Pessary In & Fresh as a Daisy

Alysia was a fifty-something married woman who presented with a cystocele (prolapse bladder) which is when the bladder drops down from it’s proper place. Alysia’s doctor presented her with the following three options:

1. No Treatment
2. Surgery
3. Pessary

Although ‘no treatment’ may sound strange, many prolapses do not cause any life altering problems for women; however, this was not the case with Alysia. She felt that her prolapse contributed to urinary urgency and frequency and that it was also impacting her sex life with her husband.

Urinary retention (when the bladder does not empty properly) is another issue common with a bladder prolapse. This was not the case for Alysia as she had been tested for it. Her doctor also performed a uroflow (test of voiding) and afterward her bladder was scanned for residual urine and there was only 60 cc’s left in. It is important to note that no one empties their bladder completely; this is because the kidneys are always functioning. As long as a person has no more than 150 cc’s in their bladder after voiding, it is considered that the bladder has been emptied.

Pessary Fitting

I fitted Alysia with a pessary ring, making sure that it was comfortable and did not fall out (I had her walk around the clinic for 20 minutes with the pessary in place). I also had her drink water so that I could make sure she could urinate with her pessary in and it did not obstruct the urine flow.

She was initially very happy because the pessary was comfortable, she was able to void, and it put her prolapse back in it’s proper position. She was also happy to learn that she could be sexually active with her pessary in and that she could care for it herself. All in all, Alysia left the clinic quite happy that day.

A Scent ‘Down There’

In a follow up appointment, Alysia returned to learn how to service her pessary. Although it was working well for her, she did notice a bit of a scent ‘down there’. A vaginal swab was negative for any infection. I suggested that she try RepaGyn®, a hormone-free ovule inserted into the vagina, because it contains Tea Tree Oil and may reduce the scent. It is not uncommon to have what I call a “pessary scent” but there are ways to manage it.

Alysia used RepaGyn® for a couple of weeks and when she returned to the clinic, she expressed delight; she no longer had a scent ‘down there’. She was particularly happy because her husband was coming home after having been away on business for one month, and in that month she felt she had accomplished a lot and was very excited about resuming sex with her husband. I trust she will be getting back to the bedroom soon after her husband arrives home!