European Journal of Obstetrics & Gynecology and Reproductive Biology 156 (2011) 125130

Contents lists available at ScienceDirect

European Journal of Obstetrics & Gynecology and

Reproductive Biology
journal homepage: www.elsevier.com/locate/ejogrb

Review

The history and usage of the vaginal pessary: a review

Reeba Oliver a, Ranee Thakar b,*, Abdul H. Sultan b
a
b

Urogynecology, Mayday University Hospital, London Road, Croydon, Surrey CR7 7YE, UK
Mayday University Hospital, London Road, Croydon, Surrey CR7 7YE, UK

A R T I C L E I N F O

A B S T R A C T

Article history:
Received 13 August 2010
Received in revised form 29 November 2010
Accepted 26 December 2010

It is expected that with the rising female life expectancy the prevalence of pelvic organ prolapse will
increase. From ancient times mechanical devices have been used to reposition prolapsed organs. Given
that surgical correction of prolapse is associated with high recurrence rates, pessaries offer a favorable
alternative. In spite of the antiquity of pessary usage the evidence for its use, the effectiveness of
symptom relief, and the nuances of clinical management with the pessary in situ have not been studied
methodically. There is a need for controlled trials to assess the efcacy of pessaries as opposed to other
non-surgical and surgical methods of treating pelvic organ prolapse. Additionally, the long term effects
and complications of pessary usage have not been assessed in trials, and knowledge about the potential
complications caused by the pessary rests mainly on anecdotal data.
This review provides a historical perspective and appraises the current knowledge regarding the
indications, effectiveness and the potential complications associated with pessary use. Data were
obtained from an electronic search of Medline (19662010) and by hand searching the citations which
were not available online. Keywords used were pelvic organ prolapse, pelvic oor dysfunction, vaginal
pessary and urinary incontinence. Textbooks are also quoted where relevant.
Most studies report moderate success rates in the short term following insertion of a pessary for the
management of prolapse and concur in the remission of almost all symptoms attributable to the
prolapse. Reported success is variable in the remission of urinary and bowel symptoms. We conclude
that based on the available evidence (mostly retrospective and prospective cohort studies), treatment
with a vaginal pessary is a feasible option that can be offered in the short term to women with prolapse.
There is a need for controlled trials to assess the long term efcacy.
2011 Elsevier Ireland Ltd. All rights reserved.

Keywords:
Pelvic organ prolapse
Pelvic oor dysfunction
Vaginal pessary
Urinary incontinence

Contents
1.
2.
3.

4.

Introduction . . . . . . . . . . . . . . . . . . . . . .
1.1.
Evolution of pessary usage . . . . .
Methods . . . . . . . . . . . . . . . . . . . . . . . . .
Indications for pessary usage . . . . . . . .
3.1.
Pelvic organ prolapse . . . . . . . . .
3.2.
Urinary incontinence . . . . . . . . .
3.3.
Other uses . . . . . . . . . . . . . . . . . .
3.3.1.
Vaginal wind . . . . . . . .
3.3.2.
Neonatal prolapse . . . .
3.3.3.
Prolapse in pregnancy .
3.3.4.
Voiding dysfunction. . .
Types of pessaries . . . . . . . . . . . . . . . . .
4.1.
Support pessaries . . . . . . . . . . . .
4.1.1.
Ring . . . . . . . . . . . . . . .
4.1.2.
Gehrung . . . . . . . . . . . .
4.1.3.
Incontinence ring/dish.

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* Corresponding author. Tel.: +44 208 401 3154; fax: +44 208 410 3681.
E-mail addresses: Ranee.Thakar@mayday.nhs.uk, raneethakar@yahoo.co.uk (R. Thakar).
0301-2115/$ see front matter 2011 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.ejogrb.2010.12.039

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126

R. Oliver et al. / European Journal of Obstetrics & Gynecology and Reproductive Biology 156 (2011) 125130

4.2.

5.
6.
7.

8.
9.
10.

Space lling pessaries . . . . . . . . . . .

4.2.1.
Gellhorn . . . . . . . . . . . . . .
4.2.2.
Donut . . . . . . . . . . . . . . . .
4.2.3.
Cube . . . . . . . . . . . . . . . . .
4.2.4.
Inatable pessary. . . . . . .
Patient assessment and pessary insertion
Pessary maintenance and follow-up . . . . .
Effectiveness of pessary usage . . . . . . . . .
7.1.
Prolapse symptoms. . . . . . . . . . . . .
7.2.
Urinary symptoms . . . . . . . . . . . . .
7.3.
Bowel symptoms . . . . . . . . . . . . . .
Predictors of success . . . . . . . . . . . . . . . . .
Complications of usage . . . . . . . . . . . . . . .
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . .

