Frequently asked questions

Training Guide for Healthcare Professionals

In this downloadable training guide, you will find all information regarding:

Different types of pessaries
Pessary placement
Pessary maintenance
Pessary follow-up appointments

How to fit a pessary?

To determine the correct pessary, it may be necessary for the patient to try different pessary shapes and sizes. The fitting kit is the perfect tool for this. Start with a pessary shape and size based on your findings after a full pelvic examination.

Once the correct shape is determined and the pessary is inserted, check that your finger can easily pass between the pessary and the vaginal wall. Ask the patient to perform a series of tests, such as squatting, sitting, or standing, without the pessary dislodging.

Also, check the pessary to ensure it performs its intended function. For example, if the indication for the pessary is stress incontinence, ask the patient to cough with the pessary out and then again with the pessary in, to test for urine leakage.

How do I know which pessary my patient needs?

The pelvic examination, vaginal depth, and size of the patient will help you determine the necessary pessary and its size. Pessaries for pelvic organ prolapse generally fall into two categories: supportive pessaries and space-occupying pessaries. The most common supportive pessary is the ring pessary. The most common space-occupying pessary is the Gellhorn.
The patient's lifestyle can also determine the choice of pessary type. Patients who are active and interested in self-care are better suited for a pessary that is easy to remove and clean. Patients with physical limitations may be better suited for a pessary that is difficult to remove but has a lower chance of spontaneous expulsion.

How do I determine the size for a pessary?

Fitting a pessary is primarily a trial-and-error process. A well-fitting pessary should not be felt by the patient when it is in place.

What if the chosen pessary doesn't fit or doesn't solve the problem?

If the chosen pessary doesn't fit or doesn't solve the patient's problem, try a different size or shape. It's important to diagnose the patient's primary complaint. Different types of pessaries have different indications, with each type designed for specific functions and patient needs. This allows for multiple pelvic floor conditions to be treated simultaneously, as women have variations in pelvic floor anatomy. For example, if a patient with stress incontinence also has stage I anterior vaginal wall prolapse, an incontinence dish with support may be more suitable.

Use this handy reference guide when selecting the appropriate pessary.