What I need to know about pessaries
For her, it's all about the pelvic floor: Alexandra Schäfer is a physiotherapist specializing in pelvic health with a practice in Southern Germany. She is also involved in further education and offers pessary therapy courses for physiotherapists. We interviewed her for our blog about pessaries and pessary therapy.
What exactly is a healthy pelvis?
For me, a healthy pelvis means strong pelvic floor muscles. They can fully relax and stretch sufficiently for bowel movements or during sexual intercourse. The ligaments and fascia should be firm enough to secure the position of the pelvic organs under stress. At the same time, they should allow enough movement so that we can move well in everyday life.
What is a pessary and what does it do?
Pessaries are medical aids. They are inserted into the vagina to support the pelvic organs or the urethra. Pessaries are not a new invention; they are already mentioned in the Hippocratic Oath. They went out of fashion for a while, as operations were considered the optimal solution for prolapses. However, that has changed again: Pessary therapy has become increasingly popular in recent years. Most specialists now readily prescribe pessaries, and women often opt for them too. Especially young, active women highly value the support provided by pessaries.
For which complaints do you recommend a pessary?
They are mainly used for pelvic organ prolapse and stress incontinence. For both problems, studies show that pessary therapy promises success. Pessaries can also be used preventively for known risk factors, such as connective tissue weakness or pelvic floor dysfunction. However, there is no study data for this.
How do you find the right pessary?
There are many different pessary shapes in various sizes. Therefore, it would be sensible to have the pessary fitted by specialists such as doctors, a physiotherapist, or in some countries, by nursing staff. Different pessaries in various sizes can be tried during this process.
What do you need to consider for care?
Ideally, women regularly remove the pessaries themselves, wash them, and leave them out overnight. This helps to avoid side effects such as pressure sores. There are pessaries that can remain in the vagina for a longer period and others that need to be removed every day. Every woman should receive individual information on hygiene and care when she gets a pessary. Pessaries are usually made of medical silicone and are cleaned with water and soap, and additionally with a soft toothbrush if necessary. They can usually be boiled, but that is usually not necessary. If a woman has had an infection (fungal or bacterial), it may be advisable to replace the pessary. Otherwise, there is a risk of biofilm formation and further infections.
What do you see as the advantages of pessary therapy?
The great advantage of pessaries: They work immediately! And most women can apply them themselves. The self-efficacy is therefore enormously high – women can take control of their problem themselves. And another thing: an operation brings a permanent change. Not so with the pessary: it can simply be removed again.
What fears are there regarding pessaries?
Many are initially worried because the rings, cubes, and cups look very large at first glance. Many can hardly imagine that you don't feel the pessaries. For some women, the idea of having a foreign object inside them is very uncomfortable. However, I often find that these fears and prejudices are very quickly forgotten when the symptoms suddenly disappear with the help of the aid. For most women, insertion and removal are no problem at all.
You also offer a "pessary course" – What kind of course is that?
Since 2024, I have been offering a further training course primarily for specialized physiotherapists who want to start fitting pessaries. This course provides theoretical knowledge on anatomy, pathophysiology, and pessary therapy. In addition, we practically practice the examination and fitting of a pessary. I developed the course because there was no training course in the German-speaking world that provided this content theoretically and practically.
Dear Ms. Schäfer, thank you very much for the interview!
Tips and Links
Are you interested in Alexandra Schäfer's course or would you like advice on pessary therapy? Then visit her website: https://becken-balance-physiotherapie.de/
Are you looking for a physiotherapist specializing in the pelvic floor near you? Here is a list of contacts: https://www.ag-ggup.de/therapeutenliste/
Photo: Alexandra Schäfer advising a patient, © private