I have used a pessary for a number of years. The first one began coming out, so I went without it for a while, but my prolapse was bad enough that the bulging tissue stuck to my underwear and I would have to peel it away frequently to get up from sitting, and the tissue was irritated and looking red. My gynecologist referred me to the head of female pelvic medicine at a hospital, asking that I be seen right away. She was not available so quickly, so I got a next-day appointment with a doctor in the same group. He fitted me with a pessary two sizes larger, which I still use. There have been some downsides to the pessary: there is a discharge, which is somewhat messy and odor-producing, so I have to use a light liner pad and change it several times a day; it has also irritated tissue, sometimes causing a sore or bleeding. The bleeding had to be checked out via ultrasound and hysteroscopy. A polyp was removed, and no malignancy was found. I was told to take a vacation from the pessary to let the sore heal, and it didn't heal so quickly, so I was without it for some time. Without the pessary, I felt tremendous pressure, a sense of needing to urinate almost all the time, but not always being able to do so. This seemed to inflame the nerves in my pelvic area, my arms, hands, and legs, which was almost unbearable. Also, I wasn't always able to empty my bladder completely. And I could have episodes of incontinence a short time after being unable to urinate. Out of desperation, I went back to using the pesssary, but it kept coming out whenever I went for an exercise walk. It was okay around the house, going grocery shopping, to an appointment, but it kept coming out during sustained exercise walking. A larger pessary was tried twice, but was found to be too large. Maybe I had lost my skill in inserting the pessary during the long vacation from it, but I seem to have regained the ability. I push up the bulging tissue, which the doc claims is the vaginal wall, before I insert it, and now it stays in again for exercise walking. I also use gloves to remove it, and put a drop of KY Jelly on the two fingers I use. I notice at times in the shower that some of the prolapsed tissue bulges over the side of the pessary, and I push it back up. With the pessary in, I feel like a person, but it may not be a long-term solution. Also, I may not always have the dexterity to insert and remove it. I am 83, and I have arthritis in various body parts, including some of my fingers.

During the pandemic, I was afraid to go anywhere, including to the urogynecologist who was treating me, which involved a half-hour drive and going into an elevator building. When I learned that the same medical group was sending one of its doctors to the medical center in my retirement community once a month, I opted to see that doctor in the medical center across the street rather than risk greater exposure of myself and the two people I live with before any of us were vaccinated. This brought about some confusion over who was my doctor, but that is a separate story. (Both doctors are associate professors at a university hospital and are involved in research.) In April, my former next-door neighbor, who is perhaps 6 years younger than me, just had the surgery, which essentially shortens the vagina, bringing the walls together, along with a hysterectomy done vaginally. She is very happy with the results. Now she can comfortably travel to visit her daughter out of town. Of course, this surgery is an option only for women who are not sexually active. Colpocleisis is an obliterative, rather than a reconstructive surgery. I'm sure you've heard that some unlucky women who had reconstructive surgery with a certain type of mesh had problems, infections, and even died. Several years ago, I read about a doctor in Israel who was studying the use of stem cells to treat prolapse. The problem with surgery, he said, is that it often has to be repeated. I think this whole topic needs more open discussion. It's not something people are comfortable talking about. I also consulted a retired gynecologist who is a friend, and he is encouraging. I'm supposed to have a procedure called urodynamics, to gain more information for the surgeon, in a few days. That's about all I can write now.

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