Hubbry Logo
PessaryPessaryMain
Open search
Pessary
Community hub
Pessary
logo
7 pages, 0 posts
0 subscribers
Be the first to start a discussion here.
Be the first to start a discussion here.
Pessary
Pessary
Pessary
View on Wikipedia
from Wikipedia
Gold-plated stem pessary (intrauterine device) from 1920

A pessary is a prosthetic device inserted into the vagina for structural and pharmaceutical purposes. It is most commonly used to treat stress urinary incontinence to stop urinary leakage and to treat pelvic organ prolapse to maintain the location of organs in the pelvic region.[1] It can also be used to administer medications locally in the vagina or as a method of contraception.

Pessaries come in different shapes and sizes, so it is important that individuals be fitted for them by health care professionals to avoid any complications.[1] However, there are a few instances and circumstances that allow pessaries to be purchased without a prescription or without seeking help from a health care professional.[2] Some side effects may occur if pessaries are not sized properly or regularly maintained, but with the appropriate care, pessaries are generally safe and well tolerated.[3]

History

[edit]
An assortment of pessaries

Early use of pessaries dates back to the ancient Egyptians, as they described using pessaries to treat pelvic organ prolapse.[3] The term 'pessary' itself is derived from the Ancient Greek word pessós, meaning round stone used for games.[4][5] Pessaries are even mentioned in the oldest surviving copy of the Greek medical text, the Hippocratic Oath, as something that physicians should never administer for the purposes of an abortion: "Similarly I will not give to a woman a pessary to cause abortion."[6] The earliest documented pessaries were natural products. For example, Greek physicians Hippocrates and Soranus described inserting half of a pomegranate into the vagina to treat prolapse.[3] It was not until the 16th century that the first purpose-made pessaries were made.[5] For instance, in the late 1500s, Ambroise Paré was described as making oval pessaries from hammered brass and waxed cork. Nowadays, pessaries are generally made from silicone and are well tolerated and effective among patients who need them.[3]

Medical uses

[edit]

Pelvic organ prolapse

[edit]

The most common use for pessaries is to treat pelvic organ prolapse. A pelvic organ prolapse can occur when the muscles and tissues surrounding the bladder, uterus, vagina, small bowel, and rectum stop working properly to hold the organs in place and the organs begin to drop outside the body. The most common cause of such prolapse is childbirth, usually multiple births. Obesity, long-term respiratory problems, constipation, pelvic organ cancers, and hysterectomies can all be causes for pelvic organ prolapses as well.[7] Some signs and symptoms include feeling pressure in the pelvic area, lower back pain, painful intercourse, urinary incontinence, a feeling that something is out of place, constipation, or bleeding from the vagina.[7] Pessaries are manual devices that are inserted into the vagina to help support and reposition descended pelvic organs, which helps to prevent the worsening of prolapse, helps with symptom relief, and can delay or prevent the need for surgery.[3][5] Further, pessaries can be used for surgery preparation as a way to maintain prolapse without progression.[3] This is especially useful when a surgery may need to be delayed.[3]

Stress urinary incontinence

[edit]

Stress urinary incontinence is leakage of urine that is caused by sudden pressure on the bladder. It occurs during activities that increase the amount of pressure on the bladder such as coughing, sneezing, laughing, and exercising.[8] The pressure causes opening of the sphincter muscles which usually help prevent urine leakage. Stress urinary incontinence is a common medical problem, especially in women; about 1 in 3 women are affected by this condition at some point in their lives.[8] Pessaries are considered a safe non-surgical treatment option for stress urinary incontinence, as they can control the urine leakage by pushing the urethra closed. Pessaries can be removed at any time.[8][9]

Other

[edit]

Some additional uses for pessaries are for an incarcerated uterus, prevention of preterm birth and an incompetent cervix.[3][10] In early pregnancy the uterus can be displaced, which can lead to pain and rectal and urinary complications.[3] A pessary can be used to treat this condition and support the uterus.[3] Preterm birth is when babies are born prematurely, which puts the baby at increased risk for complications and even death. Currently, the use of pessaries to help prevent preterm birth is an ongoing area of research.[10] The use of pessaries for an incompetent cervix is not commonly practiced today, but they have been used in the past.[3] Specifically, an incompetent cervix is when the cervix begins to open up prematurely.[11] This can lead to a preterm birth or even a miscarriage. Pessaries can be used to correctly position the cervix, increasing the success of pregnancy.[3]

Types of pessaries

[edit]
Different types of pessaries

Therapeutic pessaries

[edit]

A therapeutic pessary is a medical device similar to the outer ring of a diaphragm. Therapeutic pessaries are used to support the uterus, vagina, bladder, or rectum.[12] Pessaries are most commonly used for pelvic organ prolapse and considered a good treatment option for women who need or desire non-surgical management or future pregnancy.[12] It is used to treat prolapse of uterine, vaginal wall (vaginal vault), bladder (cystocele), rectum (rectocele), or small bowel (enterocele). It is also used to treat stress urinary incontinence.[13]

There are different types of pessaries but most of them are made out of silicone—a harmless and durable material.[14] Pessaries are mainly categorized into two types, supporting pessaries and space-occupying pessaries.[5] Support pessaries function by supporting the prolapse and space-occupying pessaries by filling the vaginal space.[3] There are also lever type pessaries.[15]

Support pessary

[edit]

Ring with support pessaries are the supporting type.[5] These are often used as a first-line treatment and used for earlier stage prolapse since individuals can easily insert and remove them on their own without a doctor's help. These can be easily folded in half for insertion.[12][14]

Gellhorn pessaries are considered a type of supporting and space-occupying pessary.[5] These resemble the shape of a mushroom and are used for more advanced pelvic organ prolapse.[5][14] These are less preferred than ring with support pessaries due to difficulty with self-removal and insertion.[14]

Marland pessaries are another type of supporting pessary.[12] These are used to treat pelvic organ prolapse as well as stress urinary incontinence.[12] These pessaries have a ring at their base and a wedge-shaped ridge on one side.[14] Although these pessaries are less likely to fall out than standard ring with support pessaries, individuals find it difficult to insert or remove them on their own.[14]

Space-occupying pessary

[edit]

Donut pessaries are considered space-occupying pessaries.[5] These are used for more advanced pelvic organ prolapse including cystocele or rectocele as well as a second or third-degree uterine prolapse.[12] Due to its shape and size, it is one of the hardest ones to insert and remove.[14]

Cube pessaries are space-occupying pessaries in the shape of a cube that are available in 7 sizes. The pessary is inserted into the vagina and kept in place by the suction of its 6 surfaces to the vaginal wall. Cube pessaries must be removed before sexual intercourse and replaced daily.[5] Cube pessaries are generally used as a last resort only if the individuals cannot retain any other pessaries.[3] This is due to undesirable side effects such as vaginal discharge and erosion of the vaginal wall.[3][5] In order to remove the cube pessary, the suction must be broken by grasping the device.[3]

Gehrung pessaries are space-occupying pessaries that are similar to the Gellhorn pessaries.[3] They are silicone devices that are placed into the vagina and used for second or third degree (more severe) uterine prolapse. These contain metal and should be removed prior to any MRI, ultrasound or X-rays. They can also be used to help with stress urinary incontinence such as urine leaks during exercising or coughing. These types of pessaries need to be fitted by a health care professional to ensure proper size. Once placed it should not move when standing, sitting, or squatting. It should be cleaned with mild soap and warm water every day or two.[16]

Lever pessary

[edit]

Hodge pessaries are a type of lever pessary. Although these can be used for mild cystocele and stress urinary incontinence, they are not commonly used. Smith, and Risser pessaries are other types of lever pessaries and they differ in shape.[14][15]

Pharmaceutical pessaries

[edit]

