Pessaries tend to come in supportive pessaries, like rings or various other ones you can get in silicone. So these rings are available in PVC which this one is, and polythene which we don’t use, they are much thinner and harder. But I know that some patients in the community that have polythene pessaries in which is absolutely fine. And they come in sixteen different sizes, so 50 millimetre up to 80 millimetre in 3-millimetre intervals, and from an 80 millimetre to 110 millimetre in 5-millimetre intervals. So these are supportive pessaries that go in the vagina for pelvic organ prolapse. And then you can have space occupying, occupying pessaries such as these, this is a silicon Gellhorn, so it’s made of silicon so it’s softer and this is a hard plastic shelf pessary. So these are space occupying, this is, the prolapse will be dammed back in the vagina by this pessary. But when we talk about these pessaries with ladies we, it’s really important to discuss whether they want to maintain the ability to have intercourse, because with these space occupying devices in the vagina intercourse is not possible. But with something supportive like a ring, then intercourse is possible with the pessary in, or some ladies choose to take the pessary out, have intercourse, and then we’ll put it back in for them. So we’ll teach them how to take their pessary out and teach them how to put it back in again, or some ladies are self-managing these because they don’t wish it all the time, they just wish it for something high impact like dancing, exercise, you know going to the gym or whatever. So they’ll self-manage, and only put them in before they want them, and then they’ll take them out and leave them out for a while. So there are a huge range of different pessaries around, but primarily for pelvic organ prolapse.

There’s no exact science to pessary fitting whatsoever, no matter what you’re fitting, quite often we’ll see two, ladies two or three times before a) we’ll get one to stay or b) it’s comfortable, ‘cos pessaries are all about putting the smallest in to support your prolapse that’s the easiest to remove. Okay. So it depends on a lot of factors about what choice of pessary you use, so how big is the prolapse, how much support have they got in the vagina, and what does the vagina skin look at, what’s the perineal support like, how short or how short is their vagina, ‘cos if it’s shorter than 6 centimetres you’re unlikely to get a pessary to stay in. Does it feel comfortable? Is it supporting their prolapse or is it just their prolapse is so big you know like a ring is not going to work at all.