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Ring Pessaries - Polythene & PVC (Vinyl)

A ring Pessary may be used for a prolapsed uterus ('collapsed womb' or 'dropped womb'), whereby the uterus prolapses into the vagina. This condition may vary in severity from first to third degree. A prolapsed uterus may be caused, or the risk of its occurrence increased, by:

• an inherited weakness of the structure of collagen or ligaments which support the pelvic floor;
• poor muscle tone;
• damage during childbirth;
• inherently incorrect womb position especially if the womb is retroverted.

The condition can give rise to pressure on the bladder or rectum, leading to difficulty in urination or retention of urine, or to severe constipation. Acute or chronic back pain may result.

A ring pessary may alleviate any pain or discomfort in these situations by acting as a support for the displaced uterus. As such it compensates for connective tissue weakness, poor muscle tone, damage or related problems and helps to forestall complications.

When a prolapse occurs in a younger woman, a doctor might recommend an operation to correct it, whereby the muscles are stitched back into position. In an older woman, particularly if past childbearing age, a hysterectomy may be suggested. In both of these cases a pessary can be worn to provide relief during the period pending the operation. Portia pessaries are made of either polythene or PVC (vinyl). A polythene pessary has a narrower minor section (ring thickness) but is more rigid than a PVC pessary. Both types of pessary are available in a range of sizes as listed below. The size is measured as the external (major) diameter.

Only a qualified medic should perform the examination to determine which type and size of pessary is to be used. This will depend on the individual patient and the particular circumstances of her condition. A pessary may be purchased against a doctor's prescription. The pessary must be fitted or removed under the guidance of a medical professional trained in such procedures. When inserted it must be pushed high into the vagina and made to surround the cervix. The back edge of the pessary should lie within the posterior fornix, the front edge behind the symphysis pubis (pubic bone).

After fitting, the pessary should be changed at 3 monthly intervals as a minimum, or otherwise as judged by the medic. Both the pessary itself and the condition of the vagina (see next paragraph) should be inspected during this procedure. At inspection at short intervals, and if not excessively soiled, a pessary may be cleaned with warm soapy water, rinsed thoroughly with suitably clean water and refitted. As directed in the UK Drug Tariff, antiseptics containing phenols or cresols should be avoided, as these may be absorbed, causing severe irritation in use. In any case a pessary should be discarded after one year's use and replaced with a new one. A pessary is for single-patient use only, and must not be re-used by another patient.

Use of a pessary is counter-indicated if irritation or allergy arises due to any component materials. A polythene pessary contains, substantially, only polythene, and an allergy to this is unlikely. A PVC pessary contains polyvinyl chloride, the plasticiser di(2-ethylhexyl) phthalate (DEHP, 'DOP'), a small amount of titanium dioxide (colour) and a trace of light liquid paraffin. Reaction may occur where contact is made with the pessary, which may result in granulation formation or excessive discharge. Irritation is thought to be due to deposits of urine-derived crystals in some cases. These crystals may also be responsible for at least some staining. During inspection, the vagina should be checked for ulceration, bleeding, infection or other problems. If these arise temporary removal of the pessary and / or symptomatic treatment of the problem may be indicated, for example with oestrogen cream for any local vaginitis which might occur.

Ring pessaries are listed in the Drug Tariff and are manufactured to Drug Tariff Technical Specifications 20 Sections 2 and 3. They are Class 11B Medical Devices as defined by the EU Medical Devices Directive (93/42/EEC).

Portia pessaries are coded by type (prefix) followed by size (suffix). The order code prefixes are:

Polythene (PE) 365/-

PVC (Vinyl) 366/-

The outer diameter in mm forms the suffix part of the code. For example, a 68mm polythene pessary has the code 365/68.