Treating vaginal yeast infections is one of the most common uses of pharmaceutical pessaries. They are also known as vaginal suppositories, which are inserted into the vagina and are designed to dissolve at body temperature. They usually contain a single use antifungal agent such as clotrimazole. Oral antifungal agents are also available.[17]

Pessaries can also be used in a similar way to help induce labor for women who have overdue expected delivery dates or who experience premature rupture of membranes. Prostaglandins are usually the medication used in these kinds of pessaries in order to relax the cervix and promote contractions.[18]

According to Pliny the Elder, pessaries were used as birth control in ancient times.[19]

Occlusive pessaries

[edit]
Main article: Cervical cap
See also: Womb veil

Occlusive pessaries are most commonly used for contraception. Also known as a contraceptive cap, they work similar to a diaphragm as a barrier form of contraception. They are inserted into the vagina and block sperm from entering the uterus through the cervix. The cap must be used in conjunction with a spermicide in order to be effective in preventing pregnancy. When used correctly the cap is thought to be 92–96% effective. These caps are reusable but come in different sizes. It is recommended for anyone attempting this form of contraception to be fitted for the correct size by a trained health care professional.[20]

Stem pessary

[edit]

The stem pessary, a type of occlusive pessary, was an early form of the cervical cap. Shaped like a dome, it covered the cervix, and a central rod or "stem" entered the uterus through the external orifice of the uterus, also known as the cervical canal or the os, to hold it in place.[21]

Side effects and complications

[edit]
Pessary covered in phosphate after being left in the vagina for an extended time

When pessaries are used correctly, they are tolerated well for pelvic organ prolapse or stress urinary incontinence.[22] However, pessaries are still a foreign device that is inserted into the vagina, so side effects can occur.[23] Some more common side effects include vaginal discharge and odor.[12] Vaginal discharge and odor may be associated with bacterial vaginosis, characterized by an overgrowth of naturally occurring bacteria in the vagina.[24] These symptoms can be treated with the appropriate medications.

More serious side effects include fistula formation between the vagina and rectum or the vagina and bladder, or erosion, or thinning, of the vaginal wall.[12] Fistula formation is rare, but erosion of the vaginal wall occurs more frequently. Low estrogen production can also increase the risk of vaginal wall thinning.[25] For individuals with pessaries that are not fitted for them, herniations of the cervix and uterus can occur through the opening of the pessary. This can lead to tissue necrosis in the cervix and uterus.[23] To prevent these side effects, individuals can be fitted properly for their pessaries and undergo routine follow-up visits with their health care professionals to ensure the individual has the correct pessary size and no other complications.[12] In addition, those with an increased risk of vaginal wall thinning can be prescribed estrogen to prevent erosion and prevent these complications.[3]

If pessaries are not used properly or not maintained periodically, more serious complications can occur. For example, the pessary can become embedded into the vagina, which makes it harder to remove. Estrogen can decrease the inflammation of the vaginal walls and promote skin cells in the vagina to mature, so use of estrogen cream can allow removal of the pessary more easily.[23] In rare cases, pessaries would need to be removed through surgical procedures.[3]

To prevent complications, individuals should not use pessaries if they have characteristics that exclude them from this method of therapy. Contraindications to pessary use include current infections in the pelvis or vagina, or allergies to the material of the pessary (which can be silicone or latex).[13] In addition, individuals should not be fitted for a pessary if they are less likely to properly maintain their pessary.

See also

[edit]

References

[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia

Pessary

View on Grokipedia
from Grokipedia
A pessary is a removable prosthetic device inserted into the to provide structural support for pelvic organs, primarily to manage (POP) and, in some cases, stress urinary incontinence (SUI). These devices, typically made of medical-grade or rubber, come in various shapes such as ring, Gellhorn, or space-filling types, tailored to the patient's and condition severity. Pessaries have ancient origins, with descriptions of similar devices in Egyptian papyri and used by for uterine support, initially crafted from materials like fruits, cork, or metals before evolving to modern biocompatible polymers in the . They offer a non-surgical alternative to for symptomatic POP, with evidence indicating symptom relief in many patients and long-term tolerability when properly fitted and maintained. Common side effects include and odor, while rare complications such as erosions, fistulas, or infections underscore the need for regular follow-up to ensure safety and efficacy. Self-management protocols have shown potential to reduce complications compared to clinic-only care, though professional oversight remains essential.

Historical Development

Ancient Origins and Early Uses

The earliest documented references to pessaries appear in ancient Egyptian medical texts, where they were employed to address uterine prolapse. The Ebers Papyrus, dating to approximately 1550 BCE, describes symptoms consistent with pelvic organ descent and recommends inserting cup- or ring-shaped devices into the vagina to alleviate discomfort and support displaced organs. These rudimentary pessaries likely consisted of natural materials such as softened papyrus or linen soaked in medicinal substances, reflecting an empirical approach to mechanical support rather than surgical intervention. In , around the 5th century BCE, physicians expanded on these concepts, with and his followers documenting pessary use for . One method involved inserting half a into the , as noted by the physician Polybus, to provide occlusion and astringent effects that purportedly reduced swelling and repositioned the uterus. Greek texts also describe pessaries fashioned from wool tampons impregnated with hot oils or astringents, or even -shaped stones—whence the term "pessary" derives from the Greek pessos, meaning an oval pebble. These devices aimed to mechanically elevate tissues while delivering topical therapies, though efficacy relied on rudimentary anatomy and trial-based observations rather than systematic validation. Roman medical writers, building on Greek traditions by the 1st century CE, continued pessary applications for and related conditions like , using similar materials including cork, metal, or vegetable-based inserts. Authors such as advocated for supportive pessaries to prevent further descent, emphasizing gentle insertion to avoid irritation. Early uses thus centered on non-invasive symptom relief for disorders, predating formal gynecology and highlighting a persistent reliance on intravaginal mechanical aids across Mediterranean civilizations.

Evolution in Modern Gynecology

In the early , pessaries reached peak popularity in gynecology, with over 100 varieties available around 1900 for treating and malposition. Innovations included the 1902 by Carl Hollweg for a wishbone-shaped pessary designed to support the and prevent abnormal descent. Materials transitioned from rigid substances like cork, , and gold-plated stems to more flexible rubber, reducing complications such as and while resembling contemporary designs. By the mid-, pessary use declined sharply due to advancements in surgical techniques, including hysterectomies and reconstructive procedures, which offered perceived permanency over conservative management. Despite this, pessaries persisted as a non-invasive option, particularly for patients unfit for . The resurgence began in the late , driven by an aging population, increasing prevalence, and preference for reversible treatments avoiding operative risks. Modern pessaries predominantly employ medical-grade silicone, valued for its , durability, and ease of sterilization compared to earlier rubber or iterations. Designs evolved into specialized forms like ring, Gellhorn, and pessaries, tailored to prolapse stage and , with success rates for symptom relief reported at 60-90% in clinical studies. Recent innovations include self-removable models to enhance patient autonomy, 3D-printed custom fits for improved efficacy in complex cases, and hormone-eluting variants, such as estriol-releasing pessaries sustaining delivery over three months to mitigate vaginal . Collapsible prototypes have also emerged, demonstrating safety and effectiveness in short-term trials for reduction. These developments underscore a shift toward personalized, minimally invasive care in contemporary gynecology.

