Understanding the Importance of GP Involvement in Pessary Fitting and Pelvic Health Care

Pelvic organ prolapse affects many women, causing discomfort and impacting daily life. A vaginal pessary offers a non-surgical way to support pelvic organs and relieve symptoms. However, fitting a pessary safely requires careful assessment and collaboration between your pelvic physiotherapist and your general practitioner (GP). This shared approach ensures the best outcomes and protects your vaginal health.

Why GP Assessment Is Essential Before Pessary Fitting

Before a pelvic physiotherapist fits a pessary, your GP must perform a thorough assessment. This step is crucial for several reasons:

• Check vaginal tissue health: The GP examines the vaginal walls to confirm they are strong enough to support a pessary without causing damage.

• Identify any contraindications: Certain infections, irritations, or medical conditions may prevent pessary use.

• Consider hormone therapy: For post-menopausal women, the GP may recommend topical vaginal oestrogen to improve tissue quality and comfort.

  
  

This process helps avoid complications and ensures the pessary will be effective and comfortable.

What Happens During the GP Assessment

The GP assessment usually includes the following:

Speculum Examination

The GP uses a speculum to look inside the vagina and assess:

• The condition of vaginal walls and cervix

• Any signs of irritation, thinning, or inflammation

• Suitability of tissues for pessary fitting

  
  

This examination is mandatory before the first fitting and should be repeated every 6 to 12 months while using a pessary to monitor tissue health.

Prescription of Topical Vaginal Oestrogen

If the vaginal tissues appear thin or fragile, especially in post-menopausal or breastfeeding patients, the GP may prescribe topical oestrogen. This treatment:

• Improves tissue elasticity

• Reduces dryness and discomfort

• Supports long-term pessary use

  
  

Using oestrogen for at least two weeks before fitting helps prepare the tissues for the pessary.

Review of Medical History

The GP reviews your overall health to identify factors that might affect pessary use, such as:

• Previous pelvic surgeries

• Hormonal status

• Other medical conditions

  
  

This holistic review ensures your care plan is safe and tailored to your needs.

Role of the Pelvic Health Physiotherapist in Pessary Fitting

Once your GP clears you for pessary use, the pelvic physiotherapist takes over the fitting process. Their role includes:

• Selecting the right pessary type and size based on your anatomy and symptoms

• Teaching you how to insert, remove, and clean the pessary

• Monitoring your progress and addressing any issues during follow-up visits

  
  

Physiotherapists also provide exercises and advice to strengthen pelvic muscles, complementing pessary use and improving overall pelvic health.

Why You Must Be Willing to Self-Manage Your Pessary

At Brisbane Pelvic Physiotherapy, pessaries are only fitted if you agree to self-manage. This means:

• Regularly removing and cleaning the pessary as instructed

• Monitoring for any discomfort, discharge, or signs of infection

• Attending scheduled check-ups with your GP and physiotherapist

  
  

Self-management reduces risks and helps maintain vaginal health over time.

Benefits of the Shared-Care Approach

Collaboration between your GP and pelvic physiotherapist offers several advantages:

• Safety: Ensures vaginal tissues are healthy and ready for pessary use.

• Effectiveness: Combines medical assessment with expert fitting and follow-up.

• Comfort: Tailors treatment to your needs, including hormone therapy if needed.

• Empowerment: Supports you in managing your own care confidently.

  
  

This team effort improves your quality of life while minimizing complications.

What to Expect After Pessary Fitting

After your pessary is fitted, expect to:

• Learn how to manage it yourself with guidance from your physiotherapist

• Use topical oestrogen regularly if prescribed

• Attend follow-up appointments every 6 to 12 months for vaginal exams

• Contact your healthcare providers if you experience pain, unusual discharge, or difficulty removing the pessary

  
  

Regular care helps maintain comfort and prevents problems.