Pessary

Early use of pessaries dates back to the ancient Egyptians, as they described using pessaries to treat pelvic organ prolapse. The term 'pessary' itself is derived from the Ancient Greek word , meaning round stone used for games. Pessaries are even mentioned in the oldest surviving copy of the Greek medical text, the Hippocratic Oath, as something that physicians should never administer for the purposes of an abortion: "Similarly I will not give to a woman a pessary to cause abortion." The earliest documented pessaries were natural products. For example, Greek physicians Hippocrates and Soranus described inserting half of a pomegranate into the vagina to treat prolapse. It was not until the 16th century that the first purpose-made pessaries were made. For instance, in the late 1500s, Ambroise Paré was described as making oval pessaries from hammered brass and waxed cork. Nowadays, pessaries are generally made from silicone and are well tolerated and effective among patients who need them. == Medical uses ==

Pelvic organ prolapse The most common use for pessaries is to treat pelvic organ prolapse. A pelvic organ prolapse can occur when the muscles and tissues surrounding the bladder, uterus, vagina, small bowel, and rectum stop working properly to hold the organs in place and the organs begin to drop outside the body. The most common cause of such prolapse is childbirth, usually multiple births. Obesity, long-term respiratory problems, constipation, pelvic organ cancers, and hysterectomies can all be causes for pelvic organ prolapses as well. Some signs and symptoms include feeling pressure in the pelvic area, lower back pain, painful intercourse, urinary incontinence, a feeling that something is out of place, constipation, or bleeding from the vagina. The pressure causes opening of the sphincter muscles which usually help prevent urine leakage. Stress urinary incontinence is a common medical problem, especially in women; about 1 in 3 women are affected by this condition at some point in their lives. Other Some additional uses for pessaries are for an incarcerated uterus, prevention of preterm birth and an incompetent cervix. In early pregnancy the uterus can be displaced, which can lead to pain and rectal and urinary complications. This can lead to a preterm birth or even a miscarriage. Pessaries can be used to correctly position the cervix, increasing the success of pregnancy. ==Types of pessaries==

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. 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. Support pessary Ring with support pessaries are the supporting type.. A clinical trial has shown that Reia pessaries are equally supportive as ring and Gellhorn pessaries. Reia pessaries have also been found to be less painful to insert and remove than other pessaries. Space-occupying pessary Donut pessaries are considered space-occupying pessaries. Lever pessary Hodge pessaries are a type of lever pessary. Although these can be used for mild cystocele and stress urinary incontinence, they are not commonly used. Smith, and Risser pessaries are other types of lever pessaries and they differ in shape. Pessaries can also be used in a similar way to help induce labor for women who have overdue expected delivery dates or who experience premature rupture of membranes. Prostaglandins are usually the medication used in these kinds of pessaries in order to relax the cervix and promote contractions. According to Pliny the Elder, pessaries were used as birth control in ancient times. Occlusive pessaries Occlusive pessaries are most commonly used for contraception. Also known as a contraceptive cap, they work similar to a diaphragm as a barrier form of contraception. They are inserted into the vagina and block sperm from entering the uterus through the cervix. The cap must be used in conjunction with a spermicide in order to be effective in preventing pregnancy. When used correctly the cap is thought to be 92–96% effective. These caps are reusable but come in different sizes. It is recommended for anyone attempting this form of contraception to be fitted for the correct size by a trained health care professional. Stem pessary The stem pessary, a type of occlusive pessary, was an early form of the cervical cap. Shaped like a dome, it covered the cervix, and a central rod or "stem" entered the uterus through the external orifice of the uterus, also known as the cervical canal or the os, to hold it in place. ==Side effects and complications==

after being left in the vagina for an extended time When pessaries are used correctly, they are tolerated well for pelvic organ prolapse or stress urinary incontinence. However, pessaries are still a foreign device that is inserted into the vagina, so side effects can occur. Some more common side effects include vaginal discharge and odor. These symptoms can be treated with the appropriate medications. More serious side effects include fistula formation between the vagina and rectum or the vagina and bladder, or erosion, or thinning, of the vaginal wall. For individuals with pessaries that are not fitted for them, herniations of the cervix and uterus can occur through the opening of the pessary. This can lead to tissue necrosis in the cervix and uterus. To prevent these side effects, individuals can be fitted properly for their pessaries and undergo routine follow-up visits with their health care professionals to ensure the individual has the correct pessary size and no other complications. In addition, those with an increased risk of vaginal wall thinning can be prescribed estrogen to prevent erosion and prevent these complications. If pessaries are not used properly or not maintained periodically, more serious complications can occur. For example, the pessary can become embedded into the vagina, which makes it harder to remove. Estrogen can decrease the inflammation of the vaginal walls and promote skin cells in the vagina to mature, so use of estrogen cream can allow removal of the pessary more easily. In rare cases, pessaries would need to be removed through surgical procedures. To prevent complications, individuals should not use pessaries if they have characteristics that exclude them from this method of therapy. Contraindications to pessary use include current infections in the pelvis or vagina, or allergies to the material of the pessary (which can be silicone or latex). In addition, individuals should not be fitted for a pessary if they are less likely to properly maintain their pessary. ==See also==