Pessary insertion: Choosing appropriate patients

Pessaries have been around in one form or another since biblical times, and currently there are many different kinds of pessaries to treat the various types of pelvic descent. The term pelvic organ prolapse refers to any pelvic structure that protrudes into the vagina (cystocele, rectocele, enterocele). Patients with prolapse who are asymptomatic do not require treatment. For a patient who has symptoms, a pessary can be an excellent alternative to surgery or can help to control symptoms until surgery is performed.1 Counseling patients about the option of using pessaries, fitting them in your office, and maintaining their care can become part of your practice. Eighty percent of pelvic prolapse (grades 1 and 2, defined as descending above the hymen) can be treated with ring-shaped pessaries. This article will discuss how to evaluate patients and insert this type of pessary. (For an algorithm on the diagnosis and management of pelvic organ prolapse, see page 485.)