Vaginal Pessaries: A Deep Dive - Episode Transcript

Helen

Hi, I'm Helen, and this is Why Mums Don't Jump - busting taboos about leaks and lumps after childbirth. All the stuff that happens to your pelvic floor that no one ever talks about. Incontinence, prolapse, pelvic pain - problems that affect millions of women, one in three. I'm one of them. I have a prolapse. My pelvic organs fell out of place after the birth of my second child five years ago. And if you'd told me then I'd be speaking about this stuff out loud, I would have told you to give your head a wobble.

Hi, welcome to what is the final episode of the series. Awww. So much has happened in the last few weeks and as ever, I'm just so proud of what's happening here. And I'm really grateful to everyone who listens and gets involved. You know, every time you do listen or you share the podcast, or you review the podcast, or subscribe, you're helping to get it in front of more people. More women who need this information and support around pelvic floor problems. So please keep doing that after today.

You know that my favourite bit is the messages that you send in. One mum told me this week that the podcast had made a feel seen and that's exactly what it's about. It doesn't matter that there might be thousands of miles between us, but we're all going through the same kind of thing. So please do find me on social media, if you haven't already, and join in the conversation there.

I still think there's a lot more to talk about, so I will be back for series three, and if there's anyone in particular you'd like to hear from, or any issues that you'd like me to take a look at, then let me know. And if you have any thoughts on how the podcast could reach more people, then drop me a line. I am open to all suggestions.

Today's episode was inspired by a lot of chat on my Instagram page about pessaries. It's something that many of us have heard about, some of us have tried it, but like the vadgets thing a couple of episodes ago, it's another one that needs a bit of explaining. And guess what? I have the perfect person for the job. Gaynor Morgan is known as the Pelvic Angel. She's an award winning pessary inventor, a pelvic health advocate and educator. She teaches pelvic floor pilates, or Pfilates, as it's known, and she advises doctors on pessaries. So, yeah, she's an expert, and she also has the best story of how she got into it in the first place.

Gaynor

It was quite bizarre, really, because you have to know, basically, that my mother had me when she was just 17. So I grew up with my mother more or less like a best friend rather than a mother. She had stress incontinence and had what they call the TVT - transvaginal tape, which worked for about five to six years. And then she found she was incontinent again. And all this happened around about mid 40s for her. So she was young, and she had a partner, and this really affected her life with her partner, and she was really outgoing. You know, going to discos back in the 80s on the dance floor, dancing to Soft Cell.

So all this impacted on her quality of life because she just stopped going out. And she became depressed and she went to the GP and the GP hadn't even offered her physiotherapy. She just said, here's a bunch of antidepressants, get on with it and no more surgery for you because you're overweight. So that made her feel even worse. And she battled with depression.

I was out in the Middle East at the time, so I wasn't seeing the full impact. And when I came back on leave, I really did see this. She also, at one stage, wanted to take her own life because of it. And both mum and I...so my mum was a nurse for the NHS forever and I was an NHS nurse and left nursing to go out to the Middle East. And then when my mother...you know she'd finished her relationship, because every time she was having sex, she was wetting herself and she didn't know if it was the natural lubrication of her body or if she was actually urinating. And we'd never heard of pessaries or anything, so we sat on the sofa and just said, you know what? Every time I'm menstruating, I'm using a tampon. I don't leak urine. So we looked at the anatomy side of it and thought, gosh, it's that simple. This tampon is compressing against the urethra and that is what's stopping involuntary loss of urine.

So it's important to say that mum had urinary stress incontinence. There are different types of incontinences. So with this tampon against the urethra, she was great. So what she ended up doing then was putting a condom over a tampon, because we were well aware of toxic shock syndrome and you should never use a tampon outside the recommended use, which is due to menstruation. So then we ended up saying, right, okay, we need to look at making our own. We'd actually written to the tampon manufacturer saying, 'Do you know what? If you dip this in latex...' I mean, this is how naive we were. '...you are going to have an amazing product to stop women leaking.' Well, you can imagine. They must have thought we were a couple of fruitcakes.

Helen

I love that you did that!

