Comments on: Can Pessaries "Out-sex" Surgery? A Thoughtful Approach to Incontinence and Prolapse http://healthewoman.org/2009/04/30/can-pessaries-out-sex-surgery-a-thoughtful-approach-to-incontinence-and-prolapse/ Facts Plus Stories Equals Knowledge Tue, 31 May 2011 00:40:53 +0000 hourly 1 http://wordpress.org/?v=3.2.1 By: Shelley Binkley http://healthewoman.org/2009/04/30/can-pessaries-out-sex-surgery-a-thoughtful-approach-to-incontinence-and-prolapse/comment-page-1/#comment-25911 Shelley Binkley Tue, 31 May 2011 00:34:22 +0000 http://healthewoman.org/?p=645#comment-25911 Yes, you can use a muscle stimulation insert and/or weighted vaginal cones with a pessary in place, if you can fit all that in there. The difficult thing could be fitting all the items in at the same time. Instead, if you are comfortable with removing and reinserting your pessary, I'd recommend removing the pessary while you are using the pressure-sensing insert or weighted vaginal cones, then replacing the pessary when you are not using it. Thank you for reading the blog and for sharing your information, which I know will help other women. Please let me know if you have any additional questions or comments. -SB Yes, you can use a muscle stimulation insert and/or weighted vaginal cones with a pessary in place, if you can fit all that in there. The difficult thing could be fitting all the items in at the same time. Instead, if you are comfortable with removing and reinserting your pessary, I’d recommend removing the pessary while you are using the pressure-sensing insert or weighted vaginal cones, then replacing the pessary when you are not using it. Thank you for reading the blog and for sharing your information, which I know will help other women. Please let me know if you have any additional questions or comments. -SB

]]> By: Shelley Binkley http://healthewoman.org/2009/04/30/can-pessaries-out-sex-surgery-a-thoughtful-approach-to-incontinence-and-prolapse/comment-page-1/#comment-25910 Shelley Binkley Tue, 31 May 2011 00:31:03 +0000 http://healthewoman.org/?p=645#comment-25910 Hi C, Yes, a pessary can certainly reduce uterine or vaginal prolapse enough to make it less symptomatic or not symptomatic at all. The reason the urine leakage may have gotten worse when the pessary was removed, is that by reducing the prolapse you un-kink a presumably kinked urethra. The factors that caused the pelvic prolapse in the first place can also cause a "funnel" urethra. This is a urethra in which the internal urethral sphincter is so relaxed it it non-functional. The urethra has 2 sphincter muscles, one at the junction at the bladder and the urethra (the internal urethral meatus), and the other where the urethra opens to the outside (the external urethral meatus). With a funnel urethra the internal sphincter is so slack, the urethra becomes funnel shaped, rather than tube-shaped. Sometimes a sling will be placed to "cure" the funnel urethra. Placing a sling partially obstructs the too-relaxed urethra, thus helping it to close better and provide continence. It usually works, but slings are not without complications and do have a three year failure rate of 15%. The ten year failure rate is not as well known, but may be fairly high. Thank you for reading the blog and sharing your information with other readers. Let me know if I can answer any other questions. -SB Hi C, Yes, a pessary can certainly reduce uterine or vaginal prolapse enough to make it less symptomatic or not symptomatic at all. The reason the urine leakage may have gotten worse when the pessary was removed, is that by reducing the prolapse you un-kink a presumably kinked urethra. The factors that caused the pelvic prolapse in the first place can also cause a “funnel” urethra. This is a urethra in which the internal urethral sphincter is so relaxed it it non-functional. The urethra has 2 sphincter muscles, one at the junction at the bladder and the urethra (the internal urethral meatus), and the other where the urethra opens to the outside (the external urethral meatus). With a funnel urethra the internal sphincter is so slack, the urethra becomes funnel shaped, rather than tube-shaped. Sometimes a sling will be placed to “cure” the funnel urethra. Placing a sling partially obstructs the too-relaxed urethra, thus helping it to close better and provide continence. It usually works, but slings are not without complications and do have a three year failure rate of 15%. The ten year failure rate is not as well known, but may be fairly high. Thank you for reading the blog and sharing your information with other readers. Let me know if I can answer any other questions. -SB

]]> By: Beth Gail http://healthewoman.org/2009/04/30/can-pessaries-out-sex-surgery-a-thoughtful-approach-to-incontinence-and-prolapse/comment-page-1/#comment-25828 Beth Gail Sun, 29 May 2011 14:56:35 +0000 http://healthewoman.org/?p=645#comment-25828 Does anyone know if you can use muscle stimulation with a probe if you have a pessary in? (I was just fit with a pessary, but have been using a home machine for months). Does anyone know if you can use muscle stimulation with a probe if you have a pessary in? (I was just fit with a pessary, but have been using a home machine for months).

