Because of the transvaginal mesh debacle, vaginal pessaries are again becoming the first line of treatment in the management of pelvic organ prolapse. “
For centuries women have been utilizing pessaries in the management of pelvic organ prolapse and is often the intervention of choice for women who desire more children or for women with severe health conditions which make the risk of pelvic reconstruction surgeries unacceptable.
With the advent of transvaginal mesh procedures that have flourished over the past decade by use of aggressive marketing the use of effective conservative management for pelvic organ prolapse has decreased. Now these conservative therapies which include pessaries and pelvic floor physical therapy is making a comeback due to the nightmare complications related to the transvaginal mesh procedure.
Much has been written regarding fitting and use of pessaries in the past, which still applies. A majority of women can have symptomatic relief of symptoms related to vaginal prolapse with appropriately fitting pessaries. Experienced doctors and nurses can usually find an adequate fitting pessary in the first or second fitting. There are several shapes and sizes available depending on the pelvic anatomy.
“A vaginal pessary is a removable device placed into the vagina. It is designed to support areas of pelvic organ prolapse.”
“Possible complications from wearing a pessary include:
Open sores in the vaginal wall.
Bleeding.
Wearing away of the vaginal wall. In severe cases, an opening (fistula) can form between the vagina and the rectum.
Bulging of the rectum against the vaginal wall (rectocele formation).”
Pessaries are effective in the management of prolapse but are not without complications. With proper hygiene and periodic care these complications can be avoided which include ulceration, vaginal irritation, bleeding, bowel obstruction, perforation, and urosepsis.
The FDA has warned that the risk associated with the transvaginal mesh procedure is not rare. The American Urogynecologic Society does not believe a ban is warranted on the transvaginal mesh but recommends a thorough informed consent procedure that outlines risk versus benefits of proceeding with this intervention. A trial of conservative management with the use of pelvic floor physical therapy and the use of pessaries should entertained prior to surgical management.
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