Top 20 Vaginal Pessaries for Women's Health: A Clinical Perspective

Introduction
Vaginal ring pessaries have been a cornerstone in the management of pelvic organ prolapse (POP) and stress urinary incontinence (SUI) for decades. These devices, typically made of silicone or other biocompatible materials, are designed to provide support to the pelvic organs, alleviating symptoms associated with these conditions. As a vital tool in gynecology, it's important for healthcare professionals to stay informed about the best options available. This article explores the top vaginal ring pessaries currently on the market, their features, benefits, and considerations for use.

What is a Vaginal Ring Pessary?
A vaginal ring pessary is a medical device inserted into the vagina to support the uterus, bladder, and rectum. They come in various shapes and sizes to accommodate different anatomical needs and are primarily used to manage POP and SUI. Pessaries can be a non-surgical solution for many women, offering significant symptom relief and improved quality of life.

Top 20 Vaginal Ring Pessaries
1. Gellhorn Pessary
The Gellhorn pessary is known for its reliability and effectiveness in managing advanced POP. It features a ring with a central support stem, providing robust support to the pelvic organs. Made from medical-grade silicone, the Gellhorn pessary is durable and easy to clean. It is particularly useful for women with a significant prolapse and those who cannot undergo surgery.

2. Ring Pessary with Support
This type of pessary is among the most commonly used due to its simplicity and effectiveness. It consists of a silicone ring that fits comfortably within the vagina, providing support to the vaginal walls. The Ring Pessary with Support is often used for mild to moderate prolapse and can be self-managed by the patient. Its design allows for easy insertion and removal, making it a convenient option for many women.

3. Shaatz Pessary
The Shaatz pessary is another popular choice for managing POP. Its design includes a ring with an additional ridge, providing extra support to the pelvic floor. This pessary is particularly beneficial for women with a cystocele (bladder prolapse) or rectocele (rectal prolapse). The Shaatz pessary is available in various sizes, ensuring a good fit for most patients.

4. Donut Pessary
The Donut pessary is characterized by its thick, doughnut-shaped design, which offers maximum support for severe prolapse cases. Made from soft silicone, it is comfortable for prolonged use and can be an excellent alternative for patients who find other pessary types less comfortable. The Donut pessary is particularly effective for uterine prolapse.

5. Gehrung Pessary
The Gehrung pessary features a unique curved design that conforms to the vaginal anatomy, providing targeted support for both cystocele and rectocele. This pessary is particularly useful for women with a retroverted (tilted) uterus. The Gehrung pessary's design helps maintain its position, reducing the risk of displacement.

6. Cube Pessary
The Cube pessary is designed for women with severe POP, especially when other pessaries fail to stay in place. Its cube shape provides excellent support and stability, making it a reliable option for advanced prolapse. The Cube pessary is often used in conjunction with other treatments to provide comprehensive pelvic support.

7. Hodge Pessary
The Hodge pessary is particularly useful for women with a retroverted uterus and mild to moderate POP. It features a flat, curved design that fits comfortably against the vaginal walls, providing support without causing discomfort. The Hodge pessary is available in both flexible and rigid versions, allowing for customization based on patient needs.

8. Ring with Knob Pessary
This variation of the ring pessary includes a knob, which provides additional support and can be helpful for women with a significant prolapse. The knob also aids in the retention of the pessary within the vaginal canal, reducing the risk of displacement.

9. Oval Pessary
The Oval pessary is designed to provide support for women with a narrow vaginal introitus. Its shape allows for easy insertion and removal while offering effective support for mild to moderate POP. The Oval pessary is particularly useful for women who experience discomfort with other pessary shapes.

10. Folding Pessary
The Folding pessary features a collapsible design that makes insertion and removal easier. It provides robust support for POP and can be a comfortable option for women who have difficulty with more rigid pessaries. The folding design also makes it easier to store and transport.

11. Milex Pessary
The Milex pessary is a highly customizable option available in various shapes and sizes. It is made from medical-grade silicone and is designed for long-term use. The Milex pessary is known for its durability and comfort, making it a popular choice among healthcare providers.

