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I can understand your urgency and assume you have researched what is involved with this procedure including the recovery time. My concern is that if you decide to undergo the surgery that you can no longer have Pap smears or that the cervix and uterus cannot be accessed for routine screening.

I have been using a pessary for about 5 years (age 80) for the last stage of prolapse. My UroGyn said I must use a vaginal estrogen cream for vaginal atrophy. Has anyone told you that you had vaginal atrophy? It makes removal and insertion of the pessary easier with no irritation. I tried several types and sizes until I found a type that was comfortable and large enough so that it didn’t fall out. I use the cream twice a week and also use a vaginal jelly for insertion and all is well so far.

I don’t know of anyone who has had the surgery but just wanted to share my experience in the event something was overlooked at the time you started with the pessary. Let us know what you decide.
Bladder incontinence is so common and we shouldn’t have to live that way.

FL Mary

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Replies to "@luftmensh1 Hello, I can understand your urgency and assume you have researched what is involved with..."


Hello. I appreciate your taking the time to write. I have had two pessaries over the years. The first one was prescribed by a nurse practitioner affiliated with the National Center for Advanced Pelvic Surgery. It worked for a while. I removed it twice a week before going to bed and inserted an estrogen cream for overnight. The cream was extremely expensive. Maybe it was Premarin. Eventually, the pessary would not remain in, and the bulging tissue would stick to the pads I was wearing, especially while sitting. When I got up, I would have to detach the tissue from the pad, which was irritating the tissue. I was referred to a urogynecologist from the same practice, who gave me a pessary two sizes larger, which worked, and my estrogen cream was switched to estradiol 0.01%, which was much more reasonable in cost. This worked well, although there was always a discharge, and I eventually developed a sore and some occasional bleeding. I always have used KY jelly to insert the pessary. After vacations from the pessary to let the sore heal, I began to have more difficulty inserting it and problems with it coming out, especially while walking for exercise. Over the past few months, I have used the pessary only occasionally, for example, when I have an appointment. The current urogyn, also from the same group, thinks the vagina may have stretched. He also said there is a type of pessary that is inserted and removed by the doctor, but he indicated that it's not as comfortable. He tried a larger size pessary, but determined that it was not comfortable. For the moment or two that it was in, it did feel uncomfortable.

You bring up some good points. The partial colpocleisis (LaFort) leaves some access, I believe, and has a somewhat lower rate of success. The complete colpocleisis has a higher rate of success. I've had numerous pap smears over the years that have all been negative. It may be that the pap smear is no longer indicated after a certain age. There are a number of different surgeries for pelvic organ prolapse. Most of them are rehabilitative, using mesh, although not the same mesh that was banned by FDA. Colpocleisis is obliterative and is considered a simple procedure involving local or general anesthesia.

I obtained some information from the Association for Pelvic Organ Prolapse Support (APOPS). Also, Stanford University provides a free literature search service and sent me some excellent information. In addition, Blue Cross/Blue Shield sponsored a Second Opinion interview online with two urogynecologists, one of whom (Victoria Handa) is the director of obstetrics and gynecology at the Johns Hopkins Bayview Medical Center in Baltimore. This is about an hour's drive from my home. A former neighbor of mine just had surgery for prolapse, including hysterectomy, from a local woman urogyn. So my neighbor has been a resource as well.