
advise you.

It is important that you avoid becoming constipated, if this is a problem a change in diet
or extra fluids may help. If constipation continues to be a problem, then your GP may
prescribe some medication to help keep your bowels regular. It may help to support the
perineum and cover the vaginal opening with your hand using a pad of tissue when
opening your bowels to help prevent the pessary from falling out.

Sometimes the pessary may affect bladder function, you may experience new urinary
incontinence or it may reduce existing urinary incontinence. If this happens then you
should inform your Consultant or Specialist Nurse so that they can help to manage your
problem.

Your pessary must be checked every 3 to 6 months or an interval decided by your
Consultant or Specialist nurse. It is important you attend these to check that the pessary
has not caused any soreness to the vaginal tissues. If the tissues remain healthy the
pessary will be washed and replaced.

Sexual intercourse
This depends on the style of the pessary; the majority of couples are able to have sexual
intercourse with a ring pessary inside the vagina. Other pessaries such as a Pink Milex
or shelf pessary are generally not compatible with sexual intercourse. It is possible to
teach you to remove and insert some pessaries so that you can remove them for
intercourse.

You should contact your Consultant or Specialist Nurse for initial advice if:

• Your pessary falls out
• You develop an offensive vaginal discharge
• You notice any unexpected vaginal bleeding
• You experience any discomfort
• You develop difficulty in passing urine or opening your bowels after pessary
  insertion.

You can contact the Urogynaecology Specialist Nurses on 01905 733437 who are
available Monday – Friday.

If it is out of hours or you are unable to contact the Nurses then please call the
Emergency Gynaecology Assessment Unit on 01905 761489.

If your symptoms or condition worsens, or if you are concerned about anything,
please call your GP, 111, or in an emergency 999.

If your symptoms or condition worsens, or if you are concerned about anything,
please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you
and your loved ones. If you have any questions or concerns, please do speak with a
member of staff on the ward or in the relevant department who will do their best to
answer your questions and reassure you.

Feedback
Feedback is really important and useful to us – it can tell us where we are working well
and where improvements can be made. There are lots of ways you can share your
experience with us including completing our Friends and Family Test – cards are
available and can be posted on all wards, departments and clinics at our hospitals. We
value your comments and feedback and thank you for taking the time to share this with
us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the
nurse in charge or the department manager in the first instance as they are best placed
to answer any questions or resolve concerns quickly. If the relevant member of staff is
unable to help resolve your concern, you can contact the PALS Team. We offer informal
help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf,
if you feel unable to do so, to resolve your problems and where appropriate refer to
outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate
your concerns. You can make a complaint orally, electronically or in writing and we can
advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: [email protected]

Opening times:
The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please
be aware that you may need to leave a voicemail message, but we aim to return your
call within one working day

If you are unable to understand this leaflet, please communicate with a member of staff.

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