Answer: Pessary Selection and Fitting Tips Assess for and treat causes of vaginal tenderness prior to fitting (infection, lesions, or tension myalgia).
Familiarize the woman with the pessary before fitting (let her see, feel, and fold it; use visual aids, such as pelvic models or charts, to show how it will stay in her vagina).
Fitting will be more comfortable if the woman has an empty bladder and bowel; however, to test for stress incontinence, fitting with the bladder full will facilitate assessment. If the bowel is full and cannot be emptied voluntarily, an enema onsite or rescheduling the appointment may be most helpful.
Autoclavable fitting kits are available, but keeping a small stock of silicone pessaries in commonly used sizes and shapes may offer a more true-to-life fitting experience.
Fitting comfort may be improved for women who are very apprehensive or sensitive by the use of lidocaine gel applied to the introitus 5 minutes before fitting.
If genital tissue is very atrophic or non-elastic, several weeks of topical estrogen therapy prior to fitting may be optimal.
Refitting may be necessary after weight loss or weight gain, any period of temporary removal, or during long-term use if atrophic tissue change continues (increased stenosis or decreased support).
During post-fitting pessary testing, placement of a urine receptacle ("Hat") in the commode will ease retrieval if the pessary is expelled. Otherwise, instruct the woman not to flush the pessary into the plumbing system.
A pessary that is comfortable and retained except during bowel movements may be a success if the woman chooses to either remove the pessary for defecation or support it digitally during evacuation.
If the pessary is easily expelled, try a larger size or different style. If the pessary is uncomfortable or the patient feels pressure, try a smaller size or different style. Successfully sized, the pessary should be comfortable; women often say, "I can't even tell it's there!"
Make sure a system is in place to identify missed pessary follow-up visits to avoid potential
Medical Supplies Club Customer Care
Store answer
Helpful?
