At the beginning of this year I got to trial some new pessaries. As you know I am a bit of a fan of pessaries as a conservative approach to managing pelvic organ prolapse. I have written many blogs on them – if you go to the top panel there is a prolapse and pessary section where all the blogs are categorized. The Gynaecologic (pictured above) has been produced by Grace Carey and her father Dr Marcus Carey. It is made of high quality ultra soft silicone and does feel much more flimsy than the pessaries we are used to using. I tried the pessary on quite a few patients and did not succeed in making it work. But after I heard that Professor Judith Goh and Dr Hannah Krause successfully fitted them to patients in Uganda who then proceeded to cancel their surgery, I was determined to make them work. Since then we have successfully made about seven work and will continue to try them as an option. I do feel the pessary is definitely easier to fit when the tag is cut off. The following blog has been provided by Grace Carey who has helped to design this new style of pessary called a Gynaecologic Pessary. Here is her blog giving some background to their design.
After working as the product manager for an Australian-American medical device company focused on gynaecological oncology, I took a year off to undertake the Master of Public Health degree at the University of Sydney. During this time, I worked closely with urogynaecologists and started a company to commercialise a pessary for surgical use. The S-POP (Surgical Pelvic Organ Pessary) was our first product and is fitted at the completion of prolapse surgery to support and augment the healing tissues. The S-POP is removed four weeks after surgery.
Although the theory of a pessary is sound and thousands of years old, we felt that vaginal pessaries that are currently available haven’t evolved much over the past 300 years. Even though pessaries are widely used there is remarkably little research in this field. While new shapes and styles of pessaries have been introduced, many are without any obvious scientific or research basis and some designs are more likely to be introduced out of frustration with what is already on the market. When designing a new pessary, we worked from an anatomical perspective and came up with a new design based on vaginal dimensions that were generated by studying vaginal casts from 60 women undergoing prolapse surgery. We also wanted to make self-care a priority after hearing about patients who struggled to remove and insert pessaries by themselves or fashioned their own “pessary alterations” (like using dental floss) to make removal easier. The end result is an irregular hexagon shape that minimises pressure at the apex of the vagina (where ulceration and granulation are most likely to occur) and with a finger pull to facilitate removal, which can be trimmed or cut away entirely if desired by the patient. We also spent a lot of time looking into materials and finishes to try and reduce biofilm build up.
Professor Judith Goh spoke to me about making some pessaries available for some of her overseas work in developing settings. Recently, I was fortunate to spend time with Judith and her colleagues in Kasese, Uganda. As part of their two-week fistula and prolapse camp, they undertook research into the pessaries by fitting every prolapse surgery candidate with a pessary during their initial screening consultation. The research questions looked at, among other metrics, size, comfort, retention and ease of self-removal and reinsertion. Somewhat surprisingly, we observed over 30% of women scheduled for prolapse surgery chose to go home with a pessary instead. This was very positive as pessaries cost about 1% of an operation and the fitting and management of pessaries is much easier to teach to health professionals so more women can have access to prolapse management, either in the interim before surgery is available or as a long term treatment option.
I never thought that I would be running a pessary company but after seeing the impact of them first hand in Uganda, as well as the growing demographic of women seeking alternative options in Australia, my work is cut out for me.
Thanks Grace for the introduction to your new pessaries. Here is the link to the website to purchase the pessaries (for health professionals only). I look forward to continuing to trial them with patients and love having yet another type of pessary in my pessary ‘toolbox’.