12. Marland Pessary
The Marland pessary is a flexible, ring-shaped device that provides support for mild to moderate POP. Its design allows for easy insertion and removal, and it is particularly useful for women who are sexually active, as it can be removed and reinserted as needed.

13. Sieve Pessary
The Sieve pessary features a perforated design that allows for better drainage of vaginal secretions. This can help reduce the risk of infections and improve overall comfort. The Sieve pessary is available in various sizes and can be used for both POP and SUI management.

14. Incontinence Dish Pessary
This pessary is designed specifically for women with SUI. It features a dish shape with a central support stem, providing targeted support to the urethra and bladder neck. The Incontinence Dish pessary can help reduce urinary leakage and improve bladder control.

15. Hodge with Support Pessary
This variation of the Hodge pessary includes an additional support ridge, providing extra stability for women with moderate to severe POP. The Hodge with Support pessary is available in both flexible and rigid versions, allowing for customization based on patient needs.

16. Flexible Gellhorn Pessary
The Flexible Gellhorn pessary offers the same support as the traditional Gellhorn but with added flexibility for increased comfort. This can be particularly beneficial for women who experience discomfort with more rigid pessaries.

17. Smith-Hodge Pessary
The Smith-Hodge pessary combines features of both the Smith and Hodge pessaries, offering a unique design that provides effective support for POP. Its curved shape conforms to the vaginal anatomy, reducing the risk of displacement.

18. Inflatable Pessary
The Inflatable pessary is a versatile option that can be inflated to the desired size once inserted. This allows for a customized fit and can be particularly useful for women with varying degrees of prolapse. The inflatable design also makes it easier to insert and remove.

19. Continence Dish Pessary
Similar to the Incontinence Dish, the Continence Dish pessary provides targeted support to the urethra and bladder neck. It is designed to help reduce urinary leakage and improve bladder control, making it a useful option for women with SUI.

20. Continence Ring Pessary
The Continence Ring pessary combines the benefits of a traditional ring pessary with additional support for the bladder neck. This can help reduce urinary leakage and provide effective support for mild to moderate POP.

Benefits of Vaginal Ring Pessaries

• Non-Surgical Option: Pessaries provide a non-invasive alternative to surgery for managing POP and SUI.
• Symptom Relief: They can significantly reduce symptoms such as pelvic pressure, urinary incontinence, and discomfort.
• Improved Quality of Life: By alleviating symptoms, pessaries can enhance the overall quality of life for many women.
• Customizable: Available in various shapes and sizes, pessaries can be tailored to meet individual patient needs.

Considerations for Use

• Fitting: Proper fitting by a healthcare professional is essential to ensure comfort and effectiveness.
• Maintenance: Regular cleaning and periodic check-ups are necessary to prevent complications such as infections or ulcerations.
• Patient Education: Patients should be educated on how to insert, remove, and care for their pessary to ensure optimal outcomes.

How to Choose the Right Pessary
Choosing the right pessary involves several factors, including the type and severity of prolapse, the patient's anatomy, and personal preferences. Here are some steps to guide the selection process:

1. Assessment: A thorough pelvic exam is necessary to determine the type and extent of prolapse.
2. Trial Fitting: Different pessary sizes and shapes should be tried to find the most comfortable and effective option.
3. Patient Comfort: The chosen pessary should not cause discomfort or pain during use.
4. Ease of Use: Consider how easy it is for the patient to insert, remove, and clean the pessary.
5. Follow-Up: Regular follow-up appointments are essential to monitor the pessary's effectiveness and address any issues.

Conclusion
Vaginal ring pessaries remain a valuable tool in the management of POP and SUI, offering a non-surgical solution for many women. With a variety of options available, healthcare professionals can select the best pessary based on individual patient needs and preferences. By staying informed about the latest developments and best products on the market, doctors and healthcare practitioners can provide the highest level of care to their patients.