The history and usage of the vaginal pessary: a review

It is expected that with the rising female life expectancy the prevalence of pelvic organ prolapse will increase. From ancient times mechanical devices have been used to reposition prolapsed organs. Given that surgical correction of prolapse is associated with high recurrence rates, pessaries offer a favorable alternative. In spite of the antiquity of pessary usage the evidence for its use, the effectiveness of symptom relief, and the nuances of clinical management with the pessary in situ have not been studied methodically. There is a need for controlled trials to assess the efficacy of pessaries as opposed to other non-surgical and surgical methods of treating pelvic organ prolapse. Additionally, the long term effects and complications of pessary usage have not been assessed in trials, and knowledge about the potential complications caused by the pessary rests mainly on anecdotal data. This review provides a historical perspective and appraises the current knowledge regarding the indications, effectiveness and the potential complications associated with pessary use. Data were obtained from an electronic search of Medline (1966-2010) and by hand searching the citations which were not available online. Keywords used were pelvic organ prolapse, pelvic floor dysfunction, vaginal pessary and urinary incontinence. Textbooks are also quoted where relevant. Most studies report moderate success rates in the short term following insertion of a pessary for the management of prolapse and concur in the remission of almost all symptoms attributable to the prolapse. Reported success is variable in the remission of urinary and bowel symptoms. We conclude that based on the available evidence (mostly retrospective and prospective cohort studies), treatment with a vaginal pessary is a feasible option that can be offered in the short term to women with prolapse. There is a need for controlled trials to assess the long term efficacy.