From the Guidelines
To remove a pessary in the ED, gently insert a speculum to visualize the device, then use ring forceps or your fingers to grasp and carefully withdraw it, taking care to avoid causing tissue damage or discomfort to the patient. When removing a pessary, it's essential to prioritize the patient's comfort and safety, ensuring that the procedure is done with minimal risk of complications.
- Proper patient positioning is crucial, with the patient in the lithotomy position to provide adequate access and lighting.
- Lubricating the vaginal canal with a water-based lubricant can help reduce discomfort during the procedure.
- The type of pessary (e.g., ring, cube, Gellhorn) may require specific techniques for removal, such as compressing one side of a ring pessary to create an oval shape or breaking the suction on a cube pessary before removal 1.
- After removal, inspecting the pessary for integrity and examining the vaginal walls for signs of erosion, ulceration, or infection is important for assessing the need for further treatment or follow-up care.
- In cases where the pessary is difficult to remove or complications are present, consulting with gynecology for assistance is recommended to avoid causing further tissue damage.
From the Research
Removing a Pessary in the Emergency Department (ED)
- There is limited information available on the specific procedure for removing a pessary in the ED setting.
- However, studies suggest that pessary removal and reinsertion can be a painful process, and measures such as using topical lidocaine or lubricating jelly may be taken to reduce discomfort 2.
- In general, pessary removal and reinsertion are typically performed by a healthcare provider, such as a nurse or physician, who has experience with pessary management 3.
- The process of removing a pessary typically involves gently grasping the pessary and pulling it out of the vagina, taking care not to cause discomfort or injury to the surrounding tissues.
Considerations for Pessary Removal
- The type and size of the pessary being used may affect the removal process, with larger pessaries potentially being more difficult to remove 2.
- The use of topical anesthetics, such as lidocaine, may be considered to reduce pain and discomfort during pessary removal and reinsertion 2.
- Patient education and communication are important aspects of pessary management, including instruction on how to properly care for and remove the pessary 3, 4.
Clinical Evidence
- Studies have shown that pessary use can be an effective treatment for pelvic organ prolapse and stress urinary incontinence, with high patient satisfaction rates 5, 4, 6.
- However, pessary use can also be associated with adverse events, such as vaginal discharge, urinary incontinence, and erosion or irritation of the vaginal walls 5.