Mechanism of Action

Biomechanical Support Principles

Pessaries operate as passive mechanical devices that provide support to the walls and pelvic organs by occupying space within the and exerting counterforces against prolapse-inducing pressures. These devices counteract gravitational pull and transient increases in intra-abdominal pressure, such as those occurring during Valsalva maneuvers, by repositioning descended organs toward their anatomical norms. The primary biomechanical principle involves the redistribution of mechanical loads from weakened structures to the pessary's supportive framework, thereby reducing strain on ligaments and muscles. Support mechanisms vary by pessary design, with space-occupying types, such as Gellhorn or donut shapes, functioning through volumetric filling that elevates vaginal walls and prevents further descent by limiting organ migration. Ring pessaries, conversely, leverage anatomical landmarks: the anterior rim abuts the for anterior stability, while the posterior aspect engages the sacrospinous ligaments or muscles, creating a fulcrum that transmits upward forces to the vaginal apex. This lever action distributes compressive and tensile forces across the pelvic diaphragm, mimicking natural supportive tensions but externally. Material properties, typically medical-grade with hyperelastic behavior, allow deformation under load while maintaining restorative shape, as modeled in finite element analyses simulating tissue-pessary interactions. Biomechanical efficacy depends on precise fitting to match vaginal dimensions and stage, ensuring adequate contact pressure without erosion; studies indicate that properly fitted devices reduce displacement by paralleling and resisting downward motions observed in dynamic . However, pessaries do not alter underlying tissue , such as muscle contractility or elasticity, serving instead as adjuncts that defer progression rather than resolve causative weaknesses. Custom designs incorporating patient-specific stiffness and geometry, enabled by , optimize load-bearing by aligning with individual mechanics.

Physiological Interactions

Vaginal pessaries interact with primarily through mechanical support that alters force distribution on weakened tissues and muscles, potentially influencing muscle function and local tissue responses. By occupying vaginal space and elevating prolapsed organs, pessaries reduce chronic strain on the , which may facilitate improved contractile efficiency in muscles such as the puborectalis. A prospective study of women with found a 2.1% increase in puborectalis displacement during contraction (from 17.2% to 19.0%) after three months of pessary use, with more pronounced effects (2.7% increase) in those without levator avulsion, suggesting enhanced muscle shortening without significant changes in hiatal area during contraction. This adaptation likely stems from reduced resting load, allowing better muscle recruitment, though hiatal area at rest increased slightly by 3.0% overall (4.1% in non-avulsed cases), indicating possible subtle widening of the levator hiatus. Tissue-level interactions involve direct contact with vaginal mucosa, where sustained pressure can induce physiological changes including , increased discharge, and . Erosions arise from and localized ischemia in compressed areas, exacerbated by higher vaginal and dysbiotic shifts, which correlate with and impaired epithelial integrity. Postmenopausal women with atrophic mucosa are particularly susceptible, as thinner heightens ulceration risk, often mitigated by topical to restore tissue resilience and vascularity. Pessary-induced discharge, reported in up to 20% of users, reflects altered vaginal dynamics, with frequent anaerobic overgrowth leading to if removal intervals exceed weekly checks. Broader physiological effects include potential impacts on and continence pathways, where support reduces bulge symptoms and urethral hypermobility, indirectly enhancing pelvic nerve feedback and muscle coordination for stress . However, complications like ulceration or formation, though rare (affecting <5% with proper fitting), underscore the need for monitoring to prevent chronic inflammation or adhesion formation. No evidence supports pessary-induced pelvic floor atrophy; instead, by offloading dysfunctional supports, it may permit concurrent muscle strengthening via exercises, preserving or improving long-term neuromuscular integrity.

Clinical Indications

Pelvic Organ Prolapse Management

Pessaries serve as a primary non-surgical intervention for managing symptomatic pelvic organ prolapse (POP), mechanically supporting prolapsed organs such as the uterus, bladder, or rectum to alleviate symptoms including vaginal bulge, pelvic pressure, and urinary or bowel dysfunction. Clinical guidelines recommend pessaries for women with stage II-IV POP who prefer conservative management or are poor surgical candidates due to comorbidities or age. Ring-shaped silicone pessaries are most commonly fitted for POP, with success depending on proper sizing and patient tolerance. Evidence from a 2022 systematic review and meta-analysis of eight studies involving 627 patients demonstrated significant symptom relief, with mean reductions in Pelvic Floor Distress Inventory-20 scores of -46.1 points (95% CI -65.4 to -26.8) and Pelvic Floor Impact Questionnaire-7 scores of -36.0 points (95% CI -46.0 to -26.0) after pessary use, primarily over 3-month follow-ups in women averaging 63 years old with mostly stage II-III prolapse. Initial symptom resolution occurs in 70-90% of users within 2-4 months, though long-term adherence varies, with a median duration of 3.3 years and only 47% continuing use over 15 years in a retrospective cohort. Factors associated with discontinuation include patient preference for surgery (30% within median 19 weeks), discomfort, and erosion, while self-management training improves retention and satisfaction without increasing complications.00503-5/fulltext) In a 2022 noninferiority randomized trial (PEOPLE) of 440 Dutch women with symptomatic POP, pessary treatment yielded subjective improvement in 76.3% at 24 months, compared to 81.5% with surgery, failing to meet noninferiority criteria (risk difference -6.1%; 1-sided 95% CI -12.7 to ∞). Surgery showed superior objective outcomes (83.3% vs. 70.3%) and better urinary symptom relief, but pessary had fewer serious adverse events like infections (9% surgery vs. higher discomfort/expulsion in pessary at 42.7%/20.6%), with 54% crossing over to surgery due to inadequate relief. Pessary fitting success is lower in stage IV prolapse (44.6% for ring types), emphasizing trial fittings and follow-up to assess fit and educate on hygiene to prevent vaginal erosion or odor. Despite these limitations, pessaries offer a reversible, low-risk option, particularly cost-effective for self-managed care over four years.

Stress Urinary Incontinence Treatment

Pessaries serve as a non-surgical intervention for stress urinary incontinence (SUI), a condition characterized by involuntary urine leakage during activities that increase intra-abdominal pressure, such as coughing or sneezing. Specifically, continence ring pessaries or ring pessaries with a supportive knob are positioned in the vagina to elevate and stabilize the urethra and bladder neck, thereby restoring continence by countering hypermobility or intrinsic sphincter deficiency. Clinical guidelines recognize pessaries as an initial management option for women opting for conservative therapy, particularly those unsuitable for or preferring to avoid surgery. The American Urological Association/Society of Urodynamics, Female Pelvic Medicine & Urethral Reconstruction guideline on SUI includes pessaries among nonsurgical treatments, alongside pelvic floor muscle training. Fitting success rates reach 89-92% in multicenter studies, with proper sizing and placement essential for efficacy; the device is typically inserted with the knob directed toward the urethra for targeted support. Evidence from systematic reviews and meta-analyses supports pessary efficacy, demonstrating significant reductions in SUI symptoms. A 2022 meta-analysis found pessaries effective for non-surgical SUI management, with 76% of patients reporting subjective continence post-treatment compared to 0% in untreated controls. Improvement occurs in 36-66% of cases, though outcomes vary by patient factors like prolapse stage and adherence to follow-up. In a randomized trial, pessary therapy showed noninferiority to surgical interventions for patient-reported improvement at 12 months, with a 10% noninferiority margin. Long-term use requires regular monitoring to prevent complications such as vaginal erosion, odor, or infection, which are infrequent with proper care. Studies indicate pessaries are safe for extended application, with serious adverse events rare, supporting their role as a reversible alternative to invasive procedures. However, efficacy may diminish over time without refitting, and combination with pelvic floor physiotherapy can enhance outcomes in select patients.

