Pessaries and pelvic organ prolapse – The history
The word pessary comes from the Greek word pesos and the Latin word pessarium meaning oval stone.
Pessaries have been around hundreds of years to treat symptoms as a treatment for menstrual problems, dysmenorrhea, incompetent cervix, infertility, uterovaginal prolapse and displacement of the uterus and treatment of women who showed symptoms of a pelvic organ prolapse has been around for thousands of years.
The earliest text found to be on obstetrics and gynaecology is that of Soranus of Ephesus a Greek physician (A.D. 98-138), which can be found in the ‘Bibliothèque Royale’ in Paris. Soranus had observed and reviewed a number of techniques used for management of uterovaginal prolapse during the Hippocratic era.
Soranus challenged and criticized treatments involving suspending the patient upside down by her feet from a moving frame which moved rapidly up and down for a few minutes, which was said to reduce the prolapse. The woman was then left to hang upside down for up to a day.
He also criticized the practise of his peers when they used ox meat inserted into the vagina and also those who used the method of a ‘hairy bag to the uterus, so that the sharp pains to the uterus caused from the hair caused the uterus to contract.
Pleasant aromas where used for patients to smell so as to disguise the unpleasant pungent odour of the ‘fumigation procedure to the uterus’ surgeons carried out. Their reasoning behind this method was that they believed the uterus would revoke the bad odours and move up in the direction towards the pleasant ones. Soranus condemned these treatments as harmful, painful and mostly ineffective.
Soranus had his own ideas about the treatment of a uterine prolapse, a method which was less painful and later on the pessary for pelvic organ prolapse and lubricant was to be innovated from this method.
He made the patient bathe the uterus in luke warm olive oil then corresponding to the shape and the diameter he would make a woollen tampon wrapped in very thin linen. He then dipped the tampon in diluted vinegar or the juice of acacia mixed with wine and applied this to the uterus whilst moving the uterus very gently upwards towards its natural anatomical state. To ensure the uterus stayed in position he wadded the whole vaginal cavity with wool. After this the woman’s legs were bandaged together where she remained on rest for 3 days. After 3 days the ‘pessary of wool and linen were removed.
Today’s methods have evolved still using pessaries as a non – surgical support mechanism for various types of pelvic organ prolapse conditions. There are many pessary shapes and sizes available, the most common used today are the ring and Gellhorn pessaries.
Pessaries are made from either PVC or silicone. Silicone being the favoured choice as it is flexible yet strong enough to support the prolapse and silicone is an inert material which reduces the chance of infection drastically.
There are various surgical procedures to correct pelvic organ prolapse conditions and the DaVinci Robot is one of the least invasive procedures for surgery to date.
Who knows, that maybe in another 100 years from now we will find the use of today’s pessaries and surgical procedures barbaric and unthinkable, but until we find the perfect solution to help women who suffer pelvic organ prolapse we just have to keep educating and raising the awareness that there are solutions out there for pelvic organ prolapses.
Written by Gaynor Morgan
For more information about types of pessaries and procedures visit www.incostress.com
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