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.