]]> By: Cathy http://healthewoman.org/2009/04/30/can-pessaries-out-sex-surgery-a-thoughtful-approach-to-incontinence-and-prolapse/comment-page-1/#comment-25589 Cathy Wed, 25 May 2011 14:41:58 +0000 http://healthewoman.org/?p=645#comment-25589 Shelley-- Is it possible that a pessary can actually 'cure' a uterine prolapse, or at least reverse it enough to not need surgery? I am 56, post-menopausal and went in about two years ago for a prolapsed uterus. It turned out I have both a cystocele and a rectocele as well. I was reluctant to have the recommended surgery so used a pessary for almost 2 years. Finally the leakage got so bad that I gave in and agreed to the surgery, which is scheduled for next week. However, my doctor removed the pessary a month ago in preparation for the surgery and I have not had a recurrence of the uterine prolapse--it seems to be back to where it was before I started having problems. I do realize the cystocelee problem is probably being masked by some kinking. This leaves me even more reluctant to do this. I'm pretty sure my doctor is going to want me to go through with it anyway. Any suggestions? Shelley–

Is it possible that a pessary can actually ‘cure’ a uterine prolapse, or at least reverse it enough to not need surgery? I am 56, post-menopausal and went in about two years ago for a prolapsed uterus. It turned out I have both a cystocele and a rectocele as well. I was reluctant to have the recommended surgery so used a pessary for almost 2 years. Finally the leakage got so bad that I gave in and agreed to the surgery, which is scheduled for next week. However, my doctor removed the pessary a month ago in preparation for the surgery and I have not had a recurrence of the uterine prolapse–it seems to be back to where it was before I started having problems. I do realize the cystocelee problem is probably being masked by some kinking.
This leaves me even more reluctant to do this. I’m pretty sure my doctor is going to want me to go through with it anyway. Any
suggestions?

]]> By: Marianne http://healthewoman.org/2009/04/30/can-pessaries-out-sex-surgery-a-thoughtful-approach-to-incontinence-and-prolapse/comment-page-1/#comment-24973 Marianne Sun, 15 May 2011 17:39:49 +0000 http://healthewoman.org/?p=645#comment-24973 When my doctor suggested the use of a pessary I felt just a little bit squeamish. Silly, because I used a diaphragm before my first baby came via low forceps delivery. After that low forceps delivery (following a 46 hours delivery, baby spent a lot of time int he birth canal and was very cone headed afterward with swollen spots on her face from the forceps that lasted about one month) the muscles supporting my bladder were damaged and I could no longer hold a diaphragm in place. Thank you so much for your post on this subject. The last thing we want as women is to no longer feel like we are attractive and appealing. But, not coping with this problem only serves to make us feel like we are less. I know other women are struggling with this, but somehow we do not dare to talk about it at book club or other places where women meet. I know other women struggle. I had friends say, "my friend has this problem..." Only to later hear they had a hyster for prolapse... Now I just need to learn about what kind of pessary to try. I think I am going to be a bit more willing to talk to my Dr. I am going to ask to see the pessary tray during my visit. I want to talk to my Dr. about the benefits of each type. Thank you for the information! When my doctor suggested the use of a pessary I felt just a little bit squeamish. Silly, because I used a diaphragm before my first baby came via low forceps delivery. After that low forceps delivery (following a 46 hours delivery, baby spent a lot of time int he birth canal and was very cone headed afterward with swollen spots on her face from the forceps that lasted about one month) the muscles supporting my bladder were damaged and I could no longer hold a diaphragm in place.
Thank you so much for your post on this subject. The last thing we want as women is to no longer feel like we are attractive and appealing. But, not coping with this problem only serves to make us feel like we are less.
I know other women are struggling with this, but somehow we do not dare to talk about it at book club or other places where women meet.
I know other women struggle. I had friends say, “my friend has this problem…” Only to later hear they had a hyster for prolapse…
Now I just need to learn about what kind of pessary to try. I think I am going to be a bit more willing to talk to my Dr. I am going to ask to see the pessary tray during my visit. I want to talk to my Dr. about the benefits of each type.
Thank you for the information!

]]> By: Shelley Binkley http://healthewoman.org/2009/04/30/can-pessaries-out-sex-surgery-a-thoughtful-approach-to-incontinence-and-prolapse/comment-page-1/#comment-22958 Shelley Binkley Mon, 04 Apr 2011 20:47:09 +0000 http://healthewoman.org/?p=645#comment-22958 Yes, you can have intercourse wearing a pessary. If it's bothersome, just take it out during intercourse. Yes, you can have intercourse wearing a pessary. If it’s bothersome, just take it out during intercourse.