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1. Introduction
1.1. Evolution of pessary usage
Pelvic organ prolapse (POP) and its treatment have had a
variable course through the annals of history. Over many centuries,
various civilisations such as the ancient Egyptians, Chinese, Indians
and through to the Christian and modern eras, have propagated
their own unique medications and potions for treatment of
prolapse. Scripts from the Kahun papyrus from ancient Egypt, 2000
years before the birth of Christ, advocated standing the patient
over an assortment of burning ingredients to force the prolapsed
organs back into the pelvis [1]. Substances including mould,
fermented beer and manure have been advocated either for
application on the prolapsed organs or for consumption by the
patient to treat prolapse. In later periods, Hippocrates advocated
succusion, where the patient was tipped head down and shaken to
return the prolapsing organs into the pelvis with the aid of gravity.
One of the earliest pessaries used was placement of half a
pomegranate in the vagina, as described by the Greek physician
called Polybus [2]. Other methods described include a linen
tampon soaked with astringent vinegar and a piece of beef as
advocated by Soranus, another Greek physician. It was only later in
the sixteenth century that the rst purpose-made device to be used
as a pessary, as opposed to naturally occurring objects, was
described. Ambrose Pare created oval shaped pessaries, followed
by C. Bauhin (1588) and William Fabry of Hilden in (1592) who
devised pessaries of various shapes ranging from oval to globular,
to t differing vaginal proportions. The word pessary comes from
a Greek word pessos meaning an oval stone used in a checkerslike game. Oval stones were inserted into the uteruses of saddle
camels using a hollow tube, to prevent conception during long
desert voyages. This practice was widespread in both Arabia and
Turkey and would have translated to apply to all intrauterine
devices.
Surgical procedures such as hysterectomy were considered only
when the uterus became gangrenous in chronic procidentia, as the
absence of effective anaesthetic techniques and surgical sterility
resulted in high mortality and morbidity. Reliance on mechanical
methods for prolapse reduction decreased with the advent of
modern surgical techniques, anaesthesia and asepsis. While it has
been established indisputably that either the removal or the
repositioning of the prolapsed organs is ideal treatment for relief of
symptoms, there is no consensus of opinion on the usage of
pessaries. Considering the history of the pessary there is a paucity
of scientically reliable information about their usage. Nearly one
hundred years after the rst review [2] questions still abound as to
the type of pessary to be used, the long-term effectiveness and
whether pessary usage affects the progression or regression of POP.

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127
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In this review we aim to address the indications for pessary

usage and also the evidence for their effectiveness in affording
symptom relief.
2. Methods
An electronic search of Medline from 1966 to 2010 was done.
Keywords used were pelvic organ prolapse; pelvic oor dysfunction; vaginal pessary and urinary incontinence. The citations which
were not available online were identied by hand-searching.
Textbooks are also quoted where relevant.
3. Indications for pessary usage
3.1. Pelvic organ prolapse
Support and repositioning of prolapse of pelvic organs is the
commonest indication for vaginal pessary usage [3,4]. The aim of
mechanical treatment in the management of POP is to prevent
worsening of the prolapse [5], decrease the frequency and severity
of prolapse symptoms and to avert or delay the need for surgery
[6]. The reported success rate of pessary use is between 56 and 89%
at two to three months [79] while Komesu et al. [10] reported a
success rate of 56% at 612 months after insertion.
3.2. Urinary incontinence
Pessaries used to treat urinary incontinence (UI) have been
shown to be effective and up to 59% of women using incontinence
pessaries continued using them approximately a year after
insertion [11]. They are currently underused by medical professionals due to perceived difculty of self-insertion and correct
positioning. To address the latter concern, Farrell et al. [12]
designed a more easily insertable, self-positioning incontinence
pessary called the Uresta pessary. Although in this pilot study the
numbers were small, 76% continued using their pessary at one
year. In a prospective cohort study of 38 women, Robert and
Mainprize [13] found that only six (16%) continued to use the
pessary at one year. Although the numbers were too small there
was a trend towards improved success rates in younger patients
(41 years vs. 52 years) and in those without previous surgery,
suggesting this to be an alternative option to offer.
Pessary insertion is used as a simple preoperative test to assess
the need for surgery for occult stress urinary incontinence (SUI), as
the urodynamic test ndings with the pessary in situ are similar to
the urodynamics test ndings after surgery. Unmasking occult SUI
is used as a preoperative measure, to indicate if a concomitant
procedure for SUI is necessary at the time of the prolapse surgery.
Studies have tried to predict the need for the above with varying

