Female Genital Prolapse
A prolapse is the descent of the uterus and/or vaginal walls. A vaginal ring pessary can be used to help correct a uterovaginal prolapse. This guide offers some information on both the sizing and fitting of a pessary.
Guidance on the Fitting of a Vaginal Ring Pessary
- The vaginal ring pessary should be fitted strictly under medical guidance provided by a medical professional.
- The pessary fitter should wash their hands and put on disposable gloves.
- The patient should be asked to remove all underwear and lie down on their back. Cover patient with a modesty sheet.
- The patient should be shown the ring pessary before fitting and given an explanation of the procedure and its aims.
- The pessary fitter should measure the distance between the cervix or vaginal vault (in cases of previous hysterectomy) and the symphsis pubis by inserting the index and middle fingers into the vagina.
- After carrying out this procedure ascertain the correct size of ring pessary required by placing the measuring fingers against the measurement lines on this pessary fitting guide.
- Remove the correct size pessary from the sealed pouch. If using a PVC pessary, immerse in warm water to make it more pliable, taking care to ensure that it has cooled before placing in the vagina.
- The patient should lie on her back with her knees drawn up and separated, the fitter should hold the pessary with the thumb and forefinger of the dominant hand and compress into an oval shape. If appropriate, a water-based lubricant should be applied. Using the non-dominant hand, the fitter should part the labia to find the vaginal entrance and slide the pessary into the posterior part of the vagina using a gentle backwards and downwards motion until it settles in the posterior fornix. The pessary should spring back into its circular shape once inside the vagina. When secured posteriorly, the fitter should hook the front portion of the pessary behind the symphsis pubis. The cervix (if present) should be seen positioned centrally through the ring.
- The patient should be asked if she is comfortable once the pessary has been fitted and she should sit, stand, walk, bear down, pass urine and ideally have a bowel movement. The patient should be issued with instructions on the maintenance of the pessary and an appointment made for a future pessary check/change. Contact details should be given in case of problems.
- To remove a fitted pessary, the fitter should insert the index finger of the dominant hand into the patient’s vagina to locate the ring. With the same finger, hook the ring from underneath the symphsis pubis and remove gently using a continual downward traction movement.
Bray Group manufactures two types of Portia Ring Pessary; Flexible PolyVinyl-Chloride (PVC) and Rigid Polythene. PVC pessaries range from 50mm-110mm, Polythene pessaries range from 50mm-100mm. The pessaries are designed for single-patient use only.
Manufacturer’s recommendation is that Portia pessaries are replaced after 6 months, but the final decision rests with the medical professional.
- PVC The wall of the PVC pessary is 12.5mm thick and when placed in warm water the pessary softens and becomes more pliable.
- Polythene The wall of the Polythene pessary is 7.5mm thick and is more rigid.