User:Y.Jung, Future UCSF Pharm.D/sandbox

Therapeutic pessaries
A therapeutic pessary is a medical device similar to the outer ring of a diaphragm. Therapeutic pessaries are used to support the uterus, vagina, bladder, or rectum. Pessaries are most commonly used for pelvic organ prolapse and considered a good treatment option for women who need or desire non-surgical management or future pregnancy. It is used to treat prolapse of uterine, vaginal wall (vaginal vault), bladder (cystocele), rectum (rectocele), or small bowel (enterocele). It is also used to treat stress urinary incontinence.

There are different types of pessaries but most of them are made out of silicone --a harmless and durable material. Pessaries are mainly categorized into two types, supporting pessaries and space-occupying pessaries. But, there are also lever type pessaries.

Ring with Support Pessary

Ring pessaries are the supporting type. These are often used as a first-line treatment and used for earlier stage prolapse since patients can easily insert and remove them on their own without a doctor's help. These can be easily folded in half for insertion.

Gellhorn Pessary

Gellhorn pessaries are the supporting and space-occupying pessaries. These resemble the shape of a mushroom and are used for more advanced pelvic organ prolapse. These are less preferred than ring with support pessary due to difficulty with self-removal and insertion.

Marland Pessary

Marland pessaries are the support pessaries. These are used to treat pelvic organ prolapse as well as stress urinary incontinence. These pessaries have a ring at their base and a wedge-shaped ridge on one side. Although these pessaries are less likely to fall out than standard ring with support pessaries, patients find it difficult to insert or remove them on their own.

Donut Pessary

Donut pessaries are the space-filling pessaries. These are used for more advanced pelvic organ prolapse including cystocele or rectocele as well as a secondor third-degree uterine prolapse. Due to its shape and size, it is one of the hardest ones to insert and remove.

Cube Pessary

Gehrung Pessary

These are U-shaped pessary.

Hodge Pessary

'''Hodge pessaries are the lever pessaries. Although these can be used for mild cystocele and stress urinary incontinence, these are not commonly used. Smith, and Risser pessaries are other types of lever pessaries and they differ in shape.'''

The Cerclage Pessary is used to treat pregnant women with cervical incompetence in order to support the cervix and turn it backward towards the sacrum. It may be indicated in pregnancies with a history of premature labor, multiple pregnancies or mothers who are exposed to physical strain (e.g. standing for a long time). It may also be indicated in pregnant women suffering from prolapse of the genital organs.

The pessary can be placed temporarily or permanently, and must be fitted by a physician, physician assistant, midwife, or advanced practice nurse. Some pessaries can be worn during intercourse.

The Cerclage Pessary is used to treat pregnant women with cervical incompetence in order to support the cervix and turn it backward towards the sacrum. It may be indicated in pregnancies with a history of premature labor, multiple pregnancies or mothers who are exposed to physical strain (e.g. standing for a long time). It may also be indicated in pregnant women suffering from prolapse of the genital organs.

The pessary can be placed temporarily or permanently, and must be fitted by a physician, physician assistant, midwife, or advanced practice nurse. Some pessaries can be worn during intercourse.

Stress urinary incontinence is leakage of urine that is caused by sudden pressure on the bladder. It occurs during activities that increase the amount of pressure on the bladder such as coughing, sneezing, laughing and exercise. The pressure causes opening of the sphincter muscles leading to urine leakage. Stress urinary incontinence is a common medical problem especially in women as about 1 in 3 women are affected by this condition at some point in their lives. Pessaries are considered a safe treatment option for stress urinary incontinence as it can control the urine leakage by push the urethra closed. A pessary can be removed any time.