Vaginal pessaries for prolapse

DR SUE TUTTY 

GP Liaison, Primary care

About 40 per cent of women will experience prolapse in their lifetime and this number is likely to increase with the aging population. Women report a wide variety of symptoms that affect their quality of life, sexual functioning and daily activities.

Vaginal pessaries are one treatment option for prolapse and are commonly used to restore the prolapsed organs to their normal position. A pessary can be useful for the whole range of prolapse symptoms including for severe prolapse while awaiting surgery.

Currently CM Health sees women with prolapse at a first specialist clinic and then, if a pessary is inserted, brings the women back to a pessary clinic at least every 6 months. However, most women with prolapse are never seen at the clinic, and could be adequately cared for by their GP with a pessary or/and a referral to physiotherapy.

Some GPs in primary care are already skilled to fit and change pessaries, although this usually only happens where the patient can contribute to the cost of the procedure and the pessary. If this service was more available in primary care, it could be provided to a wider range of women, in a timely manner and closer to home. While not all GPs are confident in fitting pessaries, a larger group of them would be proficient in doing the 6 month checks.

Using planned care funding from the Ministry of Health, we have established a process to fund the fitting and followup of vaginal pessaries in primary care. This is expected to take some pressure off the demand for pessary clinic appointments and free up staff to take on alternative duties. The funding will ensure that the woman only needs to pay for her initial visit to the doctor, with all the costs following that, including the price of a fitting kit (for the practice) and of the pessary itself, covered.  Examples of pessaries (taken from the Milex Pessary training manual)