Pessary

Last revised by Mohammad Taghi Niknejad on 15 Jan 2024

A pessary is a device inserted into the vagina which can either be mechanical or pharmaceutical.

Strictly speaking, a pessary only refers to a medical device designed to be placed in the vagina to support the pelvic floor. Therefore, stating vaginal pessary is tautologous, although this form of words can still be seen in reports, especially when there is the possibility of confusion about the device's location.

Mechanical pessaries are inserted to support the vagina, and therefore the other pelvic organs lying superior and posterior to it, preventing prolapse of pelvic organs into the vagina and through the pelvic floor; pessaries secondarily decrease pressure on the bowel and urinary bladder 1.

A mechanical pessary is most commonly used to treat uterine prolapse. It is also used to treat stress urinary incontinence, a retroverted uterus, cystocele and rectocele. A bewildering array of shapes and sizes are available, nevertheless there are two main types:

  1. support pessaries

  2. space filling pessaries

A pharmaceutical pessary is imbued with compounds that are active locally.

Pessaries are not a contraindication to performing an MRI (see MRI safety).

An understanding of the radiological appearance of these devices is useful to avoid misinterpreting them, and to be aware when they are malpositioned/mal-located.

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