Gaynor

And I think this is where innovators and inventors, they do dare to take that step...sort of out of their comfort zone. And if somebody laughs at them, they'll think, well, no, actually, I'm going to prove you're wrong. So we had this air dried clay, because I used to do a lot of activities with my daughter when she was young. And then we got a candle and a McDonald's straw and then a keychain, the round part of a keychain. So we immersed that into this air drying clay and we thought, this is going to be our mould. So if you imagine this, then we filled that up with liquid latex and then when it dried - it took days to dry - and when it dried, she put a condom over it. So when we took it out, it was just like a tampon with a little stem on it, and the ring was so we could retract it back out of the body.

And then people were like...you know, I came from a very small village in Wales, so everybody knew...if you farted in the wrong direction, Mrs Jones down the road would soon complain. So we had women knocking on the door saying, can we have one of these products? We were quite happily making them in the kitchen, not realising that there could have been a lawsuit around the corner. That we could have caused some kind of damage to somebody.

Anyway, we went to Swansea Hospital, Singleton Hospital, and Mum was under a brilliant gynaecologist there and she started talking to her gynaecologist. And this gynaecologist, Mrs Morgan, turned around, and she said, actually, my husband is one of the lead Urogynaecologists in Wales. I'm going to talk to him about this invention of yours.

Helen

Wow.

Gaynor

So that's how it all started. So Mr Emery then called my mum and said, can I have a look at this device that you're sort of handing out to patients? So we went down there and he said, 'Yeah, I think there's something in this. The mechanism of it would certainly work.' So he said, 'Go away, do your research, get me some proper material and we'll look at it seriously.' So I did, and this took...we're talking over ten years research and all this. This didn't happen overnight.

And so we went to all the medical fairs and everything, looked for the best material, and the best material which was the most inert, was medical grade silicone. So we started then producing this in the UK. So we did the prototypes, got MHRA approval, so all the legalities were in place, and we went to clinical trial with it. And then...it was a small trial, but nevertheless, we had 73%, I think, success rate, and we had 30% coming off the waiting list for surgery. So this little device, which was costing a few pounds, was giving people quality of life back. So, unfortunately, Mum passed away very young suddenly, just before the clinical trials were produced.

Helen

Such a shame.

Gaynor

So she didn't get to see that.

Helen

I'm so sorry.

Gaynor

Yeah, I was devastated. And I've got to be honest, I lost two years of my life just in oblivion. I can't even remember the two years after mum died. And so I thought, you know what? I can either spiral into the wine bottle or I can pull my finger out of my backside and move forward and help as many people as I can.

Helen

And what a legacy for your mum.

Gaynor

Yeah, I mean, I opened the business in her memory and it just went from strength to strength. And the product, which was called Incostress, it gained momentum globally. And the letters that I'm having back from daughters of mothers, mothers saying it's made a huge difference. So that's how I got into the pesory realm, because I was contacted then by a pessary manufacturer saying, 'Oh, could you sell ours?' I said, 'Well, I'll sell it, but you have to train me up.' So I've been trained up on all of the pessaries from all of the top manufacturers and then I started getting requests from hospitals in the UK. Can you come and train our staff on these pessaries?

So if I go back a little bit, a pessary is a medical device that is inserted into the vagina, holds up and supports the internal organs, so it can be useful for urinary stress incontinence. It can also be used as a trainer to stabilise the bladder when people have got overactive bladder. So if you've got urgency, key-in-the-door syndrome, 'Ooh, I need to go to the toilet, can't get there and you've wet yourself before you've reached the toilet.' So a pessary can be sort of inserted and used as the stabiliser. It can also be used then for pelvic organ prolapse.

Helen

I'm hoping this is where this might be really useful to people because if you are in this world, unfortunately, you've got issues that you need to be looking into. You've perhaps heard of a pessary and I think you might have heard of a ring pessery. But actually there's so much more available and different shapes and sizes that do different things for different women and it's so easy just to...even if you try one, and it doesn't work. You think pessaries, that's it, they don't work for me. So is there a good way to kind of categorise them or say, okay, we've got this kind, and we've got this kind, and this is what...is there an easy way to break it down like that?