Contraceptive and Occlusive Applications

Pessaries have been employed as contraceptive devices since ancient times, functioning primarily as occlusive barriers to prevent sperm from reaching the cervix. In ancient Egypt around 1850 B.C., prescriptions recorded in the Petri Papyrus described pessaries composed of substances like sodium carbonate and honey, intended to block conception through physical occlusion and chemical spermicidal effects. These early formulations relied on a combination of mechanical blockage and viscous materials to adhere to the vaginal walls and cervix, though their efficacy was limited by inconsistent application and lack of standardized sizing. In the 19th and early 20th centuries, occlusive pessaries evolved into more structured barrier methods, such as the "womb veil," a rubber or diaphragm-like device inserted to cover the cervical os and impede sperm passage. The mechanism involves creating a physical seal against the cervix, often enhanced by spermicidal agents, to trap or immobilize spermatozoa; patents from the mid-20th century, like US2704068A, describe designs that generate a slight vacuum upon insertion to maintain occlusion. Advocates like promoted such pessaries in the 1910s–1920s as women-controlled methods superior to less reliable alternatives, citing Dutch clinical data from international congresses reporting failure rates as low as 2–5% with proper use, though these figures predated rigorous modern trials and likely underrepresented typical-use failures due to user error. Clinical evidence for occlusive pessaries as contraceptives remains sparse and largely historical, with modern studies focusing more on spermicide-impregnated variants than pure barriers. A 2006 Indian trial involving 3,200 women using nonoxynol-9 vaginal pessaries reported acceptability but highlighted risks of vaginal irritation and epithelial disruption, potentially increasing HIV transmission susceptibility, with no long-term efficacy data exceeding 80–90% under supervised conditions. Polyherbal pessaries combining spermicidal and antimicrobial properties have shown in vitro sperm immobilization rates over 99%, but in vivo contraceptive effectiveness trials are limited, with typical failure rates estimated at 15–20% akin to diaphragms due to displacement during intercourse or poor fit. Overall, while occlusive pessaries offer hormone-free contraception with dual protection against some infections via spermicides, their use has declined in favor of more reliable methods like intrauterine devices, given inconsistent adherence and higher unintended pregnancy risks in typical use.

Classification and Types

Support and Therapeutic Pessaries

Support pessaries provide mechanical elevation to prolapsed pelvic organs by resting against the vaginal fornices and pubic symphysis, thereby redistributing intra-abdominal pressure away from weakened pelvic floor structures. These devices are primarily indicated for symptomatic pelvic organ prolapse (POP) stages II to IV, offering a nonsurgical alternative for patients unfit for or preferring to avoid surgery. Unlike space-occupying pessaries, support types rely on vaginal wall integrity for stability rather than volumetric filling, making them suitable for milder to moderate prolapse where sufficient vaginal length and tone exist. The ring pessary, the most commonly prescribed support type, features a flexible, O-shaped silicone ring typically 6 to 10 cm in diameter, which encircles the cervix and elevates the uterus or vaginal vault. It can be fitted with or without a supportive knob for additional bladder neck elevation in cases of concomitant stress urinary incontinence (SUI). Clinical surveys indicate ring pessaries are used in over 70% of initial fittings due to their ease of insertion, patient tolerance, and low complication rates, with success rates exceeding 80% in symptom relief for anterior compartment prolapse. Shaatz pessaries resemble a ring but incorporate multiple finger-like projections extending radially to enhance circumferential support, particularly effective for cystocele or rectocele components in multi-compartment prolapse. This design increases surface contact with vaginal walls, improving stability in patients with reduced vaginal caliber. Gehrung pessaries, arched and hinged for easier insertion, provide targeted posterior support and are often selected for uterine prolapse with intact vaginal tone. Hodge pessaries, featuring a perforated stem and lever mechanism, offer precise anterior-posterior alignment but require more vaginal length and are less favored in modern practice due to higher erosion risks. All support pessaries are constructed from medical-grade silicone to minimize irritation and infection, with removal recommended every 3 to 6 months for cleaning and inspection. Therapeutic applications extend beyond mechanical support to include adjunctive roles in SUI management, where continence ring variants with drainage holes prevent pooling and ulceration while elevating the urethra. Evidence from randomized trials demonstrates pessary therapy yields 60-70% patient satisfaction in POP symptom control at 12 months, comparable to surgical outcomes in select cohorts, though long-term adherence varies from 37% to 77% influenced by provider follow-up and self-management training. Contraindications include active vaginal infection or inadequate vaginal capacity, with complications like odor or erosion occurring in under 10% of users when properly managed.

Space-Occupying and Lever Designs

Space-occupying pessaries are designed to fill the vaginal vault, thereby providing mechanical support to displaced pelvic organs by countering downward pressure from intra-abdominal forces. These devices are particularly suited for advanced pelvic organ prolapse (stages 3 and 4), where supportive ring pessaries may prove inadequate, as they create a physical barrier that elevates and stabilizes the vaginal walls, cervix, or vaginal vault. Common variants include the Gellhorn, donut, cube, and inflatable types, each tailored to specific anatomical configurations; for instance, the Gellhorn pessary features a concave disc with a drainage stem for suction-based retention, making it the most frequently prescribed space-occupying design despite challenges in self-removal due to its rigid structure. The donut pessary, resembling a toroidal ring, occupies vaginal space uniformly and is indicated for uterovaginal prolapse with an intact uterus, allowing potential intercourse if removed, though it requires precise sizing to avoid erosion. Cube pessaries, with their geometric prismatic shape, compress the levator ani muscles to approximate the introitus, offering efficacy in severe prolapse but increasing risks of ulceration from pressure points. Inflatable models, such as the Inflatoball, enable customization via post-insertion balloon expansion, facilitating easier fitting for patients with variable vaginal capacity, though deflation mechanisms demand clinician oversight to prevent retention failures. Overall, these pessaries demonstrate symptom relief in 60-90% of cases for prolapse reduction, per clinical reviews, but necessitate regular monitoring for complications like vaginal discharge or erosion. Lever pessaries represent a distinct category employing a biomechanical fulcrum mechanism, leveraging against the pubic symphysis and sacrospinous ligaments to correct uterine retroversion or mild-to-moderate prolapse (stages 1-2). Originating from 19th-century designs like the Hodge pessary, they feature curved arms that provide directional support without fully occupying vaginal space, rendering them suitable for patients with narrow introitus or flattened pubic arches where ring devices falter. Variants include the Smith pessary for narrow arches, Risser for flat arches, and standard Hodge for general retroversion, with insertion involving folding the arms for passage and subsequent expansion for retention; however, their use has declined in favor of space-occupying alternatives due to lower versatility in advanced prolapse and potential for expulsion under high intra-abdominal pressure. Efficacy data indicate adequate support in select anatomies, but long-term studies highlight higher dissatisfaction rates compared to ring or Gellhorn types, attributed to discomfort from the lever's rigidity.

Pharmaceutical and Occlusive Variants

Pharmaceutical pessaries consist of solid or semi-solid vaginal inserts formulated to deliver active pharmaceutical ingredients directly to the vaginal mucosa for localized therapeutic effects. Unlike mechanical support devices, these variants prioritize drug release mechanisms, often employing polymers or bases that dissolve or erode to facilitate absorption through the vaginal epithelium. Common applications include treatment of vaginal infections, such as candidiasis with antifungal agents like clotrimazole or miconazole, and management of postmenopausal vaginal atrophy via estrogen-releasing formulations. These pessaries enable targeted delivery, minimizing systemic exposure compared to oral routes, though efficacy depends on factors like vaginal pH, mucus layer integrity, and patient adherence to insertion protocols. Emerging innovations integrate pharmaceutical elements into customizable designs, such as 3D-printed thermoplastic polyurethane (TPU) pessaries that combine drug elution with mechanical properties for dual support and therapy in pelvic disorders. Clinical studies indicate these systems can sustain release over extended periods, potentially improving compliance for chronic conditions, though long-term data on bioavailability and safety remain limited to preclinical and early-phase trials. Regulatory approval focuses on bioequivalence to established suppository-like forms, with formulations required to demonstrate stability and uniform drug dispersion to prevent under- or overdosing. Occlusive pessaries function primarily as barrier devices that seal the cervical os to block sperm ascent, serving historical contraceptive roles rather than structural support. Developed in the 19th and early 20th centuries, examples include the Mensinga pessary, a rubber diaphragm precursor invented around 1880 by Dutch physician Eduard Martin Mensinga, and the womb veil, an American occlusive variant used to cover the cervix. These devices typically require spermicide application for enhanced efficacy, with modern analogs like the FemCap cervical cap—a silicone cup fitted over the cervix—demonstrating pregnancy prevention rates of approximately 71-86% in typical use as of 2010 data. In contemporary practice, occlusive variants have largely declined due to lower effectiveness compared to hormonal methods or intrauterine devices, with usage rates dropping significantly since the mid-20th century amid advancements in barrier contraception. Some designs incorporate dual functions, such as supporting uterine position while enabling local medication application via occlusion, as patented in 1977 for combined therapeutic occlusion. Risks include potential for displacement, allergic reactions to materials, or increased infection if not cleaned properly, underscoring the need for provider fitting and patient education. Evidence from historical cohorts supports their role in non-hormonal contraception for select populations, but systematic reviews highlight inferior outcomes versus modern alternatives.

