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Commentary: Pessary – Don't Keep It a Secret

Cathy Null

Whenever you want to get a four-year old's attention you lean down, cup your hand over their ear, and whisper, "I want to tell you a secret." So lean in close because I want to tell you a secret.  I don't know why this is a secret but it seems to be and I want to change that.  The secret is "pessary."  P E S S A R Y.  If you know what I'm talking about you don't need to listen to this message.  If you already know what a pessary is, please spread the word. My experience has been that my friends and relatives don't know what a pessary is.  That includes my 90-year old mother and my 60-plus year old friends.  You can think of this as a public service announcement.

I didn’t know what a pessary was until about 15 months ago.  I was seeing a physical therapist for incontinence.  And maybe that too is a secret…yes, there are physical therapists who specialize in incontinence. I had developed incontinence after a delayed diagnosis of Hodgkin's lymphoma which included large doses of steroids.  Or maybe it was because of the chemo I had for the cancer. Or maybe it’s because I’ve had 3 children.  Most women never know exactly what causes their incontinence.  I don’t know for sure what has caused mine.

I now know there are two main types of incontinence: stress and urge.  

Stress incontinence occurs when you strain your muscles in the pelvic area: a sneeze, a cough, lifting something heavy, or just plain bending over in some cases.

Urge incontinence is sometimes called overactive bladder syndrome. Your body has a sudden urge to urinate.

For stress incontinence, a pessary might be helpful. 

So from the physical therapist I scheduled an appointment with a urogynecologist. Yep, that’s a legit medical specialty.  A gynecologist who also has the knowledge and skills of a urologist.  Again, unknown to me until 15 months ago.  My urogynecologist is a woman but I imagine there are men who train in this very specialized field.  She suggested 4 possible treatments: drugs, 2 different kinds of surgery, and the least invasive and for me the most obvious option, a pessary.  

Full disclosure, I had already tried the drugs.  My urologist, a highly respected male doctor at a university hospital, had prescribed drugs -- 2 different drugs to be exact, which you take for months.  I had no positive outcomes with drugs.  And I might also add they are very expensive.  I had the luxury of very good prescription coverage and they were still very expensive.

So just exactly what is a pessary?  According to Wikipedia, “Early use of pessaries dates back to the ancient Egyptians, as they described using pessaries to treat pelvic organ prolapse. The term ‘pessary’ itself, is derived from the Ancient Greek word 'pessós', meaning a round stone used for games. ... It was not until the 16th century that the first purpose-made pessaries were made.”

Pessaries have been used historically to prevent uterine prolapse, as a barrier contraceptive to prevent pregnancy, and to prevent excessive uterine bleeding.  Today the pessary is used by women who experience incontinence for whatever reason: age, physical condition, or lifestyle.  Many female athletes use them during their athletic endeavors. 

Today pessaries are made of inert plastic or silicone.  They are intended to be inserted and removed either by the woman or her healthcare provider.  There are many types of pessaries and a healthcare provider determines the type for each woman. In my case, I saw a Physician’s Assistance associated with my Urogynecologist for the fitting and will depend on my primary care doctor for maintenance.  

We live in a world where television commercials include drugs for Peyronie’s disease. In case you’re unfamiliar with these commercials, they compare the male sex organ to vegetables. Other commercials aimed at women reference the “gush moment” and promote sanitary pads.  We see commercials and advertisements for disposable underwear for women.  My question is why don’t we see commercials for pessaries -- the least invasive, drug-free incontinence solution for women?

How can women make informed decisions about healthcare if we don’t have all the information?  I was shocked when I heard about pessaries, not because there are pessaries but because in 72 years I’d never heard of a pessary.  

A pessary doesn’t work for every woman, and they may not work for me in the long run. But shouldn’t we all know about this option? Please share this information with all the women you know.

Cathy Null is retired from the College of Fine Arts and Communication at Western Illinois University.

The opinions expressed are not necessarily those of the university or Tri States Public Radio.

Diverse viewpoints are welcomed and encouraged.