Gaynor

From a medical side of view, yes. You've got the three categories. So you've got the space filling pessaries which are like your donuts, your cubes, and they will basically sit in the vagina. You can't have intercourse while these are in place because they're taking up too much space. So that's one category.

The other category is then the lever pessaries. So the lever pessaries, they were originally designed for people with a uterus, which is turned the wrong way basically. And then the cervix is pointing the wrong way. So these will just hook onto the cervix and just gently bring the cervix pointing back to the sacral area.

So then the biggest ones that are used are the support pessaries. So these are the three categories. So rings would come into support pessaries. There's so many...um...the Shaatz and I'm not swearing, so these are literally placed in. They're there. Now some pessaries can be left in for up to three months at a time. And then they come out, you know, the doctor will take it out, check, everything is okay, and then you're good to go. You can put it back in again. Some are self managing, so you take it out every day or you take it out every two or three days. This is the beauty about pessaries, is that the women have full control over what goes in and what comes out of their body.

Helen

And so how...is it the case that certain pessaries are for...like it depends on your anatomy? Or which bit has prolapsed? Or how old you are or your lifestyle? Or how do you begin to know what's the right one?

Gaynor

Right? Don't bring age into it. Argh! So many doctors, GP's will say, oh, you're too young for a pessary. Well, there's nothing in the legislation that says that...as long as you're an adult female, then you're not...the youngest lady I know, she had a fourth degree tear on childbirth, and she's been using a pessary. She was 18. And then people say, oh, you're too old for a pessary. No. If it can support the internal organs, there isn't a date or an age limit on there.

When I do the training to the physiotherapist and the doctors, what we get them to do is get everything about their lifestyle. So the pessary marries up with what kind of prolapse they have, what grade of prolapse. So you've got a grade one, which is hardly noticeable, but you might get a little bit of symptoms...you may be asymptomatic. Or you get a grade four where the internal organ is literally hanging out of the vagina. So certain pessaries would be suitable for that type. Certain pessaries wouldn't. But it really is important to find out the lifestyle of the patient. The patient always comes first, and it makes me laugh because a lot of people forget that you might be over 60, over 70, over 80, and they assume you're not having a sex life. I mean, I've got one lady, she's in her 80s, God love her, and she's still got a healthy sex life. And then she came to me and she said, 'My doctor has given me this pessary. I can't get it out. He's told me to keep it there...' It was the donut. '...keep it there, and I'll see you in three months', but, she said, I need my sex!

Helen

Yes, good for her.

Gaynor

So again, if you are a GP listening, please just ask the question, because you can get pessaries that these patients can insert and they can have intercourse with the pessary in situ.

Helen

But if you are otherwise fit and well, apart from the prolapse or the incontinence or whatever it is, do you believe there is a pessary for everyone that can help?

Gaynor

There are certain people that I think would not fit that, and that usually falls into patients who have had what's called an avulsion. So women who have given birth...and they may have had forceps delivery or traumatic birth. What can happen is that the ligaments from the pelvic floor, the muscle that is attached to the bone...that comes off or is very...sort of very, very thin. So that's an avulsion. And these patients, you need some kind of integrity within the pelvic floor to keep the pessary in place. So these patients would probably find it super, super difficult to retain a pessary.

Helen

Yeah. Okay. So you need a tiny bit of strength, at least a little bit of grip in some way to hold it in. Okay.

And so, as someone who's obviously, you know, seen a lot of women with pessaries, what's the improvement in lives that you have seen? Like, how good a fix is it, or can it be?

Gaynor

I mean, some of these women have grown from suicidal to 100% back to being normal, if we can call it normal again. But again, a pessary is just a tool. I always advocate that you need physiotherapy, proper pelvic floor training. Let's get that pelvic floor up to the strength, up to where it needs to be.

Helen

It's fascinating because I've said it before on the podcast, but I personally tried a couple of ring pessaries in different sizes. I remember the first one fell out in the hospital car park as I left. I went back, got a bigger one, got a different one, tried a couple. And it was okay. And I kind of got to the point where I wore one for quite an extended period of time, but then I was seeing a physiotherapist and wanting to do more work in that sense. So I had it removed, so that she could investigate and see what was going on, basically. And I didn't really feel any different afterwards, so I never put it back in again. But now I would like to go back and see what else might be available because I just feel like it's something that's worth persevering with a little bit.

