The silicone ring pessary called most useful for majority of women with vaginal prolapse.(Gynecology)

YOSEMITE, CALIF. -- Pessaries for vaginal prolapse come in many shapes and styles, but the simplest one is still the best--the ring pessary, Dr. Charles W. Nager said at a meeting on obstetrics and gynecology sponsored by Symposia Medicus.

In a wide-ranging lecture on vaginal and pelvic organ prolapse, Dr. Nager said there has not been much serious study of pessaries and their use. But, in his clinical experience, the ring pessary has proved the most advantageous.

The silicone ring pessary can fold in half like a diaphragm, making it is easy and comfortable to put in, which means the patient can take it out by herself periodically, a major benefit, said Dr. Nager, director of the division of urogynecology and pelvic medicine at the University of California, San Diego.

Dr. Nager said he had no financial interest in any companies that market pessaries.

When a patient needs a pessary, Dr. Nager said he almost always tries the ring first; about 90% of his patients end up using it. Other urogynecologists appear to share his high opinion of the ring. In a survey of 359 members of the American Urogynecologic Society, 22% said the ring was the only pessary they used.

Dr. Nager said he assesses a patient who has a pessary once within the first month after placement and then every 3 months for at least the first year, with a reduction in visits thereafter.

Dr. Nager strongly urged health care providers to teach patients to remove and wash the pessary at least one night a week. He often sees patients much less frequently if they are able to regularly remove their pessary; he sometimes follows such patients with just an annual visit