ABSTRACT
This chapter discusses that there is no standardized way to fit a pessary. The goal is to fit the patient with a pessary that is comfortable while alleviating the patient's symptoms. A comprehensive pelvic examination is fitted prior to pessary with an empty bladder in the dorsal lithotomy position to assess the postvoid urine residual and the stage of prolapse is used as a split speculum and the pelvic organ prolapse quantification (POPQ) system. The patient is informed of potential complications of pessary use, including urinary retention, defecatory dysfunction, vaginal bleeding, or erosions, and is instructed to call with the development of any concerning symptoms. At the follow-up appointment, a directed history is obtained including the relief or persistence of vaginal bulge or pressure symptoms, discomfort, expulsion, voiding or defecatory dysfunction, development of stress urinary incontinence, and vaginal bleeding or discharge. Pessary fitting is accomplished with minimal ease in a vast majority of patients with basic providers' training.
