The evolution of pessaries A pelvic organ prolapse (POP) occurs when one or more of the organs in the pelvis slip from their usual positions. This can cause them to bulge into the vagina, resulting in discomfort for patients.1 The treatment history for prolapse is long and varied, and has seen much evolution over the […]
A pelvic organ prolapse (POP) occurs when one or more of the organs in the pelvis slip from their usual positions. This can cause them to bulge into the vagina, resulting in discomfort for patients.1
The treatment history for prolapse is long and varied, and has seen much evolution over the centuries,2 but there are different types of pessaries, offering a conservative form of treatment for patients.3
Vaginal pessaries for prolapse themselves have a rich history, with their use dating back thousands of years to Hippocrates, which has been documented in early Egyptian papyruses.4
It is useful to look at the history of vaginal pessaries to understand how they have evolved to become the specialist devices they are today and judge if they are a suitable modern-day treatment of POP.
Before the modern-day understanding of human anatomy and medicine, there were a range of prolapse treatments.
These included:
Today, a range of treatment options exist, which include:
In more severe cases where conservative treatments have not been successful, surgical treatment can be offered.3
Vaginal pessaries are removable devices that are designed to be inserted into the vagina and sit against the vaginal walls to support the pelvic floor muscles. The aim is to restore the prolapsed organs to their normal positions as well as relieving symptoms which can include urinary stress incontinence,5 alongside a dragging feeling inside your vagina.
Pessaries can offer a suitable option to manage prolapse symptoms in women who want to have children, do not want to undergo surgery or who are waiting for surgery.5
They offer a favourable alternative to invasive surgery2 and have been used for centuries to relieve prolapse symptoms, but the materials and approach to use has evolved considerably over time.
The ancient Egyptians were the first to describe prolapse and vaginal pessaries were a known treatment. Furthermore, the ancient Greeks and Romans are known to have created vaginal pessaries for prolapse using curious materials. For instance, fruits such as pomegranates were soaked in vinegar and inserted into the vagina to hold the uterus in place.6
In Pompeii, a bronze cone-shaped pessary was discovered, which was thought to be attached to the body to hold the pelvic organs in place.6
By the Middle Ages, women used linen and cotton wool soaked in many different potions but by the 16th century vaginal pessaries had evolved and oval, pear-shaped and ring pessaries were made from materials such as hammered metals and waxed cork.4
Pessaries continued to evolve, in 1663, the first book on gynaecology was published, which described the use of a cork pessary with a hole in it to allow the passage of vaginal discharge in prolapse treatment.4
By the 20th century, the popularity of vaginal pessaries for prolapse flourished due to the discovery of vulcanised rubber which can be made rigid by combining with sulphur and heating. This meant that the design could match the curvature of the anatomy for proper positioning of the device.7,6
There has been considerable refinement of existing pessaries, as well as research and development into the creation of new ones.4 Now, a wide range of vaginal pessaries for prolapse are available and are typically divided into two classes as either support or space-filling pessaries.8
They come in a variety of shapes and sizes, designed to suit all needs. These include ring, Gellhorn, shelf, cube, donut and inflatoball pessaries.9
Vaginal pessaries are non-invasive and are now widely used as a first line treatment for POP10 with a UK study finding that 86.7% of gynaecologists prescribe them.11
There are few contraindications for vaginal pessary use, which means they are suitable for most women,12 offering an excellent alternative to surgery due to the effectiveness of mechanical pessaries at reducing symptoms.8
Furthermore, use for 3-12 months has been shown to not only reduce symptoms but to improve the overall quality of life of patients as well,10 with a recent study showing a 93.8% increase in quality of life after six months use in patients with advanced POP.13
Today, vaginal pessaries for prolapse are generally made from a variety of materials,4 including PVC or silicone.12
PVC pessaries are made up of plastic and need to be replaced every 3-6 months in a clinical setting.12
Silicone pessaries are longer lasting than PVC and, depending on the manufacturer’s guidance, can be washed and reused for up to 5 years.12 The reason for this is due to silicone possessing the following properties:
Silicone pessaries are also easier to insert and have a reduced risk of erosion due to the softness and flexibility of silicone.15 As well as improving the experience for patients, reported outcomes have shown few contraindications and low complication rates.13
Mediplus provides a range of pessaries to support POP, including both support pessaries and space-filling pessaries.
A ring pessary is the most commonly used pessary due to the ease it can be used by both the patient and healthcare provider, but for more advanced prolapses, space-filling pessaries are available, including Gellhorn or shelf pessaries.9
POPY™ was the world’s first silicone shelf pessary, offering a more flexible and comfortable option compared to other options.
The innovative pessary offers a wide range of benefits.
Enhanced quality of life. POPY™ mitigates the impact of prolapse on everyday life.
Ease of use. High-quality medical-grade silicone ensures that the POPY™ is soft and malleable for ease of fitting and removal.
Reduced risk of erosion. The softness of the POPY™ pessary reduces the risk of erosion.
Expert design. The POPY™ range is the result of extensive consultation with both clinicians and patients to ensure optimal effectiveness and patient comfort.
Mediplus provides a range of pessaries to support prolapse patients, including both support pessaries and space-filling pessaries. A ring pessary is the most common amongst patients and healthcare provides due to its ease of use.14 For more advanced prolapses, there are space-filling pessaries available including Gellhorn or shelf pessaries.
POPYTM is a shelf pessary which, made from silicone is a more flexible and comfortable option compared to other shelf pessaries.
You can see our full range of pessaries by visiting our product page.
References:
Anaesthesia
Gynaecology
OPERATING ROOM
UROLOGY