R. Oliver et al. / European Journal of Obstetrics & Gynecology and Reproductive Biology 156 (2011) 125130

success, however [14,15]. Chaikin et al. [14] prospectively

evaluated 24 continent women with urogenital prolapse. Reduction of prolapse with a pessary unmasked occult SUI in 14 women
(58%) who underwent a concomitant pubovaginal sling procedure
but 14% of those still developed SUI postoperatively. Reena et al.
[15] evaluated a larger series of 78 women. Preoperatively, 68% of
women were found to have occult SUI, and of these 64% were found
to have UI after surgery for POP.
The Colpopexy and Urinary Reduction Efforts (CARE) randomized surgical trial investigated whether stress leakage during
urodynamic testing with prolapse reduction predicted postoperative SUI [16]. Preoperatively, only 12 of 313 (3.7%) subjects
demonstrated urodynamic SUI without prolapse reduction and 6%
(5 of 88) after prolapse reduction with pessary. Women who
demonstrated preoperative USI during prolapse reduction were
more likely to report postoperative stress incontinence, regardless
of concomitant colposuspension (controls 58% vs. 38% (p = 0.04)
and Burch 32% vs. 21% (p = 0.19)).
The evidence to date suggests that the pessary insertion test is a
reliable method to unmask occult SUI and the authors recommend
its use prior to corrective surgery for prolapse in the anterior
compartment.
3.3. Other uses
3.3.1. Vaginal wind
Although vaginal wind is a very distressing and embarrassing
condition, its prevalence is underestimated and it is a difcult
condition to treat successfully [1719]. The mechanism is poorly
understood. It is postulated that it might be due to the creation of a
vaginal space while the woman is at rest, resulting in air being
trapped in the space as the introitus closes with movement. With
activity, the air is expelled through a narrowed or closed introitus.
Insertion of a pessary prevents closure of the vagina and introitus,
thereby preventing trapping and subsequent expulsion of the air.
Hsu [17] reported a case successfully treated by daily insertion of a
tampon, and Jeffery et al. reported successful treatment by
insertion of a cube pessary [18]. Krissi et al. [19] suggested the
use of a modied pessary to treat vaginal wind.
3.3.2. Neonatal prolapse
Pessaries have been used successfully as a temporary measure
to correct neonatal prolapse, mainly seen in association with
neural tube defects such as spina bida [20]. Small doughnutshaped pessaries constructed from 1 to 2 cm Penrose drains have
been used effectively. As the prolapse is usually temporary,
mechanical repositioning of the prolapse with the pessary is all
that is necessary.
3.3.3. Prolapse in pregnancy
Pessaries have been used successfully as temporary measures
for prolapse during pregnancy to afford symptom relief until
delivery. Donut pessaries have been reported to be useful in
women at risk of incompetent cervix and preterm delivery. The
existing literature on the above function of the pessary lacks
inclusion criteria and contains selection biases. Because of the poor
nature of most of the studies, it has been recommended that
pessaries should not replace cerclage use in women with an
incompetent cervix [21].
3.3.4. Voiding dysfunction
It has been suggested that pessaries correct voiding dysfunction
and reduce post-void residuals. Lazarou et al. [22] have used
pessaries to predict postoperative cure of retention with a good
positive predictive value. In this study, the use of pessary
preoperatively was associated with relief of urinary retention in