]]> By: mary http://healthewoman.org/2009/04/30/can-pessaries-out-sex-surgery-a-thoughtful-approach-to-incontinence-and-prolapse/comment-page-1/#comment-17379 mary Wed, 29 Dec 2010 22:28:10 +0000 http://healthewoman.org/?p=645#comment-17379 Can you have sexual intercourse with the device in? My situation is that my bladder has fallen. I had very heavy babies! Currently sex is painful and there is no sensation. Thank you Can you have sexual intercourse with the device in? My situation is that my bladder has fallen. I had very heavy babies! Currently sex is painful and there is no sensation. Thank you

]]> By: Ann Scherner PT http://healthewoman.org/2009/04/30/can-pessaries-out-sex-surgery-a-thoughtful-approach-to-incontinence-and-prolapse/comment-page-1/#comment-9775 Ann Scherner PT Sun, 16 May 2010 21:37:38 +0000 http://healthewoman.org/?p=645#comment-9775 This is a very interesting website and lots of good information. I am a physical therapist specializing in womens health - primarily urinary/fecal incontinence, prolapse, pelvic pain. I do disagree with your description of how to do Kegels - trying to do 10 sets of 10 reps is way to much exercise for the pelvic floor muscles, especially since these muscles usually weak and that is one of the reasons for incontinence. Also, the endurance training for these muscles has been shown very important, having women progress to 8-10 second contract/relax for 3+ sets of 10. The key factor though is making sure women are doing them correctly, not holding their breath, not using othe muscle groups instead of the pelvic floor muscles. There are good studies that have shown verbal instruction is not sufficient for women to learn how to exercise their pelvic floor muscles. Many of my patients have told me that they were "told to do the exercises, but not taught." I would highly recommend physicians and health care practitioners not assume by verbal instruction that women know how to do these exercises - physical therapists have specialized training in evaluation of the pelvic floor/abdominal muslces, in teaching these exercises and in progressing patients through treatment including a home exercise program. This is a very interesting website and lots of good information. I am a physical therapist specializing in womens health – primarily urinary/fecal incontinence, prolapse, pelvic pain. I do disagree with your description of how to do Kegels – trying to do 10 sets of 10 reps is way to much exercise for the pelvic floor muscles, especially since these muscles usually weak and that is one of the reasons for incontinence. Also, the endurance training for these muscles has been shown very important, having women progress to 8-10 second contract/relax for 3+ sets of 10. The key factor though is making sure women are doing them correctly, not holding their breath, not using othe muscle groups instead of the pelvic floor muscles. There are good studies that have shown verbal instruction is not sufficient for women to learn how to exercise their pelvic floor muscles. Many of my patients have told me that they were “told to do the exercises, but not taught.” I would highly recommend physicians and health care practitioners not assume by verbal instruction that women know how to do these exercises – physical therapists have specialized training in evaluation of the pelvic floor/abdominal muslces, in teaching these exercises and in progressing patients through treatment including a home exercise program.

]]> By: Cara http://healthewoman.org/2009/04/30/can-pessaries-out-sex-surgery-a-thoughtful-approach-to-incontinence-and-prolapse/comment-page-1/#comment-7454 Cara Fri, 05 Feb 2010 18:46:26 +0000 http://healthewoman.org/?p=645#comment-7454 Thank you for this article. I'm seeing the urogynocologist Monday and this has been immensely helpful to know what I want to try, as well as giving me valuable information about pessaries. Before reading this I didn't really want to try one, now I think that should be the first step. Thank you for this article. I’m seeing the urogynocologist Monday and this has been immensely helpful to know what I want to try, as well as giving me valuable information about pessaries. Before reading this I didn’t really want to try one, now I think that should be the first step.

]]> By: Shelley Binkley http://healthewoman.org/2009/04/30/can-pessaries-out-sex-surgery-a-thoughtful-approach-to-incontinence-and-prolapse/comment-page-1/#comment-1488 Shelley Binkley Tue, 26 May 2009 17:50:53 +0000 http://healthewoman.org/?p=645#comment-1488 @Jeff Thank you for reading and commenting. Other devices to assist with Kegels are the Athena and various weighted vaginal cones. These can be purchased on-line. The Athena has a pressure sensor in it to relay feedback to the individual re: strength of their kegels. A pessary would probably be less expensive than either the Athena or the weighted vaginal cones. Here are some options for purchasing either the Athena or weighted vaginal cones. http://www.athenaft.com/ and http://www.vaginalweights.org/incontinence_products.html @Jeff Thank you for reading and commenting. Other devices to assist with Kegels are the Athena and various weighted vaginal cones. These can be purchased on-line. The Athena has a pressure sensor in it to relay feedback to the individual re: strength of their kegels. A pessary would probably be less expensive than either the Athena or the weighted vaginal cones. Here are some options for purchasing either the Athena or weighted vaginal cones. http://www.athenaft.com/ and http://www.vaginalweights.org/incontinence_products.html

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