Review The history and usage of the vaginal pessary: a review Reeba Oliver a , Ranee Thakar b, * , Abdul H. Sultan b a Urogynecology, Mayday University Hospital, London Road, Croydon,Surrey CR7 7YE, UK b Mayday University Hospital, London Road, Croydon,Surrey CR7 7YE, UK Contents 1. Introduction ..................................................................................................... 126 1.1. Evolution of pessary usage . ................................................................................... 126 2. Methods .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 3. Indications for pessary usage . ...................................................................................... 126 3.1. Pelvic organ prolapse . ....................................................................................... 126 3.2. Urinary incontinence ........................................................................................ 126 3.3. Other uses ................................................................................................ 127 3.3.1. Vaginal wind ....................................................................................... 127 3.3.2. Neonatal prolapse .................................................................................. 127 3.3.3. Prolapse in pregnancy . ............................................................................... 127 3.3.4. Voiding dysfunction.................................................................................. 127 4. Types of pessaries ............................................................................................... 127 4.1. Support pessaries .......................................................................................... 127 4.1.1. Ring .............................................................................................. 127 4.1.2. Gehrung ........................................................................................... 127 4.1.3. Incontinence ring/dish................................................................................ 127 European Journal of Obstetrics & Gynecology and Reproductive Biology 156 (2011) 125–130 A R T I C L E I N F O Article history: Received 13 August 2010 Received in revised form 29 November 2010 Accepted 26 December 2010 Keywords: Pelvic organ prolapse Pelvic floor dysfunction Vaginal pessary Urinary incontinence A B S T R A C T It is expected that with the rising female life expectancy the prevalence of pelvic organ prolapse will increase. From ancient times mechanical devices have been used to reposition prolapsed organs. Given that surgical correction of prolapse is associated with high recurrence rates, pessaries offer a favorable alternative.In spite of the antiquity of pessary usage the evidence for its use, the effectiveness of symptom relief, and the nuances of clinical management with the pessary in situ have not been studied methodically. There is a need for controlled trials to assess the efficacy of pessaries as opposed to other non-surgical and surgical methods of treating pelvic organ prolapse. Additionally, the long term effects and complications of pessary usage have not been assessed in trials, and knowledge about the potentia complications caused by the pessary rests mainly on anecdotal data. This review provides a historicalperspective and appraises the current knowledge regarding the indications, effectiveness and the potentialcomplications associated with pessary use.Data were obtained from an electronic search of Medline (1966–2010) and by hand searching the citations which were not available online. Keywords used were pelvic organ prolapse, pelvic floor dysfunction, vaginal pessary and urinary incontinence. Textbooks are also quoted where relevant. Most studies report moderate success rates in the short term following insertion of a pessary for the managementof prolapse and concur in the remission of almost all symptoms attributable to the prolapse.Reported success is variable in the remission of urinary and bowel symptoms. We conclude that based on the available evidence (mostly retrospective and prospective cohort studies), treatment with a vaginal pessary is a feasible option that can be offered in the short term to women with prolapse. There is a need for controlled trials to assess the long term efficacy. ß 2011 Elsevier Ireland Ltd. All rights reserved. * Corresponding author. Tel.: +44 208 401 3154; fax: +44 208 410 3681. E-mail addresses: Ranee.Thakar@mayday.nhs.uk, raneethakar@yahoo.co.uk (R. Thakar). Contents lists available at ScienceDirect European Journal of Obstetrics & Gynecology and Reproductive Biology j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / e j o g r b 0301-2115/$ – see front matter ß 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejogrb.2010.12.039