127

75% patients. This study was a retrospective review with a

relatively small sample size, various types and sizes of pessaries
were used to reduce the prolapse, and concomitant incontinence
procedures were performed in addition to pelvic reconstructive
surgery that may have contributed to urinary retention postoperatively.
4. Types of pessaries
Of the multitude of pessaries described, currently only
approximately 20 models remain in general use (Fig. 1) [23].
Modern pessaries are made of inert silicone-coated rubber and
hence can be used in patients allergic to latex. Vaginal pessaries
can be broadly divided into two types: support pessaries and space
lling pessaries (Table 1).
4.1. Support pessaries
4.1.1. Ring
The ring is the most commonly used pessary [4]. It is mostly
effective in women with rst and second degree prolapse and is
available in sizes 0 (44.5 mm) to 13 (127 mm). Because it is open it
has the disadvantage of the cervix protruding through the opening.
The advantages of ring usage are the ability to continue penetrative
intercourse and the ability to retain the ring in the vagina for long
periods without the need for daily removal. The Dish pessary is a
closed, perforated ring pessary which is useful in cases of
procidentia as the uterus cannot prolapse through the closed ring,
but the closed structure prevents sexual intercourse.
4.1.2. Gehrung
The Gehrung is a folding pessary available in sizes 0 through 10
and provides support to rectoceles, cystoceles and procidentia. The
advantage is that it can be manually moulded to t the patients
type of prolapse. The pessary should be positioned with the
convexity of the curved bars towards the anterior vaginal wall and
is commonly used to manage rectoceles.
4.1.3. Incontinence ring/dish
Similar in appearance to the ring pessary, but with an anterior
protuberance that provides support to the urethra and bladder
neck. It is available in sizes 0 (44.5 mm) to 13 (127 mm). Sexual
intercourse is possible with the incontinence ring in situ, but not
with the incontinence dish in situ.
4.2. Space lling pessaries
4.2.1. Gellhorn
This pessary is useful in higher grades of prolapse and is
available in sizes from 1.5 in. through 3.75 in. The Gellhorn is not
compatible with sexual intercourse. The concave surface should be
positioned against the vaginal cuff or the cervix and the stem
should br positioned posterior to the introitus. Short-stemmed
variations are available for women with shorter vaginal lengths.
The Gellhorn will not be retained if the perineal support is lax.
4.2.2. Donut
The Donut pessary is effective for the treatment for more severe
grades of prolapse, especially if the perineal support is lax. It is
available in sizes 08. The Donut does not need to be removed daily.
4.2.3. Cube
The cube pessary is available in sizes 07 and needs to be
removed prior to penetrative sexual intercourse. It retains its
position in the vagina by suction of its six concave surfaces on the
vaginal wall and daily removal and replacement are necessary as

[()TD$FIG]

R. Oliver et al. / European Journal of Obstetrics & Gynecology and Reproductive Biology 156 (2011) 125130

128

Fig. 1. Variety of pessaries in use.With permission [23].

the suction can lead to erosions and stulas of the vaginal walls.
The suction has to be broken by feeling along the string attached to
the cube prior to removal of the pessary.

vaginal walls, needs to be removed and replaced every 12 days.

The major disadvantage is that it is made of rubber and therefore
cannot be used in latex allergy patients.

4.2.4. Inatable pessary

These are adjustable pessaries chosen for self-adjustment and
specic or intermittent use according to the patients circumstances. It is available in sizes from 2 to 2.75 in. Like the cube
pessary, the inatable pessary, by reason of impaction against the

5. Patient assessment and pessary insertion

The cardinal point of patient assessment is the suitability of the
particular patient for the particular pessary, taking into account
the sexual activity, type and degree of prolapse, ability of the

Table 1
Pessary types, uses and sizes.
Type of pessaries
Support pessaries
Ring
Gehrung
Incontinence ring

Specications of use

Sizes

First and second degree UV prolapsed, easiest to use, No requirement for daily removal
Not used for SUI
Cystoceles and rectoceles with or without uterine descent, no requirement for daily removal
Not used for SUI
Used for SUI and Stages IIV POP, No requirement for daily removal

Sizes 0 (44.5 mm) to 13 (127 mm)

(increments of 6 mm)
Sizes 0 (38 mm) to 10 (83 mm)
(increments of 6 mm)
Sizes 0 (44.5 mm) to 13 (127 mm)
(increments of 6 mm)

Space-occupying pessaries
Gellhorn
Third degree UV prolapse with decreased perineal support, no requirement for daily removal,
not used for SUI, removed prior to intercourse
Donut
Third degree UV prolapse, no requirement for daily removal,
not used for SUI, removed prior to intercourse
Cube
Third degree UV prolapse, daily removal necessary
Not used for SUI, removed prior to intercourse
Inatable
Stages IIV POP, daily removal necessary, not used for SUI, removed prior to intercourse

Sizes 0 (38 mm) to size 10 (95 mm)

