Pessaries are used as a conservative management approach to women’s pelvic health conditions including pelvic organ prolapse (POP) and stress urinary incontinence (SUI). In general, using a pessary is safe. There are few risks, so long as one follows the recommended protocol prescribed by their health care professional. Mismanagement of a pessary, on the other hand, can lead to serious health concerns. Today we are going to discuss contraindications or red flag situations when a woman cannot use a pessary. Be sure you don’t miss our related blogs: “Medical Conditions that may Prevent Pessary Use – Part II” which discusses yellow flag situations when a pessary may not be a safe option for a woman, ” Potential Side Effects and Risks of Pessary Use”, and “When to Seek Medical Attention”.
Contraindications
The medical history of each woman must be considered when contemplating the use of a pessary, as there are certain conditions where the use of a pessary could pose increased risk for that individual woman. Many of these situations are reversible and pessary use can safely be considered after the underlying medical condition has been adequately addressed. The following are a list of contraindications of when a pessary should not be prescribed due to health and safety concerns.
- Undiagnosed vaginal bleeding
- After appropriate investigations have been conducted and a reason for the bleeding determined, pessary use may be considered depending on the underlying cause.
- Severe vaginal atrophy
- Hormone replacement therapy may be prescribed by your physician or specialist to help combat and reverse symptoms of atrophy. Sometimes a topical estrogen is prescribed such as Premarin or a vaginal suppository ovule such as Vagifem. It is important to note that research has shown that the use of estrogen in this manner is only absorbed locally and does not have a systemic effect.
- Active vaginal, vulvar or urinary infections
- A pessary should not be used during an active infection of any kind. See your physician for the appropriate treatment and then discuss or resume the use of a pessary.
- Ulcerations of the cervix, vagina, lacerations
- Open sores of the vagina or cervix must be addressed and healed prior to pessary use. Your physician will prescribe the necessary treatment to help your tissues heal before commencing use of a pessary.
- Uncontrolled diabetes
- Diabetes can contribute to decreased blood flow, impaired tissue health and delayed healing times. Thus, it is important to ensure your diabetes is well-managed before considering the use of a pessary.
- Cancer of the vulva, vagina, bladder, uterus
- Pessary use is contraindicated if a woman has vular, vaginal, bladder, or uterine cancer.
- Active inflammatory disease
- Pessary use is contraindicated if a woman has active inflammatory disease of the pelvis.
- Known silicone allergy
- Most pessaries available on today’s market are made from medical grade silicone, with the exception of the inflatoball made of latex. Although must less common, there are alternative options available for women who have silicone allergies, so be sure to advise your health care professional if you have a silicone allergy so she/he can find an appropriate alternative for you.
- Gynecological surgery with mesh insertion
- Pessary use is contraindicated if a woman has had a gynecological surgery with mesh insertion. This is to prevent the occurrence of erosion from pressure of the pessary against the tissue over the mesh.
- Ano-perineal lesions associated with Crohn’s Disease
- Pessary use is contraindicated in the instance of ano-perineal lesions associated with Crohn’s disease.
If you experience any of the above signs or symptoms, you must address the underlying medical condition before considering use of a pessary.
The information in this blog is provided as an information resource only and should not be used as a substitute for seeking personalized direction from your overseeing physician. Please consult your healthcare team before making any decisions about your pessary treatment plan, which is unique to you and your overall health. Toronto Pessary Clinic expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this blog.