Gaynor

So do you feel right now that you've not got enough support in the pelvic floor?

Helen

Yeah, I will always feel a bit bulgy. And I do run. Not really far, but I like to run. And I'm aware that I'm putting myself in a vulnerable position for things to get worse. So for those two reasons, that's something that I... I've made the call, I'll be on some big, long list somewhere, hopefully.

I mean that's what was going to be my other question. Because you will know this, if there are people listening, some people might be listening and thinking, okay, I've not tried it before, I understand it a little bit better now, but where do I go? Like, what is the official route, let's say in the UK to try to try a pessary?

Gaynor

So the official route, the first place, is your GP. Go to your GP. And a lot of GPs can fit pessaries and do fit pessaries. But isn't it so unfair that somebody living, let's say, in Hull, isn't able to get that treatment because the GP simply doesn't know about pessaries, whereas in Swansea, they've been trained up. And there's nothing...in the UK everything is so staggered and antiquated.

So they'd go to their GP, hopefully they'll give you physiotherapy. And more and more physiotherapists now are being trained up on pessaries, they're knowing about them, which is great, because they can advise the patient, or the GP would send you straight to a gynaecologist, urogynaecologist, colorectal surgeon, depending on what your condition is. You can also pick up the phone to a pelvic floor health physiotherapist and get treated straight away with them. And then there's the private route as well. So, again, there's lots of different routes, but if you are going on the NHS route, then it's the GP as your first stop. And what I'd say to women is, do your homework and don't be afraid to question your GP, don't be afraid to educate your GP, because if the GP, let's say, has never heard of a Shaatz or a donut or an inflatable pessary, they're just going to give you the standard NHS rings.

Helen

Does the NHS have access to the full range of pessaries? Because I know there are dozens of them, but you only ever really hear about the ring.

Gaynor

Yeah. So on NHS prescription, you've only got the ring, you've got the PVC ring and you've got the silicone rings, and then you've got the Gellhorns. They're the only types that are available on prescription. The rest then you'd have to buy.

But they're only...saying only, I know that some people really struggle with finances, but £40, £50 will give you a Pessary for the next ten years. So over the long sort of time of it, it's not costing you anything. The only thing that you need to be aware of is that all the pessaries come in different sizes, so they have to be measured. You have to be measured properly to be able to know what size pessary you need to get.

Helen

And the routes that we've talked about. If one of those people - the GP, the physio, the specialist, the gynaecologist, or whoever - decides that it would be something that is not available on prescription, would they say, look, we have these available on prescription, I don't think these are right for you. Why don't you try the cube or whatever it is, but you will have to buy it yourself? Is that a conversation that would be had? Yeah? Okay.

Gaynor

Yeah. I think as long as the patient's willing. And I think, again, in all fairness to doctors, they're not mind readers, so a lot of doctors may not even suggest this. So it's up to the patient. Start sort of doing your research about these different pessaries. Take a picture and say, look, what about this? Do you think this will fit me? Do you think this will suit me? Most of the experience I've had, the doctors will say, well, give it a go, let's measure you. This is the measurement that you need. Off you go and buy it yourself. Come back to me and I'll fit it for you and then we'll see.

If you have a first time pessary user, then the doctor or the physio would fit you. And in an ideal world, which is not happening because of COVID, you are fitted, you walk around for 20 minutes, you go and have a cup of tea, you come back, then you try to empty your bladder to make sure that the pessary doesn't fall out down the toilet. They will check that the pessary is in situ properly and then off you go. They normally should then contact you via email within 48 hours just to check up to see how you're doing, and then two weeks later have you back in, making sure that there's no pressure coming, causing abrasions or anything. And then you're good to go for another three months.

Helen

And how should it feel if it's working?

Gaynor

So when you go for your fit in, first, my first tip for patients is take a mild analgesia, because it can be very uncomfortable. And when you're lying flat on your back with your legs akimbo and they're sort of having a good look around...