(increments of 6 mm)
Sizes 0 (51 mm) to 8 (95 mm)
(increments of 6 mm)
Sizes 0 (25 mm) to 7 (57mm)
(increments of 6 mm)
Sizes S (51 mm) to XL (70 mm)
(increments of 6 mm)

R. Oliver et al. / European Journal of Obstetrics & Gynecology and Reproductive Biology 156 (2011) 125130

patient to self-manage or attend follow-up. One of the major

factors to consider is the ability of the patient to attend for followup examinations, alone or with a carer.
At the initial visit it is recommended that the patient be
examined in the recumbent as well as the standing position, during
relaxation and straining. After insertion, expulsion should be
checked for on movement, squatting, and carrying out the Valsalva
manoeuvre. The size of the pessary should be such that it should
allow a single examining nger to be passed freely all around the
circumference and should not be expelled on squatting or the
Valsalva manoeuvre. Various methods of measurement including
using a tubular graduated device, have been promoted to measure
the size of the required pessary accurately, but the trials have taken
place on only a small number of patients. The correct size is arrived
at usually by trial and error and adequate pathways for close
monitoring and review must be in place.
Unusual but effective methods of pessary use have been
described. In women with long-standing prolapse leading to
progressive widening of the genital hiatus and weakening of the
levator ani muscles it is often impossible to retain a single pessary.
Successful retention with two pessaries of different shapes or sizes
has been described.
A survey showed that most gynecologists in the United States
prescribed the pessary and that the ring pessary was deemed to be
the easiest to use and was used most often. Seventy-ve percent of
the members of the American Urogynecologic Society used
pessaries as rst-line therapy for prolapse, but there was no clear
consensus regarding the type of pessary or their indications [3]. In
the United Kingdom, a recent postal survey identied 87% of the
consultants who responded to the survey as using vaginal
pessaries for management of POP [24]. Very few studies have
assessed the type of pessary suitable for the different types of
prolapse. Clemons et al. [25] found that the ring pessary was
successful in grades II and III prolapse, but for higher grades a
Gellhorn pessary was more successful. By contrast, the PESSRI
study, which was a randomized crossover trial of the ring versus
the Gellhorn pessary, did not nd any difference in effectiveness
between the two types [26].
6. Pessary maintenance and follow-up
There is no consensus on the follow-up regimen as it can vary
widely depending on the patients ability to remove and self-insert,
the integrity of the vaginal epithelium, and complications. The
patient must be informed of the symptoms of potential complications and should be advised to be aware of any change in her
voiding pattern. Although there is no consensus on the duration,
periodic vaginal inspections are recommended. Any frank ulceration or vaginal excoriation should prompt discontinuation of the
pessary till the vaginal skin heals and retting with a smaller sized
pessary or a different shaped pessary should be considered. Mild
vaginal irritation is common and does not necessitate discontinuation of the pessary. Although there is no consensus, six-monthly
follow-up of self-inserting patients is recommended, with more
frequent follow = up visits for patients who are unable to selfinsert. We are not aware of any literature demonstrating how often
pessaries are to be removed as it depends on the type of pessary.
Effective service has been provided by all types of health
professionals including hospital specialists, general practitioners
and specialist nurses.
7. Effectiveness of pessary usage
Pessaries have been shown to be largely successful for the
remission of most of the symptoms attributable to POP.

129

7.1. Prolapse symptoms

Most studies concur on the remission of almost all symptoms
attributable to the prolapse. A questionnaire survey by Bai et al.
[27] showed that 70% of pessary users were satised or very
satised with pessary usage and attributed their satisfaction to the
remission of prolapse symptoms. Using a validated questionnaire
Fernando et al. [9] showed a signicant improvement of the
symptom of awareness of a lump in the vagina in 71% of patients
tted with the pessary, four months after pessary insertion.
Clemons et al. [28] reported a signicant resolution of nearly all
prolapse symptoms from baseline to two months: bulge (903%),
pressure (493%), discharge (120%), and splinting (140%). In a
prospective study by Wu et al. [7], 56% of women with
symptomatic POP had a successful pessary tted: after 6 months
77% of them were satised, and after 2 years 64% were satised.
Handa et al. has shown that pessaries may improve the degree of
prolapse after one year of usage [5]. These ndings attribute a
therapeutic role to the vaginal pessary in addition to its traditional
role in the palliation of symptoms.
7.2. Urinary symptoms
Pessaries have variable success in the remission of SUI
symptoms; 45% [28] and 23% [9]. Discontinuance rates in women
with SUI vary greatly (between 6% and 42%) [29]. A recent
Cochrane review reported on the effects of mechanical devices in
the management of UI [30]. Six trials involving a total of 286
women were identied, but there was little evidence to judge
whether their use is better than no treatment and also to favor the
use of one device over another. Improvement of voiding
dysfunction varied between studies with a range of 4053% [9,28].
7.3. Bowel symptoms
Fernando et al. found no signicant improvement in defecatory
symptoms with pessary usage at four months [9], but Komesu et al.
[10] showed overall improvement of pelvic oor distress
symptoms, including bowel symptoms, to be associated with
continued pessary usage.

