Pessaries for POP and SUI: Your options and guidance on use

Pessaries have been used in one form or another to help resolve pelvic organ prolapse (POP) in women for at least 2,500 years. They have come in many shapes and have been made of many materials. Here is a brief sketch of the history of the pessary.

Antiquity

Kahun papyrus (ancient Egypt, c. 2000 BCE)

Women with POP were made to stand over a fire in which different ingredients were burned. It was thought that the disagreeable odors emitted would cause the uterus to “rebel” and thus revert back into place.¹

Hippocrates (c. 460–375 BCE)

Used several techniques to resolve uterine prolapse:

• Tipping the woman upside down and shaking her, using gravity as an aid to return the prolapsed organs into the pelvis²
• Cupping of the buttocks and the lower abdomen in hopes of “sucking” the prolapsed uterus back into place³

The Greek physician Polybus (c. 400 BCE)

Placed half a pomegranate in the vagina to hold prolapsed structures in place²

Cleopatra (c. 70–30 BCE)

Treated prolapse with the vaginal application of an astringent liquid²

Celsus (c. 25 BCE–50 CE)

Used cone-shaped pessaries made of bronze with a perforated circular plate on the lower edge through which bands were attached. The bands were then tied around the body to keep the device in place⁴

The Greek physician Soranus (c. 98–138)

Utilized linen tampons soaked with vinegar—along with a piece of beef—to treat prolapse. These were then held in place by bands passed around the loins²

Galen (c. 130–210)

Used fumigation to “encourage” the uterus to return to the pelvis²

Middle Ages

Paulus of Aegina (c. 625–690) and Abbas (c. 949–982)

Both wrote about the use of pessaries made of wax³

Myrepsus (late 13th century)

Described the preparation of 45 types of pessaries consisting of different solid materials treated with perfumes, wax, honey, and herbs⁵

16th century

Caspar Stromayr (Practica Copiosa, 1559)

Used as pessaries tightly rolled sponges bound with string, dipped in wax, and covered with oil or butter⁶

Ambroise Paré (c. 1510–1590)

Developed the first ring-type pessary in the late 16th century. He used hammered brass and waxed cork in the shape of an oval to treat uterine prolapse. He also made ring-shaped devices of gold, silver, or brass which were kept in place by a belt around the waist.⁷

17th century de Castro (1546–1627)

Urged “attacking” uterine prolapse with application of a red-hot iron thus “frightening it” into receding back into the vagina⁸

Hendrik van Roonhuyse (1625–1672)

In his gynecology textbook, discussed the etiology and treatment of prolapse. He utilized a cork with a hole in it (to allow for passage of discharge) as prolapse treatment. He also wrote of removing an obstructed wax pessary that had blocked discharge of a patient’s vaginal secretions for many years⁴

18th century Thomas Simson (1696-1764)

Invented a metal spring device that kept a pessary made of cork in place⁹

John Leake (1729-1792)

Recommended the use of sponges as pessaries to avoid vaginal prolapse¹⁰

Juville (1783)

Was the first to use rubber pessaries, resembling today’s contraceptive cup, to avoid injuring the vaginal mucosa. The center of the cup was perforated with a gold tip which allowed for the discharge of vaginal secretions¹⁰

19th century

Scanzoni (1821-1891)

Recommended massage and the application of leeches to reduce local congestion and swelling of prolapsed pelvic organs before manual replacement¹¹

Hugh Lenox Hodge (1796-1873)

In his 1860 textbook Diseases Peculiar to Women, Hodge discussed at length the use of pessaries for uterine displacement. He suggested that metals, alloys, glass, and porcelain be used for pessaries rather than cork, wax, and sponges¹²

20th century

1950s—

Pessaries made of rubber, which absorb discharge and odor, are replaced by polystyrene pessaries. Currently, pessaries are made of silicone, plastic, and latex.

References

1. Stevens JM. Gynecology from ancient Egypt: the papyrus Kahun, a translation of the oldest treatise on gynecology that has survived from the ancient world. Med J Austr. 1975;2:949-952.
2. Emge LA, Durfee RB. Pelvic organ prolapse: four thousand years of treatment. Clin Obstet Gynecol. 1966;9:997-1032.
3. Van Dongen L. The anatomy of genital prolapse. South Afr Med J. 1981;60:357-359.
4. Cianfrani T. Short History of Obstetrics and Gynecology. Springfield, IL: Charles C Thomas; 1960.
5. Leonardo RA. History of Gynecology. New York, NY: Froben Press; 1944.
6. Tizzano AP, Muffly TM. Historical milestones in female pelvic surgery, gynecology, and female urology. In: Walters M, Karram M. Urogynecology and Reconstructive Pelvic Surgery, 4th ed. Philadelphia, PA: Elsevier Saunders; 2015
7. Farrell SA. Pessaries in Clinical Practice. Switzerland: Springer-Verlag; 2006.
8. Tam T, Davies MF, eds. Vaginal Pessaries. Boca Raton, FL: CRC Press; 2019.
9. Ricci JV. Genealogy of Gynaecology. Philadelphia, PA: Blakiston; 1950.
10. Miller DS. Contemporary use of the pessary. In Sciarra JJ, ed. Gynecology and Obstetrics. Philadelphia, PA: JB Lippincott Company; 1995.
11. Thomas TG. A Practical Treatise on the Disorders of Women. Philadelphia, PA: Lea Brothers and Co; 1891.
12. Hodge HL. Diseases Peculiar to Women, Including Displacements of the Uterus. Philadelphia, PA: Blanchard and Lea; 1860.