Surgery as a means of saving lives and alleviating suffering has been performed for centuries, but has historically always been considered as painful and dangerous and only used as a last resort. With the advent of anaesthesia and pain relief, the understanding of the nature of infection and it's prevention and treatment, and the ability to manage blood loss, surgical treatment for many diseases became the norm. Improvements in surgical techniques, equipment and aftercare have lead to the impression amongst doctors and patients that operations are always safe and effective. They are not!
All operations have risks. All operations have potential short and long term consequences. Not all operations achieve the result that the patient expects. The difficulties are quantifying the risks, identifying the consequences, and developing real expectations.
Most of medicine involves balancing the risks against the benefits, and considering the alternatives. In some areas this can be very difficult. Hormone Replacement Therapy, for instance, requires the patient to balance a risk to Duration of life ( which is still not quantified), against the benefits to Quality of life (which may be miraculous) considering the alternatives (often ineffective) Most surgeons readily appraise their patients of the virtues of proposed surgery, and will inform of the known risks, but often have limited experience with the alternatives.
In gynaecology, some areas that were traditionally managed surgically can now often be managed conservatively. Improvements in availability and delivery of hormonal treatments has improved menstrual control (Mirena). Better diagnostic services have allowed us to avoid exploratory operations and operations for benign processes (3D Ultrasound). Some old fashioned treatments have been revamped and improved (e.g. (Pessaries) for prolapse control).
I am happy to see anyone wishing to pursue advice about the availability of the alternatives to an operation.
Ring pessaries have been used for around a century as a non surgical means of repositioninging a prolapsing (= "falling down") womb. The oldest that I have seen were made of black rubber around a coil spring, with some internal padding. Over the years they have usually been made of vinyl as a more flexible ring, although hard perspex pessaries were sometimes used. Most modern ones are made of a softer, medical grade silicon.
They come as a large range of shapes, and an even larger range of sizes, and, in all but the most difficult prolapses, a pessary can be found to fit.
Pessaries are used to provide a physical replacement for a deficiency in vaginal wall support in much the same way that a set of dentures can be used to overcome a deficiency in the tooth department. They do not cure the problem like surgery might, just as false teeth are not as good as real or implanted teeth, but they suit the purposes of many people. Those who are too sick or too busy with commitments to have surgery, or those just not interested in an operation may benefit from a pessary. They are also useful for those who only have symptoms at certain times (usually sport) and who can insert and remove it themselves when needed.
Once fitted, pessaries can be managed two ways. For those who are too inflexible, too arthritic or too shy to remove and reinsert them, they can be left in place and checked periodically to look for pressure areas. For the others, the vagina can rest from the pressure points against the pessary if it is removed periodically, and frequent ongoing checks are not necessary.
Colin Pearse