Fitting, Insertion, and Management

Patient Selection and Sizing

Pessaries are indicated for women with symptomatic pelvic organ prolapse (POP), particularly stages II to IV, or stress urinary incontinence (SUI) exacerbated by physical activity, who prefer conservative management or face surgical risks such as advanced age, comorbidities, or desire for future pregnancy. Candidates undergo evaluation including medical history, symptom assessment, and pelvic examination with an emptied bladder to confirm prolapse extent and vaginal capacity. Guidelines recommend offering a pessary trial to all such patients, as most achieve successful fitting and symptom relief without surgery. Absolute contraindications encompass active vaginal or pelvic infections (e.g., vaginitis or pelvic inflammatory disease), severe vaginal ulceration, hypersensitivity to materials like silicone or latex, and patient inability or unwillingness to adhere to hygiene protocols and follow-up care. Relative factors complicating selection include extremely short vaginal length or prior procedures altering anatomy, such as hysterectomy, which may necessitate alternative types or preclude use in select cases. Sizing commences with digital estimation of mid-vaginal width using index and middle fingers during speculum-free exam, guiding initial selection of a support pessary like the ring (average diameter 61 mm, sizes 2 to 7) for milder POP or space-occupying Gellhorn for severe cases with wider hiatal dimensions. The optimal size accommodates the largest device without discomfort or expulsion, permitting a finger's breadth between its edge and vaginal fornices, verified in supine and standing positions with to simulate loading. Fitting success varies from 41% to 74% overall and up to 62% for stage III/IV POP, frequently requiring 2-3 iterative trials; predictors of success include longer total vaginal length and shorter perineal body. No formalized predictive models exist, relying instead on clinician experience over strict biometric criteria.

Techniques for Placement and Removal

Placement of a pessary is typically performed by a trained healthcare provider during an initial fitting to ensure proper sizing and positioning, with the patient often instructed in self-management thereafter. The procedure begins with the patient emptying her bladder to facilitate access and reduce discomfort. Water-soluble lubricant, such as KY Jelly, is applied to the leading edge of the pessary to ease insertion. For a standard ring pessary, the device is folded in half between the thumb and fingers, with the curved portion oriented toward the ceiling, then gently advanced into the vagina while separating the labia majora with the opposite hand. Once inserted, the pessary is rotated or maneuvered so that its upper rim rests behind the pubic symphysis and the lower rim supports the posterior vaginal wall or perineum, providing optimal organ support. Correct placement is verified by ensuring the device does not cause undue pressure or protrusion and allows for comfortable ambulation. Techniques vary by pessary type to accommodate design differences. For space-occupying devices like the Gellhorn or cube pessary, insertion involves compressing or folding the device more firmly before advancing it toward the posterior fornix, with the stem or drain positioned downward for accessibility. Cube pessaries, intended for short-term use, require daily insertion and removal due to limited drainage, while ring and donut types permit longer indwelling periods with periodic checks. In cases of difficulty, adjuncts such as inserting a finger under the rim to guide placement or using warm water via syringe to soften adherent tissue may be employed by clinicians. Removal follows a reverse process, emphasizing gentle traction to avoid trauma. Patients or providers hook an index finger under the lower rim of a ring pessary and pull downward toward the rectum, allowing the vaginal walls to stretch as the device is extracted without full folding. For Gellhorn pessaries, a 90-degree rotation facilitates bending and withdrawal. Post-removal, the device is cleaned with mild soap and warm water, inspected for integrity, and dried before storage or reinsertion; silicone or latex-free materials are recommended to minimize irritation. Self-management training empowers many patients to handle insertion and removal independently, with success rates improving after 1-2 instructional sessions. Hands must be washed thoroughly with soap and water beforehand, and the process is ideally performed in a seated or squatting position for better control. Frequency of self-removal varies from daily for cube types to every 3-6 months for supportive rings, balancing hygiene against convenience. Patients unable to self-manage may require continuous clinician oversight to prevent complications like erosion.

Long-Term Care and Follow-Up

Patients using pessaries for pelvic organ prolapse require regular follow-up to assess device fit, monitor for complications, and evaluate symptom control. Guidelines recommend initial follow-up visits every 3 to 6 months after successful fitting, with intervals potentially extending to 6 to 12 months for stable, asymptomatic users without adverse effects. Extended intervals of up to 6 months have been shown noninferior to more frequent 3-month checks for ring, Gellhorn, or donut pessaries in terms of complication rates and prolapse symptoms. During visits, clinicians inspect for vaginal erosion, ulceration, discharge, , or , and confirm the pessary remains supportive without migration or expulsion. Self-management programs, where trained patients independently remove, clean, and reinsert the , are increasingly endorsed for suitable candidates, promoting autonomy and reducing clinic burden without elevating complication risks. Self-managers typically clean the device weekly or as needed with mild soap and water, dry it thoroughly, and reinsert it, while monitoring for symptoms like increased discharge or discomfort that warrant professional evaluation. Studies indicate self-management yields lower overall complication rates compared to clinician-based care and supports long-term adherence, with continuation rates of 78-81% at 1-2 years. However, not all patients are candidates; those with cognitive impairment, dexterity issues, or preference for clinician oversight may continue with office-based management. Long-term care emphasizes patient education on warning signs, including persistent vaginal bleeding, foul odor, pain during intercourse, or device expulsion, which necessitate prompt medical attention to prevent rare but serious issues like fistula formation from neglected erosion. Outcomes should be tracked using validated tools like the Patient Global Impression of Improvement or prolapse-specific questionnaires to quantify symptom relief and guide adjustments. Indefinite use is feasible for many, provided regular monitoring confirms tolerance, though adherence may decline over time due to inconvenience or unresolved minor symptoms like spotting. Clinicians should reassess prolapse stage periodically, as pessary use does not halt underlying progression in all cases.

Efficacy and Clinical Evidence

Short-Term Symptom Relief Data

Vaginal pessaries achieve high short-term fitting success rates for pelvic organ prolapse, typically exceeding 85% across studies, with relief primarily targeting symptoms such as pelvic pressure, bulge sensation, and associated urinary issues. In a prospective cohort of 157 women with stage IV prolapse, 82.8% had successful fitting after two weeks, with 90% reporting prolapse symptom improvement, including 89.6% relief from pelvic pressure. Urinary symptoms improved in 58–93% of cases, encompassing voiding difficulty (93.3%) and stress incontinence (58.8%). Validated questionnaires confirm these gains, showing significant short-term enhancements in health-related quality of life; for instance, the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) scores improved substantially within three months, alongside satisfaction rates of 70–92%. Patient Global Impression of Change scores exceeded 90% satisfaction in fitted cases at two-week follow-up. For stress urinary incontinence, often comorbid with prolapse, pessary fitting succeeds in 89–92% of women, yielding 40% symptom improvement at three months and 50% reduction in urinary leakage at two months in prospective evaluations. These outcomes stem from mechanical support restoring anatomical positioning, though individual variability in vaginal dimensions and prolapse stage influences efficacy.

