Chapter 249 Pessary Fitting DESCRIPTION Pessaries are devices fitted and worn in the vagina to provide support to the pelvic organs. Pessaries are available in various sizes and shapes and are categorized as supportive (e.g., ring, Gellhorn, Gehrung) or space occupying (e.g., doughnut, cube). INDICATIONS Pelvic organ prolapse, urinary incontinence, cervical incompetence (lever or ring type), drug delivery. Pessaries are often used as either an alternative to surgery or as a presurgical trial. CONTRAINDICATIONS Undiagnosed vaginal bleeding, significant vaginal atrophy. Patients who are unable or unwilling to manage the periodic insertion and removal of the device are poor candidates. REQUIRED EQUIPMENT • Vaginal speculum • Water-soluble lubricant • Nonsterile examination gloves • Examples of appropriate pessaries in a variety of sizes (generally the “average size” and at least one size larger and smaller) TECHNIQUE Pessaries will not be well tolerated or provide optimal support in the patient who is poorly estrogenized. Therefore, a minimum of 30 days of topical estrogen therapy should be instituted prior to a trial of pessary therapy in these patients. The type of pessary chosen for a given patient is determined by the anatomic defect and the symptoms the patient is experiencing. The most commonly used forms of pessary for pelvic relaxation are the ring (or doughnut), the ball, and the cube. The indications for various types of commonly used pessaries are shown in the box. The type of pessary that can be fitted is related to the severity of prolapse. Ring pessaries are frequently a first choice, followed by Gellhorn or other pessaries if the rings do not stay in place. Pessaries are fitted and placed in the vagina in much the same way as a contraceptive diaphragm: the depth of the vagina and the integrity of the supporting structures of the vagina are gauged as a part of the pelvic examination. The size of pessary to be fitted is based on the findings of the pelvic examination. The pessary is lubricated with a water-soluble lubricant, folded or compressed, and inserted into the vagina. (Some pessaries require specific maneuvers for their insertion; always consult the manufacturer’s instructions.) Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Anemia Toxic Shock Syndrome Uterine Anomalies: Bicornuate, Septate, and Unicornuate Uterus Cervical Cancer Stay updated, free articles. Join our Telegram channel Join Tags: Netters Obstetrics and Gynecology Jun 6, 2016 | Posted by admin in GYNECOLOGY | Comments Off on Pessary Fitting Full access? Get Clinical Tree
Chapter 249 Pessary Fitting DESCRIPTION Pessaries are devices fitted and worn in the vagina to provide support to the pelvic organs. Pessaries are available in various sizes and shapes and are categorized as supportive (e.g., ring, Gellhorn, Gehrung) or space occupying (e.g., doughnut, cube). INDICATIONS Pelvic organ prolapse, urinary incontinence, cervical incompetence (lever or ring type), drug delivery. Pessaries are often used as either an alternative to surgery or as a presurgical trial. CONTRAINDICATIONS Undiagnosed vaginal bleeding, significant vaginal atrophy. Patients who are unable or unwilling to manage the periodic insertion and removal of the device are poor candidates. REQUIRED EQUIPMENT • Vaginal speculum • Water-soluble lubricant • Nonsterile examination gloves • Examples of appropriate pessaries in a variety of sizes (generally the “average size” and at least one size larger and smaller) TECHNIQUE Pessaries will not be well tolerated or provide optimal support in the patient who is poorly estrogenized. Therefore, a minimum of 30 days of topical estrogen therapy should be instituted prior to a trial of pessary therapy in these patients. The type of pessary chosen for a given patient is determined by the anatomic defect and the symptoms the patient is experiencing. The most commonly used forms of pessary for pelvic relaxation are the ring (or doughnut), the ball, and the cube. The indications for various types of commonly used pessaries are shown in the box. The type of pessary that can be fitted is related to the severity of prolapse. Ring pessaries are frequently a first choice, followed by Gellhorn or other pessaries if the rings do not stay in place. Pessaries are fitted and placed in the vagina in much the same way as a contraceptive diaphragm: the depth of the vagina and the integrity of the supporting structures of the vagina are gauged as a part of the pelvic examination. The size of pessary to be fitted is based on the findings of the pelvic examination. The pessary is lubricated with a water-soluble lubricant, folded or compressed, and inserted into the vagina. (Some pessaries require specific maneuvers for their insertion; always consult the manufacturer’s instructions.) Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Anemia Toxic Shock Syndrome Uterine Anomalies: Bicornuate, Septate, and Unicornuate Uterus Cervical Cancer Stay updated, free articles. Join our Telegram channel Join Tags: Netters Obstetrics and Gynecology Jun 6, 2016 | Posted by admin in GYNECOLOGY | Comments Off on Pessary Fitting Full access? Get Clinical Tree
