Pelvic organ prolapse and urinary incontinence are distressing conditions and management using pessaries has been described as far back as the ancient Egyptians. The word pessary comes from a Greek word ‘pesos’ which means round and it is referred to a mechanical device that is used to support the pelvic organs internally.
Throughout history, various round fruits and objects were used to support a prolapse. Hippocrates and Diocles mentioned using half cut pomegranate for support. Aurelius Cornelius Celsus described using a bronze coin cone shape that is attached to vaginal opening and tied around the body to keep it it in place. Around AD 1050, Trotula, the first recorded gynaecology practitioner, used strips of linen to make a ball pessary. Later on in Germany a tightly rolled sponge dipped in wax, bound with a string was used as a substitute for the previous options. Ambrose Pare in the 16th century designed various types of pessaries: oval and pear shaped, ring pessaries made of hammered brass and waxed cork.
Goodyear introduced rubber into pessary designs which was substituted by polystyrene plastics in the 1950s and in recent times further substituted with silicone based materials.
Pessaries were mainly fitted by gynaecologists, however in the past decade, women’s health physiotherapists with appropriate pessary training have been able to fit them. There are many different types and sizes of pessaries available. From their assessment the physiotherapist will determine what the appropriate pessary is for that individual and will provide instructions for care. Some pessaries can be left in situ and some can be taken out.
Description provided by Natasa Banicevic of Australia
