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A pessary is a prosthetic device inserted into the vagina to reduce the protrusion of pelvic structures into the vagina. It can be a route of administration of medication and provides a slow and consistent release of the medication. Pessaries are of varying shapes and sizes. 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.[1]

The term is derived from Ancient Greek: πεσσάριον, translit. pessárion, "a piece of medication-soaked wool/lint, inserted into the vagina."[2]

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."[3]

Contents

Types of pessariesEdit

 
Different types of pessaries

Therapeutic pessariesEdit

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.[4] 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.

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.[5]

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 pessariesEdit

A pharmaceutical pessary is used as a very effective means of delivery of pharmaceutical substances easily absorbed through the skin of the vagina, or intended to have action in the locality, for example against inflammation or yeast infection, or on the uterus. Pessaries were used as birth control in ancient times[vague].[citation needed]

Occlusive pessariesEdit

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

Stem pessaryEdit

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.[6]

General side effectsEdit

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).

See alsoEdit

ReferencesEdit

  1. ^ "Cystoceles, Urethroceles, Enteroceles, and Rectoceles - Gynecology and Obstetrics - Merck Manuals Professional Edition". Merck Manuals Professional Edition. Retrieved 2017-12-29.
  2. ^ "Pessary - Define Pessary at Dictionary.com". dictionary.com. Retrieved 9 April 2018.
  3. ^ Hippocrates of Cos (1923). "The Oath". Loeb Classical Library. 147: 298–299. doi:10.4159/DLCL.hippocrates_cos-oath.1923. retrieved 18 September 2018
  4. ^ American Urogynecologic Society (May 5, 2015), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, American Urogynecologic Society, retrieved June 1, 2015, which cites: * Culligan, PJ (April 2012). "Nonsurgical management of pelvic organ prolapse". Obstetrics and gynecology. 119 (4): 852–60. doi:10.1097/aog.0b013e31824c0806. PMID 22433350.
  5. ^ "Archived copy". Archived from the original on 2016-03-24. Retrieved 2016-03-11.
  6. ^ "Contraceptive Stem Pessary in Aluminium - Phisick - Medical Antiques". www.phisick.com. Retrieved 9 April 2018.