Long-Term Outcomes and Progression

Long-term adherence to pessary therapy for pelvic organ prolapse (POP) varies across studies, with continuation rates typically ranging from 50% to 80% after one year, influenced by factors such as patient age, prolapse stage, and self-management capability. In a cohort analysis, 1-year compliance reached 81.5%, dropping slightly to 78.5% at two years, with higher persistence among women without severe stress urinary incontinence. Adherence can extend beyond five years in nearly half of users, supporting pessary as a feasible option for sustained non-surgical management, though discontinuation often stems from discomfort, erosion, or preference for surgery. Evidence on pessary's impact on POP progression remains limited, primarily from observational data indicating stabilization rather than reversal. In a prospective study of 32 women fitted with supportive pessaries, no worsening of prolapse stage occurred over follow-up periods averaging 13 months, suggesting a potential therapeutic effect in halting advancement. The natural history of untreated symptomatic POP shows minimal stage change over time, implying pessaries primarily maintain status quo in adherents rather than altering underlying tissue weakness. However, up to 30.9% of pessary users among Medicare beneficiaries transitioned to prolapse surgery within seven years (median 496 days post-fitting), often due to inadequate symptom control or progression despite device use. Sustained symptom relief is common among long-term users, with prolapse symptoms improving in approximately 90% and urinary symptoms in 58-93% of cases during extended follow-up. Quality-of-life measures, including pelvic floor function and sexual activity impact, show positive effects persisting up to 24 months, though persistent vaginal pain or discharge can undermine benefits in some. Self-management protocols demonstrate equivalent efficacy to clinic-based care for prolapse-specific quality of life over four years, with added cost savings and reduced healthcare visits, provided patients receive adequate training. These outcomes underscore pessary's role in delaying surgical intervention for suitable candidates, but success hinges on regular monitoring to address complications that could precipitate failure.

Comparative Effectiveness Versus Surgery

Randomized controlled trials, such as the PEOPLE trial conducted across 21 Dutch hospitals from 2015 to 2019 involving 440 women with symptomatic stage II or greater pelvic organ prolapse, have directly compared pessary therapy to surgical repair. In this noninferiority trial, patient-reported improvement at 24 months, assessed via the Patient Global Impression of Improvement (PGI-I) scale, occurred in 76.3% (132 of 173) of the pessary group versus 81.5% (132 of 162) of the surgery group, with a risk difference of -6.1% (one-sided 95% CI: -12.7 to ∞, P=0.16); pessary did not meet the prespecified noninferiority margin of -10%. High crossover rates, with 54.1% of pessary users opting for surgery by study end, suggest limitations in long-term pessary satisfaction for some patients. Secondary outcomes in the PEOPLE trial further indicate surgery's edge in symptom relief and quality of life. Perceived symptom severity improved in 64.5% of pessary users compared to 89.6% of surgery patients (P<0.0001), while prolapse-specific quality of life scores on the PFDI-20 declined by 26.3 points (moderate effect size 0.65) with pessary versus 41.3 points (large effect size 1.11) with surgery (P<0.001). A smaller prospective self-controlled trial at Mayo Clinic (2022) with 40 completers corroborated these findings, showing both treatments reduced bulge and pressure symptoms, but 33 of 40 participants preferred surgical outcomes for greater perceived improvement. Economic evaluations alongside the PEOPLE trial demonstrate pessary's advantages in resource use. Over 24 months, pessary therapy incurred €1,807 lower healthcare costs and €1,850 lower societal costs than surgery, with no significant quality-adjusted life-year (QALY) differences (-0.03; 95% CI -0.07 to 0.002), yielding positive incremental cost-effectiveness ratios favoring pessary at willingness-to-pay thresholds up to €20,000 per QALY gained. Despite surgery's superior efficacy in patient-centered metrics from available randomized data, pessary remains a viable initial option for women unsuitable for or preferring to avoid operative risks, though real-world adherence may decline due to discomfort or inadequate symptom control.

Complications, Risks, and Criticisms

Common Adverse Effects

The most frequently reported adverse effects of pessary use include increased vaginal discharge, which occurs in up to 83.7% of users over one year and is often physiologic, thin, and watery due to altered vaginal flora from the foreign body. Vaginal odor accompanies discharge in many cases, potentially signaling bacterial overgrowth or infection, though it resolves with hygiene or antibiotics in uncomplicated instances. Vaginal irritation, erosions, or ulcerations affect 6-17% of users, typically resulting from pressure points, ill-fitting devices, or silicone/surface material interactions, and are more prevalent with prolonged wear without follow-up. Bleeding or spotting, noted in 11-56% of cases, stems from mucosal trauma or atrophy, particularly in postmenopausal women, and may necessitate estrogen therapy for mitigation. Less frequent but common complaints encompass pelvic pain (from improper sizing or displacement) and constipation (due to mechanical pressure on the rectovaginal septum), each reported in subsets of 10-20% of long-term users. These effects contribute to discontinuation rates of 20-50% within the first year, often mitigated by regular cleaning, sizing adjustments, and patient education on self-management. Overall, while adverse events exceed 50% incidence, most are mild and self-limiting with conservative interventions, contrasting with rarer surgical complications.

Rare Serious Complications

Rare serious complications from pessary use primarily arise in cases of prolonged neglect or improper management, often in elderly or cognitively impaired patients who fail to attend follow-up appointments. These events, documented predominantly through case reports and systematic reviews, include fistulas, severe erosions, and organ perforation, with an overall incidence considered exceedingly low given the device's widespread use. A 2022 systematic review of 36 case reports identified vesicovaginal fistula as the most common severe outcome (25%, n=9), followed by rectovaginal fistula (19%, n=7), highlighting erosion as a precursor mechanism where the pessary abrades vaginal walls and adjacent structures over time. Vesicovaginal fistulas occur when chronic pressure from an ill-fitted or retained pessary erodes through the vaginal and bladder walls, leading to continuous urinary leakage into the vagina and potential recurrent infections. Case reports describe complete pessary migration into the bladder, presenting as intravesical foreign bodies after years of neglect, necessitating surgical extraction and fistula repair. Rectovaginal fistulas, similarly rare, result from posterior erosion into the rectal mucosa, causing fecal incontinence or passage of gas/stool through the vagina; one documented instance involved an 82-year-old patient with a ring pessary leading to fistula formation, repaired transvaginally. Bladder rupture and complete uterine eversion have been reported in extreme erosion cases, often requiring multistage surgical intervention including graft interposition. Other infrequent severe events include pessary incarceration or impaction, where the device embeds into vaginal tissue, complicating removal and risking hemorrhage or sepsis; a review of 23 such cases reported a median patient age of 76.5 years, with symptoms like severe anemia or renal insufficiency from concealed perforation. Vascular complications, such as arterial vaginal bleeding from short-term use, represent outliers, with one case attributing hemorrhage to pessary pressure on pelvic vessels. Migration with rectal prolapse or embedment has been noted in forgotten ring pessaries, exacerbating prolapse and requiring manual or surgical disimpaction. These complications underscore the necessity of regular monitoring, as neglect amplifies risks, though prospective studies report no serious adverse events in adherent cohorts.

