How to Put in a Pessary: A Comprehensive Guide
How to put in a pessary can seem daunting at first, especially for women who are new to this form of treatment for conditions like pelvic organ prolapse or stress urinary incontinence. However, with proper guidance and practice, inserting a pessary can become a straightforward routine. This article provides a detailed, step-by-step approach to help you understand the process, prepare adequately, and ensure comfort and safety during insertion.
Understanding Pessaries and Their Purpose
What Is a Pessary?
A pessary is a medical device inserted into the vagina to support pelvic organs such as the bladder, uterus, or rectum. It is often prescribed for women experiencing prolapse (when pelvic organs drop from their normal position) or urinary incontinence. Pessaries come in various shapes, sizes, and materials, tailored to individual needs.
Benefits of Using a Pessary
- Non-surgical management of pelvic organ prolapse
- Relief from symptoms such as pressure, bulging, or urinary issues
- Can be used temporarily or long-term, depending on medical advice
- Generally well-tolerated and removable for cleaning or during intercourse
Preparing to Insert a Pessary
Gather Necessary Supplies
- Appropriate-sized pessary (your healthcare provider should recommend the right size and shape)
- Water-based lubricant (preferably sterile or medical-grade)
- Clean hands or disposable gloves
- Mirror (optional, for better visualization)
- Clean towel or cloth (for comfort and hygiene)
Choose the Right Environment
Find a private, comfortable space with good lighting. Sitting on the toilet or in a seated position on a chair or bed can help with stability and access during insertion.
Wash Your Hands
Thorough handwashing with soap and water is essential to reduce the risk of infection. If using gloves, put them on now.
Step-by-Step Instructions for Inserting a Pessary
Step 1: Prepare the Pessary
Apply a water-based lubricant generously to the entire surface of the pessary. This reduces discomfort during insertion and helps it slide smoothly into place.
Step 2: Get Into a Comfortable Position
Choose a position that allows easy access to the vagina. Common positions include:
- Sitting on the toilet with knees apart
- Sitting on the edge of a chair or bed with legs slightly apart
- Lying on your back with knees bent and feet flat on the floor or bed
Using a mirror can help if you want to see what you are doing, especially for the first few times.
Step 3: Open the Vaginal Opening
Using your fingers, gently spread the labia (inner folds of skin) to expose the vaginal opening. This provides better access and visibility.
Step 4: Hold the Pessary Correctly
Hold the pessary firmly with your fingers. If your pessary has a stem or a handle, ensure it is pointing downward or in a position you find comfortable for insertion.
Step 5: Insert the Pessary
- Gently insert the tip of the pessary into the vaginal opening, aiming slightly towards your lower back or abdominal area.
- Slide the pessary upward and inward, following the natural curve of your vaginal canal. Use gentle pressure; do not force it.
- Continue until the pessary sits comfortably behind the pubic bone and the widest part is fully inside.
If your pessary has a stem, it should be positioned so that it remains outside the vagina and can be easily grasped for removal or adjustment.
Step 6: Confirm Proper Placement
Once inserted, the pessary should feel comfortable and stable. You should not feel any discomfort or pressure. If you experience pain, remove and try again with a different size or shape, or consult your healthcare provider.
Post-Insertion Care and Tips
Check for Comfort
After insertion, sit or stand for a few minutes to assess comfort. If the pessary causes persistent discomfort, it may need adjusting or replacing.
Hygiene and Maintenance
- Wash your hands thoroughly before and after handling the pessary.
- Follow your healthcare provider’s instructions regarding cleaning or removing the pessary. Some require regular removal for cleaning, while others can stay in place for weeks.
- Use water and mild soap for cleaning if advised; avoid harsh chemicals.
Monitoring and Follow-up
Regular follow-up with your healthcare provider is essential to monitor the fit, comfort, and any potential issues like irritation or infection. Keep track of any symptoms such as unusual discharge, bleeding, or discomfort.
Common Challenges and Troubleshooting
Difficulty Inserting the Pessary
- Ensure hands are clean and lubricant is adequate.
- Try different positions to find what works best for you.
- If persistent difficulty, consult your healthcare provider for advice or alternative sizes/shapes.
Feeling of Discomfort or Pain
- Remove the pessary carefully and reinsert using more lubricant.
- Check if the pessary is the correct size and shape.
- Seek medical advice if pain persists.
Loss of the Pessary Inside the Vagina
- Most pessaries are designed with a stem or handle for easy removal. If you cannot locate it or cannot remove it, contact your healthcare provider promptly.
When to Seek Medical Assistance
- If you experience severe pain, bleeding, or signs of infection (such as foul-smelling discharge)
- If you cannot remove or reposition the pessary safely
- If you notice symptoms of urinary or vaginal problems
- During routine follow-up appointments as recommended by your healthcare provider
Conclusion
Learning how to put in a pessary correctly is key to managing prolapse or urinary issues effectively and comfortably. Remember that practice improves confidence, and your healthcare provider is a valuable resource for personalized advice and support. With patience and proper technique, inserting a pessary can become a simple and manageable part of your healthcare routine, offering relief and improving quality of life.
Frequently Asked Questions
What are the basic steps to insert a pessary correctly?
First, wash your hands thoroughly. Find a comfortable position, such as lying on your back with knees bent or standing with one foot elevated. Lubricate the pessary with water-based lubricant. Gently insert the pessary into the vagina, ensuring it sits properly behind the pubic bone or cervix, depending on the type. Follow your healthcare provider's instructions for placement and removal.
How do I know if the pessary is positioned correctly?
A correctly placed pessary should feel comfortable and stay in place without causing discomfort or pressure. You should not feel it protruding significantly or experiencing pain. If you notice discomfort, leakage, or the pessary feels out of place, contact your healthcare provider for guidance.
Can I wear a pessary all day, and how often should I remove or clean it?
Yes, most pessaries are designed to be worn during the day; some can be left in for up to 24 hours or longer as advised by your healthcare provider. It is recommended to remove and clean the pessary at least once a week to prevent infection and maintain hygiene. Follow your provider's specific instructions.
What should I do if I experience discomfort or pain after inserting a pessary?
If you experience discomfort, pain, or unusual symptoms after insertion, remove the pessary if possible and contact your healthcare provider promptly. Do not force the pessary out or leave it in if it causes significant discomfort. Your provider can assess and advise on proper placement or alternative options.
Are there different types of pessaries, and does insertion vary between them?
Yes, there are various types of pessaries, such as ring, sphere, and cube pessaries. The insertion process can vary slightly depending on the type. Your healthcare provider will instruct you on the specific technique for your pessary type to ensure proper placement and comfort.
Can I use lubricants other than water-based ones when inserting a pessary?
It is recommended to use water-based lubricants, as oil-based lubricants can damage silicone pessaries and make removal more difficult. Always check with your healthcare provider before using any other types of lubricant to ensure safety and compatibility.
How do I remove a pessary safely and comfortably?
Wash your hands thoroughly. Find a comfortable position, such as lying on your back with knees bent or standing with one foot elevated. Gently insert your fingers into the vagina, grasp the pessary, and slowly and carefully pull it out. If you have difficulty or experience pain, contact your healthcare provider for assistance.
When should I seek medical advice after inserting a pessary?
Seek medical advice if you experience persistent pain, discomfort, unusual bleeding, foul odor, or signs of infection. Also, consult your provider if you have difficulty inserting or removing the pessary or if it feels dislodged. Regular follow-up appointments are important for ongoing management.
