FAQ for pessaries

In most cases, patients can change their pessaries themselves. The frequency of change and accordingly also of cleaning may thereby vary. Cube pessaries/tandem pessaries should be removed every evening and re-inserted in the morning. The thread is attached to a fixed button in the center of the device.  Cube pessaries should be cleaned every evening under running warm water, any residue can be removed with a soft toothbrush. In case of unpleasant odor, it is recommended to add a ph-neutral soap solution. For all other pessaries, the cleaning is even easier likewise under warm running water, possibly with some soap solution. Since all pessaries are only used by one patient, the devices do not need to be sterilized or “boiled”. Disinfectants are also not required, nor are they recommended, as they irritate the mucous membrane and can destroy the natural germ flora.

During horseback riding, running, jumping or dancing, complaints of prolapse or even urine loss may increase. Therefore, some women wear a pessary only during these activities, which they would otherwise not need. If a patient is already treated with a pessary, the device does not need to be removed for any sport. During swimming, all pessaries remain in place, neither chlorine nor salt water changes the silicone. While using a cube pessary without perforation, some fluid may collect behind the pessary, which can be dried off in the evening when removing the pessary. This is not associated with any risk.

Allergy to silicone is extremely rare and has never been reported during the last 50 years of pessary care. All our pessaries are made of biologically compatible silicone, which is always tested by validated methods before the distribution and after a simulated period of 10 years.

The durability of the products as determined by “aging tests” is 10 years, which implies the function and biocompatibility during storing. From the date of the first use, our devices can be used for at least 6 months without restrictions. In case of any deficiencies detected during the first six months of use, it is advised to send us a picture with of the device and the label with the lot number.  The patient will then receive a new product free of charge. Unnecessary violence such as loosening the button or “cooking” must be avoided.

The Cerclage pessary is designed to prevent preterm birth during pregnancy but can also decrease symptoms of mild genital prolapse. If the cervix is of normal length, we recommend an urethra bowl pessary for the treatment of stress incontinence during pregnancy, a sieve bowl pessary for the treatment of prolapse grade 1-2 and a club pessary for the treatment of genital prolapse grade 3-4. In addition, customized pessaries are recommended and can be requested (see first page of our website). Cube pessaries should not be used during pregnancy.

All pessaries are a “foreign body” for the vagina; therefore, the most common side effect of pessary therapy is increased discharge.

Each patient has an individual microbiome in open body cavities such as mouth, bowel or vagina. A pessary therapy does not change the germ composition. Increased discharge does rarely indicate infections, but is most frequently the result of irritation.

We recommend the usual hygiene measures. Especially for postmenopausal women, care of the vaginal mucosa with estrogen cream twice a week, a fatty cream 7 times a week (Vaseline® or Linola®) and possibly a pH stabilization (Vagisan®). These creams can be used during insertion. If the discharge contains blood or if there is a very unpleasant odor, a physician should be consulted.

Each pessary is accompanied by instructions on how to insert and remove the products. For the cube pessary, it is important to ensure that the thread-button combination points towards the introitus, so that the thread remains manageable. During removal the thread must not be pulled, but the vacuum effect must first be released by carefully moving it back and forth. Only thereafter, the thread can aid in removing the pessary, which is easier if one leg is leaning on a chair. If the thread is not reached, the pessary can be manually removed or otherwise a physician be consulted.

During pregnancy, no additional creams are indicated. In the pre- and postmenopausal period, pessaries should be covered with estrogen creams that help to strengthen the vaginal mucosa (e.g.: 2x/week before insertion). Daily use of a lubricating cream (e.g. Vaseline or Linola®) and a  pH-stabilizing cream (e.g. Vagisan®) keep the vagina “young” and support sexual life.

Any pessary should improve the quality of life, not worsen it. If a pessary causes pain, problems with urination or defecation, either the type of pessary or the size needs to be modified. The gynecologist should be consulted. If in doubt, we can be contacted info@dr-arabin.de.

Annular pessaries allow drainage of discharge and blood – there is no indication to remove these devices. After the bleeding has stopped, it is advisable to change the pessary, clean it and to remove any fibrin deposits with a soft toothbrush. Unperforated cube pessaries should not be used during the first days of bleeding. Perforated cube pessaries should be routinely cleaned every evening or more frequently, if necessary.

In general, pessaries are  used for the treatment of genital prolapse symptoms and/or incontinence during daytime. Symptoms are rarely pronounced when the patient is in a recumbent position. Annular pessaries that are placed relatively high within the vagina do not interfere with sexual intercourse, nor should they be necessarily removed in the evening.  Cube and tandem pessaries are removed in the evening anyway – this can be done before eventual intercourse. The coating with estrogen cream, Vaseline or Vagisan® in the morning even improves sexual life in the long term. However, club pessaries, which are only indicated for severe prolapse, may be disturbing due to the stalk.

When using intrauterine pessaries (Mirena®/Jaydess® / IUD), care must be taken not to dislodge the fine thread. When using cube pessaries, where the patient wears a pessary only during the day and removes it in the evening, special care must be taken to remove the vacuum effect. The hormone-containing vaginal rings can be left in place above any pessary. Nothing is known about the combined treatment with a diaphragm, we do not recommend it due to concern that the position of the diaphragm might be dislocated.

In many countries, it is recommended not to perform surgery of the pelvic floor without a preceding therapy with pessaries. International studies have shown no significant differences in terms of satisfaction and efficiency when comparing pelvic floor operations and vaginal pessaries. Another indication for pre-operative treatment is the additional application of estrogens applied on a pessary, which improves local blood supply and thus the success of surgery. Experienced specialists still indicate pessaries after surgery of the pelvic floor to stabilize the surgical result and prevent premature recurrence. This should be discussed prior to surgery.

A request for customized (individually made) pessaries can be downloaded at www.dr-arabin.de (first page).  The MDR (Medical Device Regulation) requires a physician’s order for the fabrication of a customized device. Health insurances should be asked whether the costs for fabrication are covered. Various models that are not commercially available can be asked for. Frequently, the forms will be individualized or metal inlays inserted (like in Hodge pessaries). New designs  for the use during pregnancy and the postpartum period are developed.

Pessary therapy should improve the quality of life of women of all ages. In the past, it was common to leave pessaries in place for a long period. With ring-shaped pessaries, there may then be a risk of further dilatation of the vaginal walls, resulting in the need to use pessaries with increasingly larger diameters. This risk can be prevented by removing pessaries in the evening and re-inserting them in the morning.  In the case of pessaries that adhere due to a vacuum effect (e.g. cube pessaries), there is no risk of additional dilatation. In fact, it is often the case that patients require smaller sizes as the pelvic tissue is massaged and strengthened by this mechanism.