From the Guidelines
Patients can self-insert a pessary, but it is crucial to assess individual suitability and provide proper training from a healthcare provider. The decision to self-insert a pessary should be based on the patient's manual dexterity, vision, and comfort with their anatomy 1.
Key Considerations for Self-Insertion
- Patients should have good manual dexterity to handle the pessary correctly
- Adequate vision is necessary to ensure proper insertion and removal
- Comfort with their anatomy is essential for successful self-insertion
- Initial fitting and training should always be provided by a healthcare professional to ensure the correct size and type of pessary is selected
Process of Self-Insertion
- Wash hands thoroughly before handling the pessary
- Apply a water-based lubricant to the pessary for easier insertion
- Fold the pessary appropriately, depending on its type
- Insert the pessary into the vagina while in a comfortable position, such as squatting or with one leg elevated
Importance of Follow-Up
Regular follow-up appointments with a healthcare provider are necessary to check for potential complications, such as vaginal irritation, erosion, or infection 1.
Limitations and Special Considerations
Some patients, including those with limited mobility, arthritis in their hands, or cognitive impairments, may find self-management of a pessary challenging and should continue to have their pessary cared for by healthcare providers. Certain types of pessaries, like Gellhorn or donut pessaries, are more complex and may require professional assistance for insertion and removal.
From the Research
Pessary Self-Insertion by Patients
- Patients can be taught to manage and insert pessaries themselves with proper training and understanding of pessary management 2.
- Most patients can be successfully fitted and taught to manage the pessary either for short- or long-term relief of symptoms 2.
- However, insertion and removal of most pessary types still pose a challenge for many patients 3.
- Only a small number of patients were able to maintain the pessary by themselves, with most requiring assistance 4.
- Home health and long-term care nurses are frequently asked to periodically remove and insert pessaries, indicating that not all patients are able to self-insert 5.
Factors Affecting Pessary Fitting and Self-Insertion
- Stage IV prolapse, posterior compartment prolapse, genital hiatus, and vaginal introitus were independent predictors of unsuccessful ring with support pessary fitting 6.
- Vaginal length and history of POP reconstructive surgery were independent predictors of both ring with support and Gellhorn pessary fitting 6.
- These factors may affect a patient's ability to self-insert a pessary, highlighting the need for individualized assessment and management 6.