Why do you need a pessary
A ring or diaphragm in the vagina can help with a prolapse of your bladder and uterus. The ring keeps the organs in place better. The ring sits in the vagina and then rests on a layer of muscles (the pelvic floor). The uterus or vaginal wall (if you no longer have a uterus) hangs on the ring and no longer drops. The ring also pushes your urethra up a little so that involuntary leakage of urine can improve. The ring has to be changed every now and then, some women can do this themselves, if this does not work, the doctor can do this.
How to measure and insert a diaphragm
- With vaginal examination, measure the distance between the fornix posterior and the back of the pubis by hand.
- Make an estimate of the pessary diameter, usually this is between 65 – 90 mm.
- Heat the diaphragm with, for example, lukewarm water and squeeze the diaphragm together at the bottom with thumb and forefinger to form an oval
- Apply some lubricant
- Allow the woman to push lightly and spread the labia and insert the diaphragm slightly diagonally, avoiding contact with the urethra and clitoris.
- Then push the diaphragm further up with one finger beyond the os pubis: the front now rests against the back of the os pubis and the back is in the fornix posterior
- A finger can still be inserted between the ring and the vaginal wall and the portio is inside the ring.
- Ask the patient if she feels the pessary. If it fits correctly, the patient will not feel the diaphragm
- It can be too small and when straining or coughing or walking around it falls out. Then choose a 5-10 mm larger size.