8. Predictors of success
Komesu et al. [10] established that prolapse symptom
improvement best predicted continued pessary use. They used
the short form of the Pelvic Floor Disorders Impact Questionnaire (PFDI-20), in which lower scores represent fewer
symptoms, and a prolapse score that fell to 50% of baseline at
two months best predicted continued use. Patient choice has an
impact on pessary usage. It has been shown that older patients
are more likely to retain a pessary [8]. Additionally, it was
shown that patients with greater degrees of prolapse are 23%
more likely to choose surgery over pessary [8]. Previous
prolapse surgery and hysterectomy are predictors for discontinuation of use. Fernando et al. [9] showed that previous
hysterectomy and increased parity are associated with failure.
Clemons et al. [25] found that a short vaginal length and a wide
vaginal introitus, which can occur after prolapse surgery and
hysterectomy, were risk factors for pessary failure.
Patients with SUI are more likely to fail pessary usage and opt
for surgical corrections. Wu et al. [7], in their prospective study of
women with symptomatic POP who opted for pessaries, found that
58% of the women who complained of concomitant UI opted for
surgery. Occult SUI is also associated with dissatisfaction with
pessary usage [28].

130

R. Oliver et al. / European Journal of Obstetrics & Gynecology and Reproductive Biology 156 (2011) 125130

9. Complications of usage
Common complications are bleeding, vaginal excoriations,
ulcerations and impactions in the vagina, while rare complications
include actinomycosis and bacterial vaginosis. Vaginal ulcerations
and excoriations can be treated effectively by vaginal estrogen
application. An estradiol-17 ring (placed behind the pessary) has
also been shown to be effective. Neglected pessaries present with
more serious complications, namely stula formation and
peritonitis. Erosion into the bowel or bladder and dense adhesions
to other pelvic structures have been reported. Unusual complications of cervical entrapment, small bowel incarceration, and
hydronephrosis [29] have been reported.
The relationship between vaginal cancers and pessary use was
rst reported by Stevens in 1923. Schraub et al. [31] reviewed the
incidence and treatment of cervical and vaginal cancers associated
with long-term pessary usage in a case series of 96 patients.
Chronic inammation in association with viral infections has been
postulated to be the cause of these vaginal cancers, as in 93 of the
96 cases the tumours occurred at the site of pessary insertion.
An impacted ring pessary can be divided with an orthopaedic
bone cutter and fed through the epithelialized vaginal tunnel, thus
avoiding incision of the vaginal skin necessitating an anaesthetic
procedure. Instruments designed for incising and removing
incarcerated pessaries, called pessariotomes, have been described
as far back in the 1900s. A method of removing impacted Gellhorn
pessaries has been described by injecting 50 ml of saline into the
stem of the Gellhorn to break the suction.
A legitimate result of pessary usage leading to discontinuation
is occult or de novo SUI which was masked by the prolapse. Occult
incontinence has been reported in 3672% of women after
insertion of a pessary [14,28].
The complications due to pessary usage have been described
mainly in case reports which have promoted the idea of the
dangerous pessary. On detailed analyses of these reports it could be
seen that the complications are related to the abuse of pessary use
without adequate monitoring or periodical inspections. As complications of pessary use are mainly due to its neglect, a valid argument
cannot be put forth against its use based on the complications.
10. Conclusion
Based on available evidence, it appears that pessaries are a
viable option for women with prolapse and incontinence and
should be offered as an alternative to surgical correction to all
suitable women. A recent Cochrane review did not identify any
randomized controlled trials on which treatment with pessaries
can be based and research in this area needs to be encouraged [6].
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