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Pessary

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Pessary

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Gold-Plated Stem Pessary (Intrauterine Device) from 1920 A pessary is a prosthetic device inserted into the vagina, commonly used to treat stress urinary incontinence and pelvic organ prolapse. It can also be a route of administration for medication and provide a slow and consistent release of the medication. Pessaries come in different shapes and sizes, so individuals can be fitted for them by health care professionals. They may cause vaginal ulceration if they are not correctly sized and routinely cleansed. Depending on locale, pessaries can be fitted by health care practitioners; in some countries, pessaries may be available over the counter. An assortment of pessaries Pessaries are mentioned in the oldest surviving copy of 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." The term 'pessary' is derived from the Ancient Greek word 'pessós,' meaning round stone used for games.

Contents

• 1Types of pessaries
  • 1.1Therapeutic pessaries
  • 1.2Pharmaceutical pessaries
  • 1.3Occlusive pessaries
    • 1.3.1Stem pessary
• 2General side effects
• 3See also
• 4References

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. Pessaries are a treatment option for pelvic organ prolapse. A pessary is most commonly used to treat prolapse of the uterus. It is also used to treat stress urinary incontinence, a retroverted uterus, cystocele and rectocele. Historically, pessaries may have also been used to perform abortions.

There are different types of pessaries but most of them are made out of silicone—a harmless and durable material.

Ring with Support Pessary

These are often used as a first-line treatment since patients can easily insert and remove them on their own.

Gellhorn Pessary

Marland Pessary

Donut Pessary

Cube Pessary

Gehrung Pessary

Hodge Pessary

These pessaries are rarely used.

The Cerclage Pessary is used to treat pregnant women with cervical incompetence in order to support the cervix and turn it backward towards the sacrum. It may be indicated in pregnancies with a history of premature labor, multiple pregnancies or mothers who are exposed to physical strain (e.g. standing for a long time). It may also be indicated in pregnant women suffering from prolapse of the genital organs.

The pessary can be placed temporarily or permanently, and must be fitted by a physician, physician assistant, midwife, or advanced practice nurse. Some pessaries can be worn during intercourse.

Pharmaceutical pessaries[edit]

Treating vaginal yeast infections is one of the most common uses of pharmaceutical pessaries. They are also known as vaginal suppositories in 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.

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.

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

Occlusive pessaries[edit]

Main article: Cervical cap

See also: womb veil

An occlusive pessary is generally used in combination with spermicide as a contraceptive.

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 os, to hold it in place.

General side effects[edit]

Side effects that are shared among most different types of pessaries include: risks of increased vaginal discharge, vaginal irritation, ulceration, bleeding, and dyspareunia (painful intercourse for the male or female).