Factors Influencing Adherence and Failure

Patient adherence to pessary therapy for pelvic organ prolapse varies widely, with short-term compliance rates at 3 months ranging from 41% to 76%. Long-term continuation rates at 5-7 years span 14% to 86%, influenced by individual patient characteristics and device management. Discontinuation after 1 year occurs in approximately 16% of cases, often due to mechanical or symptomatic issues rather than progression of prolapse. Factors associated with successful adherence include older age, lower body mass index (BMI), and adequate pelvic floor muscle function. Younger patients exhibit higher discontinuation rates, potentially due to greater physical activity or discomfort tolerance differences, with risk decreasing by about 7% per 5-year age increase. Lower BMI correlates with better fitting success, as higher BMI independently predicts unsuccessful pessary placement. Active pelvic floor muscles reduce expulsion risk, while self-management capability enhances long-term use, with 84% success in select stage IV cases. Adequate vaginal length (total vaginal length >7.3 cm) also supports retention. Common causes of pessary failure or discontinuation include frequent expulsion (19.9-26.3% of cases), insufficient symptom relief (19%), and complications such as erosion (up to 45.3%), vaginal discharge, odor, or pain/pressure (35-42%). Advanced prolapse (stage IV) lowers fitting success to 44-58%, often compounded by obesity or prior reconstructive surgery. Underactive pelvic floor function and shorter vaginal length further elevate failure risk during initial fitting, with overall unsuccessful rates reaching 42%. Personal factors like desire for surgery or worsening incontinence contribute minimally compared to mechanical issues.

Recent Advancements and Future Directions

Innovations in Design and Materials

Advancements in pessary materials have emphasized , flexibility, and reduced tissue irritation. , introduced as a primary material in the mid-20th century, offers superior softness and elasticity compared to earlier (PVC), minimizing risks like vaginal erosion and ulceration. Clinical trials initiated in 2024 hypothesize that ring pessaries achieve higher retention rates and self-management success than PVC counterparts, potentially lowering complication rates from 30% to 10%. (TPU), a flexible , has gained traction for its moldability in , enabling production of customized devices with integrated features like reservoirs. Design innovations leverage to create patient-specific pessaries, addressing limitations of standardized shapes. Since 2021, technologies combining ultrasound imaging, AI analysis, and 3D fabrication have produced tailored ring pessaries that conform precisely to pelvic anatomy, improving support for . A 2023 study demonstrated that such custom 3D-printed devices effectively treat in women unsuitable for off-the-shelf options, with finite element modeling confirming enhanced biomechanical performance. These approaches, presented at the 2024 American Urological Association meeting, reduce fitting trials and enhance long-term adherence. Collapsible and self-removable designs represent further progress in user autonomy. Prototypes incorporating hinged or foldable mechanisms, developed by 2025, simplify insertion and removal without clinician assistance, potentially decreasing clinic visits and infection risks associated with prolonged indwelling. Hormone-eluting variants, such as silicone rings releasing estriol, integrate pharmacological therapy for atrophy prevention; in vitro tests from 2022 showed sustained drug delivery over months, supporting combined mechanical and estrogenic effects. These developments, while promising, require larger randomized trials to validate superiority over conventional models.

Emerging Research on Combinations and Customization

Research into customized pessaries has advanced through patient-specific designs leveraging and anatomical modeling to improve fit and efficacy for (POP). A 2023 prospective study evaluated 3D-printed pessaries tailored to individual vaginal geometry, reporting significant reductions in symptoms and higher patient satisfaction scores after a 3-week trial period, with all participants preferring the custom device over standard options due to better comfort and stability. Similarly, a 2024 presentation at the American Urological Association highlighted Cosm Medical's 3D-printed pessaries, which use precise measurements to create bespoke supports, potentially reducing expulsion rates and enhancing long-term adherence compared to off-the-shelf models. Ongoing clinical trials, such as NCT06954701 initiated in 2024, are testing personalizable pessaries mimicking the vagina's natural shape to simplify and removal, aiming to address common barriers like discomfort and provider dependency. Combination therapies integrating pessaries with adjunctive interventions show promise for optimizing outcomes in POP management. The ATLAS randomized trial demonstrated that pessary use combined with physiotherapy produced greater symptom improvements (e.g., 49% enhancement in prolapse-specific metrics) than pessary monotherapy (33%), attributing benefits to synergistic strengthening of supportive tissues. A 2025 found that intravaginal conjugated supplementation alongside pessary therapy increased continuation rates from 51-76% at 12 months, likely by alleviating vaginal and , though it noted no significant difference in reduction. Emerging self-management protocols, including patient-taught pessary insertion combined with training, have been associated with 70-80% success in independent use within 3-6 months, reducing clinic visits while maintaining efficacy. These developments underscore a shift toward multimodal approaches, with preliminary data suggesting customization reduces failure rates by 20-30% in heterogeneous POP cases, though larger longitudinal studies are needed to confirm durability and cost-effectiveness. Hybrid designs, such as collapsible pessaries paired with topical agents, are under investigation for enhanced tolerability in active patients.

