Products - Instructions for Pessary Treatment

Cube Pessary

Application: Different degrees of vagina and uterine prolapse can be treated with the cube pessary. The vacuum effect achieves a good adhesion so that this pessary can even be used in cases when the pelvic floor is not strong enough to support the common ring pessaries. Cube pessaries are also suitable for relaxation of scars, for extending vaginal obstructions and to treat problems with miction or cohabitation. In addition, the pessaries are used before prolapse operations in order to improve the tissue circulation (application with estriol cream). The flexibility of the material facilitates self treatment.

a large prolapse, one can use a smaller pessary over night, or the pessary may only be removed approximately once a week by a nurse and be inserted again in the morning with plenty of estriol cream. Irrespective of the age of the patient, it is of advantage to spread an estriol cream on 2 or 3 edges of the cube before insertion. This will aid in the insertion, but also improve the tissue circulation and recovery of a vagina flora. Exclusively creams containing estriol should be used. Since one needs a relatively large amount of cream (large surface) to reach a gliding effect, we recommend the use of a low dispensed cream with 0.1

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Size: The length of the edge of the cube determines its size ranging from minimum 25mm edge length (size 0) up to maximum 45mm edge length (size 5). The right choice of the cube by the consulting physician is a prerequisite for good adhesion. The cube should be large enough to remain in its position, on the other hand, a cube which is too big, may press on the bladder or intestine and is more difficult to be removed. Treatment should be started with a cube which just adheres also while coughing and pressing. A correction may be necessary after a few days or weeks. In cases with prolapse rather small models, in cases with a constricted vagina larger models should be chosen. In cases with isolated prolapse of the uterus a small pessary will be placed in the upper third of the vagina (picture), in cases with an additional prolapse of the bladder and intestine a larger pessary will be placed rather in the middle third of the vagina (picture).

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Use: In general, cube pessaries are changed by the patient herself, after having been instructed by a physician or a nurse. The cube should be removed daily in the evening and inserted again in the morning. Thus the vagina walls can recover over night. In some cases it may make sense to leave the pessary also over night for preparing the tissue before an operation. In cases with

mg estriol/1 g cream, in rare cases with 0.5 mg estriol/1 g cream. For insertion of the cube the woman may put one foot on a stool or the edge of a bed, in a position comparable to the insertion of a tampon; if this is too difficult, it may be sufficient to insert the pessary while spreading the legs, if necessary while leaning against a wall or while lying and thereby to push the cube as far as possible up the vagina. For removing the cube the woman has to pull the cube by its thread to varying directions, if necessary also while slightly pressing - until a resistance is felt by the pelvic floor muscles. With the forefinger and middle finger the patient may loosen the edges of the cube to remove the vacuum effect and pull the pessary further down.

Side effects/Complications: If the thread should exceptionally tear, the pessary should be removed by the physician. In rare case with a large cystocele the cube pessary may manifest a stress incontinence, which would then signify the same effect by pelvic floor suspension surgery. In this case, the pessary should be turned with the edge into the region between bladder and urethra, or another model (urethra or urethra bowl pessary) should be preferred. Contraindications for estriol creams should be considered (e.g. pregnancy, breastfeeding, estrogen-dependent tumors). If the patient is not able to change the pessary by herself, it may be advisable to integrate a nurse or a member of the family into the procedures.

Advice: The product should only be used by one patient and be stored by room temperature. The pessary may be cleaned under warm running water without using any disinfectant.