Helen

Rummaging around.

Gaynor

...yes seeing what's going on...number one, it's uncomfortable, and number two, your natural instinct is to tighten everything up and make it worse. So try to relax as much as possible. And then once you've had your pessary fitted, it is not unusual to have cramping period like paints for the first 12 hours.

Helen

Right, okay.

Gaynor

It shouldn't be unbearable. You should be able to walk around and do your normal things. If that cramping pain is so unbearable that it's giving you a backache that you can't control. If you've got shooting pains down your legs, any of these, call the doctor immediately, have it removed, see what's going on. Because a lot of the time, again, women who have given birth and who have got pudendal nerve damage, sometimes a pessary can push on to the different nerves and trigger off like a snowball effect. So, again, there are reasons why pessaries cause pain. We need to get to the root cause of that, maybe find a different shape...and maybe it just isn't then the route to go for that patient, unfortunately

Helen

And then ideally, sort of more short to medium term, you should just not be aware of it? And perhaps just feel a little less symptomatic?

Gaynor

Yeah, most of the patients, they forget about it. Like when you've got a tampon in, when you've got your period, and you don't feel it at all. Some patients, if they've got sort of quite a low prolapse, then they might just feel it when they're sitting down, or they might just be aware that it's there, but it should not interfere in any of your daily life chores.

Helen

I hear sometimes from people who have bought their own pessaries. Maybe the waiting lists are just far too long, or they've felt like actually they've managed to get enough information to do it themselves. Is that something we should be considering or? What do you think? It's a difficult one, isn't it?

Gaynor

Yeah, I'm kind of against this. Simply because you don't know what's going on with your internal organs. You don't know if...let's say, somebody's had previous surgery, the scar tissue, what the state of that is. Don't second guess the size of a pessary, because that's really important. If you end up with the wrong size and you can't get the pessary out, it can cause complications. So I would always, always advocate that you need to see a medical professional first to see if you are a candidate and talk about the pessary. Don't rush off and get anything, any of these gadgets off the internet. So be it a medical device as a pessary, or these pelvic, floor toning, electrical stimulation, again, these are all things that really need to be done under the guidance of a professional person.

Helen

And I'm just thinking about innovation in the pessary market. Is it still happening? Is this some sort of golden goose of pessaries that is yet to be invented that can sort us all out?

Gaynor

Wouldn't that be amazing? The two pessaries that I brought to market, they're suitable for some, they're not suitable for everybody. And I think because we're all individual and we are all different on the inside and the outside, our vaginas are as unique as our thumbprint. There isn't going to be one pessary that can sort of say, here we go, this is going to fix everybody. It's just not. I can't see it happening in my lifetime, but there are companies out there who are continuously working on different methods, shapes and everything. So innovation doesn't stop.

Helen

I loved that conversation. I hope it was helpful. None of it, as ever, is intended as medical advice, so please seek out your own professional help. And if you're thinking of trying a pessary, then let me know how you get on.

I'll put Gaynor's details in the show notes, but you can find her on Instagram @pelvicangel. It's worth mentioning, too, that earlier this year, the UK's first ever clinical guideline for pessaries was released and there's loads of good information in it, so I'll link that in the show notes, too.

You can support the podcast at buymeacoffee.com/whymumsdontjump and it can be completely anonymous, if you prefer. Thanks to everyone who's done that so far. It really means a lot.

Thanks to all the brilliant guests who shared their stories and expertise over the course of series two. I never underestimate what it takes to do that. Emma Barnett, Tiffany Sequeira, Chantelle Sandham, Jilly Bond, Peace Bailey, Clare Bourne, Dr. Jan Russell, Amanda Savage, Gaynor Morgan. And, of course, Sky and Jess. Thank you to my husband, Paul for your support and a banging website, and to Cat Pearson, a listener who volunteered her design skills to rebrand Why Mums Don't Jump in the best possible way. You've been listening to Why Mums Don't Jump with me, Helen Ledwick. You can find me on social media @whymumsdontjump, where I'll keep you up to date with what's happening, or online at whymumsdontjump.com. Bye for now.