Application: The thick round ring consists of flexible comfortable silicone. In contrast to the "simple" ring pessary, it does not have a steel spring filling, but a larger circumference of the ring part. Thus the overlay surface is larger and the risk of necrosis becomes smaller. Preferably older patients with prolapse problems and without incontinence are treated with the thick round ring. An intact pelvic floor (possible with reduced strength) is required for this pessary which can also be changed by the patient herself.
Sizes: Various sizes can be adapted, ranging from a minimum of 50mm to a maximum of 100mm. The pessary with the smallest diameter that just remains in its position should be chosen.
Use: The physician adapts the pessary on the first examination, whereby it should be tested whether the insertion withstands stress like coughing, pressing and movements. After the test, the position of the pessary should be checked again. If possible, it should be recommended that the patient changes the pessary herself, i.e. she has to remove it in the evening and to insert it in the morning. The coating with an estrogen cream facilitates the insertion and improves the local blood circulation as well as the formation of epithelium and connective tissue. Exclusively creams containing estriol (shorter adhesion to the receptor) should be used. Since a relatively small amount of cream is needed (small surface) for the gliding effect, we recommend to use a
higher dispensed estriol containing cream with 1 mg estriol/1 g cream. The change of the pessary will best take place while standing whereby the patient may put one foot on a stool or the edge of a bed, in a position comparable to the insertion of a tampon; if this is too difficult, it may be sufficient to insert the pessary while spreading the legs, if necessary while leaning against a wall or while lying. The patient should be trained how to insert the pessary (e.g. first to press it and then push it to the upper part of the vagina) and how to remove it (surrounding of the ring with her forefinger, edging and loosening of the pessary). However, older patients prefer a changing by the physician or a nurse at about 4 to 12 weeks intervals. Under these conditions, one should insert an estriol cream or ovulum once a week.
Side Effects/Complications: The therapy with this pessary is meant - in combination with additional measures (physiotherapy, estrogens) to cure or at least to reduce the patient's problems caused by prolapse. Also if surgery is planned in the long term, the ring, in combination with local estrogens, can be used as a ..preparation before the operation". The daily change by the patient or the change by the physician and/or nursing staff at about every 4 weeks with local estrogen therapy avoids complications like infections, bleedings or even ulcers. If the prolapse is insufficiently cured or if various sizes do not stay in their position, one has to change to a cube pessary and local estrogen therapy. Contraindications for estriol creams should be considered (e.g. pregnancy, lactation period, estrogen-dependent tumors). If the patient is not able to change the pessary by herself, it may be advisable to integrate a nurse or a member of the family into the procedures.
Advice: The product should only be used by one patient and can be stored by room temperature. The pessary may be cleaned under warm running water without using any disinfectant.