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A vaginal pessary (an object inserted into the vagina to hold the uterus in place) may be used as a temporary or permanent form of treatment. Vaginal pessaries come in many shapes and sizes, and they must be fitted for each woman individually.
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Vaginal pessaries are effective for many women with uterine prolapse, however, depending on the extent of the prolapse and vaginal wall relaxation, pessaries may be of little or no use. In addition to the limits of their use in treatment there are other drawbacks.
Pessaries may cause an irritating and abnormal smelling discharge, and they require periodic cleaning, usually done by the physician. In some women they rub on and irritate the vaginal mucosa, and in some cases may erode and cause ulcerations. Some types of pessaries may interfere with normal sexual intercourse by limiting the depth of penetration.
If the woman is obese, attaining and maintaining optimal weight is recommended. Heavy lifting or straining should be avoided.
There are some surgical procedures that can be done without removing the uterus, such as a sacral colpopexy. This procedure involves the use of surgical mesh for supporting the uterus.
Most surgery should be deferred until symptoms are significant enough to outweigh the risks. The surgical approach depends on:
- The woman's age and general health
- Desire for future pregnancies
- Preservation of vaginal function
- Degree of prolapse
- Associated conditions
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