[How I treat… a pelvic organ prolapse at the doctor's office]

The use of gynecological pessary to put back up prolapsed organs to their normal position appears to be as effective as surgical management to relieve symptoms related to uro-genital prolapse and restore body image. This millenary device can be used temporarily, awaiting a surgical solution or as a therapeutic test (mimicking the effect of a surgical procedure to predict its functional outcome or identifying a masked urinary incontinence). It can also represent an alternative to surgery (patient choice, women who wish to complete childbearing or who are unsuitable for surgery because of medical comorbidities) and thus can be used in first intention. Pessary can also be used to confirm or deny the responsibility of pelvic organ prolapse for atypical symptomatology as pelvic heaviness or pain. However, this use requires adjuvant treatment. In this paper, we highlight an original effective process not yet published to optimize the tolerance of pessary.