References

  1. https://pmc.ncbi.nlm.nih.gov/articles/PMC5909791/
  2. https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/pessary
  3. https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/multimedia/pessary-use/img-20006056
  4. https://www.sciencedirect.com/science/article/abs/pii/S0301211511000200
  5. https://pubmed.ncbi.nlm.nih.gov/15830115/
  6. https://www.popypessary.com/history-of-pessaries
  7. https://pmc.ncbi.nlm.nih.gov/articles/PMC2876320/
  8. https://www.glowm.com/section-view/heading/Pessaries%2520for%2520Treatment%2520of%2520Pelvic%2520Organ%2520Prolapse/item/805
  9. https://pmc.ncbi.nlm.nih.gov/articles/PMC9579882/
  10. https://journals.lww.com/fpmrs/fulltext/2023/01000/vaginal_pessary_use_and_management_for_pelvic.2.aspx
  11. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370%2823%2900503-5/fulltext
  12. https://www.sciencedirect.com/science/article/abs/pii/S0022534708002371
  13. https://historymedjournal.com/index.php/medicine/article/download/245/214/409
  14. https://link.springer.com/chapter/10.1007/978-1-84628-315-4_1
  15. https://www.glowm.com/section-view/heading/contemporary-use-of-the-pessary/item/25
  16. https://www.sciencedirect.com/topics/medicine-and-dentistry/pessary
  17. https://library.uthscsa.edu/2017/09/gold-stemmed-pessaries-a-shadow-of-the-past/
  18. https://www.newtopsilicone.com/medical-grade-silicone-pessaries-design-materials-manufacturing-guide/
  19. https://pmc.ncbi.nlm.nih.gov/articles/PMC12028327/
  20. https://pmc.ncbi.nlm.nih.gov/articles/PMC10487415/
  21. https://www.nature.com/articles/s41598-022-23791-9
  22. https://www.ajog.org/article/S0002-9378%2824%2900591-X/abstract
  23. https://pmc.ncbi.nlm.nih.gov/articles/PMC7173753/
  24. https://uwspace.uwaterloo.ca/items/1b300643-b69b-42bf-b9d7-71c9c35d2e98
  25. https://www.physio-pedia.com/Pessary
  26. https://pubmed.ncbi.nlm.nih.gov/33207004/
  27. https://www.sciencedirect.com/science/article/abs/pii/S1751616124003187
  28. https://link.springer.com/article/10.1007/s00192-025-06374-w
  29. https://pmc.ncbi.nlm.nih.gov/articles/PMC8042456/
  30. https://pmc.ncbi.nlm.nih.gov/articles/PMC10476593/
  31. https://www.jogc.com/article/S1701-2163%2821%2900347-9/fulltext
  32. https://www.sciencedirect.com/science/article/abs/pii/S1701216321003479
  33. https://www.aafp.org/pubs/afp/issues/2000/0501/p2719.html
  34. https://www.ncbi.nlm.nih.gov/books/NBK563229/
  35. https://pmc.ncbi.nlm.nih.gov/articles/PMC8129636/
  36. https://www.ncbi.nlm.nih.gov/books/NBK525762/
  37. https://journals.lww.com/greenjournal/fulltext/2022/10000/role_of_pessaries_in_the_treatment_of_pelvic_organ.13.aspx
  38. https://www.nice.org.uk/guidance/ng123
  39. https://pubmed.ncbi.nlm.nih.gov/37542565/
  40. https://www.sciencedirect.com/science/article/pii/S0378512223004346
  41. https://jamanetwork.com/journals/jama/fullarticle/2799654
  42. https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.18333
  43. https://www.mayoclinicproceedings.org/article/S0025-6196%2824%2900324-0/fulltext
  44. https://www.auanet.org/guidelines-and-quality/guidelines/stress-urinary-incontinence-%28sui%29-guideline
  45. https://pubmed.ncbi.nlm.nih.gov/35420550/
  46. https://www.auajournals.org/doi/10.1097/JU.0000000000001974.05
  47. https://gpm.amegroups.org/article/view/5739/html
  48. https://www.ncbi.nlm.nih.gov/books/NBK235269/
  49. https://patents.google.com/patent/US4031886
  50. https://patents.google.com/patent/US2704068A
  51. https://sanger.hosting.nyu.edu/articles/speech_use_of_pessary/
  52. https://pubmed.ncbi.nlm.nih.gov/16836262/
  53. https://pubmed.ncbi.nlm.nih.gov/16750546/
  54. https://www.intechopen.com/chapters/87880
  55. https://pmc.ncbi.nlm.nih.gov/articles/PMC8547748/
  56. https://www.uptodate.com/contents/vaginal-pessaries-indications-devices-and-approach-to-selection
  57. https://www.iuga.org/spotlight-v16-1/expert-opinion-vaginal-pessaries-in-the-management-of-pelvic-organ-prolapse
  58. https://my.clevelandclinic.org/health/treatments/16036-pessaries
  59. https://www.popypessary.com/different-types-of-pessaries
  60. https://journals.lww.com/md-journal/fulltext/2019/04050/long_term_compliance_of_vaginal_pessaries__does.47.aspx
  61. https://www.jogc.com/article/S1701-2163(20)30913-0/fulltext
  62. https://thepogp.co.uk/_userfiles/pages/files/pessary_types_guide.pdf
  63. https://pmc.ncbi.nlm.nih.gov/articles/PMC4479661/
  64. https://radiopaedia.org/articles/pessary-1?lang=us
  65. https://pmc.ncbi.nlm.nih.gov/articles/PMC8232205/
  66. https://www.primescholars.com/articles/intra-vaginal-drug-delivery-systeman-overview.pdf
  67. https://pubmed.ncbi.nlm.nih.gov/35390451/
  68. https://proceedings.aiche.org/conferences/aiche-annual-meeting/2021/proceeding/paper/372a-novel-vaginal-pessary-platform-3d-printing-concomitant-mechanical-support-and-drug-delivery
  69. https://patents.google.com/patent/US7824383B2/en
  70. https://www.verywellhealth.com/vaginal-pessary-4795713
  71. https://muvs.org/en/contraception/barriers/mensinga-pessary-id1383/
  72. https://www.jogc.com/article/S1701-2163(20)30913-0/pdf
  73. https://www.clinsurggroup.us/articles/JGRO-5-164.php
  74. https://med.umich.edu/1libr/urology/InsertingAndRemovingPessary.pdf
  75. https://www.ucsfhealth.org/education/pessaries
  76. https://www.iuga.org/spotlight-v16-1/tips-tricks-vaginal-pessary-insertion-removal-techniques
  77. https://pmc.ncbi.nlm.nih.gov/articles/PMC1949074/
  78. https://www.brighamandwomens.org/obgyn/urogynecology/forms-and-education-materials/pessary-instructions
  79. https://pmc.ncbi.nlm.nih.gov/articles/PMC4949618/
  80. https://www.ncbi.nlm.nih.gov/books/NBK603994/
  81. https://www.obgproject.com/2020/01/07/how-often-should-women-with-pessaries-have-a-follow-up-visit/
  82. https://pmc.ncbi.nlm.nih.gov/articles/PMC10381278/
  83. https://pmc.ncbi.nlm.nih.gov/articles/PMC10701109/
  84. https://pmc.ncbi.nlm.nih.gov/articles/PMC11380633/
  85. https://pmc.ncbi.nlm.nih.gov/articles/PMC8808767/
  86. https://continencematters.com/assets/files/Pessary_Guidelines.pdf
  87. https://pmc.ncbi.nlm.nih.gov/articles/PMC3097351/
  88. https://www.maturitas.org/article/S0378-5122%2823%2900434-6/fulltext
  89. https://pmc.ncbi.nlm.nih.gov/articles/PMC9857016/
  90. https://pmc.ncbi.nlm.nih.gov/articles/PMC10810943/
  91. https://pubmed.ncbi.nlm.nih.gov/37659128/
  92. https://pubmed.ncbi.nlm.nih.gov/12466904/
  93. https://pubmed.ncbi.nlm.nih.gov/22907839/
  94. https://www.ajog.org/article/S0002-9378%2823%2900009-1/fulltext
  95. https://link.springer.com/article/10.1007/s00192-023-05594-2
  96. https://obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.70343
  97. https://pmc.ncbi.nlm.nih.gov/articles/PMC9298049/
  98. https://www.mayoclinic.org/medical-professionals/obstetrics-gynecology/news/pessary-use-and-surgery-improve-prolapse-symptoms-yet-patients-favor-surgical-outcomes/mac-20538110
  99. https://bmjopen.bmj.com/content/14/5/e075016
  100. https://pubmed.ncbi.nlm.nih.gov/36715742/
  101. https://exxcellence.org/list-of-pearls/complications-of-pessary-use/?categoryName=&searchTerms=&featu
  102. https://pubmed.ncbi.nlm.nih.gov/19906018/
  103. https://pubmed.ncbi.nlm.nih.gov/28815277/
  104. https://pubmed.ncbi.nlm.nih.gov/36267197/
  105. https://pubmed.ncbi.nlm.nih.gov/22402642/
  106. https://link.springer.com/article/10.1007/s00192-022-05352-w
  107. https://ijms.info/IJMS/article/view/1175/1395
  108. https://gpm.amegroups.org/article/view/9639/html
  109. https://www.sciencedirect.com/science/article/abs/pii/S170121632030685X
  110. https://www.cureus.com/articles/358330-vaginal-ring-pessary-migration-and-embedment-with-rectal-prolapse-a-rare-complication-of-a-forgotten-ring-pessary-in-an-elderly-patient
  111. https://ogscience.org/upload/pdf/ogs-21232.pdf
  112. https://pubmed.ncbi.nlm.nih.gov/39787965/
  113. https://pubmed.ncbi.nlm.nih.gov/29700950/
  114. https://pmc.ncbi.nlm.nih.gov/articles/PMC10810921/
  115. https://www.mdpi.com/2077-0383/14/8/2737
  116. https://www.contemporaryobgyn.net/view/causes-of-unsuccessful-pessary-fitting-in-women-with-pelvic-organ-prolapse
  117. https://pmc.ncbi.nlm.nih.gov/articles/PMC5306061/
  118. https://link.springer.com/article/10.1007/s00192-021-05002-7
  119. https://pubmed.ncbi.nlm.nih.gov/39365360/
  120. https://clinicaltrials.gov/study/NCT06641804
  121. https://www.sciencedirect.com/science/article/abs/pii/S093964112200073X
  122. https://formlabs.com/blog/cosm-3d-printing/
  123. https://www.urotoday.com/video-lectures/aua-2024/video/4047-revolutionizing-pelvic-organ-prolapse-treatment-innovative-3d-printed-pessaries-bilal-iftikhar-chughtai.html
  124. https://www.medstarhealth.org/blog/pelvic-organ-prolapse-device-research
  125. https://journals.lww.com/fpmrs/fulltext/2023/09000/patient_specific_pessaries_for_pelvic_organ.4.aspx
  126. https://www.clinicaltrials.gov/study/NCT06954701
  127. https://www.bmj.com/content/389/bmj-2025-084418
  128. https://pmc.ncbi.nlm.nih.gov/articles/PMC11420336/
Add your contribution
Related Hubs
User Avatar
No comments yet.