Imaging description

A vaginal pessary is an object, usually made of rubber or plastic, inserted into the vagina to support the uterus and pelvic floor (the term can also be used more widely to include contraceptive vaginal devices or medicated vaginal suppositories) [1]. The commonest appearance is of a radiopaque ring-like structure in the vagina seen at CT (Figure 83.1), although a wide variety of shapes is available. Pessaries are usually only slightly opaque on plain radiographs. In 2001, a hormone-releasing vaginal contraceptive device (NuvaRing®) that appears as a radiolucent 5 cm diameter ring, was approved for use by the United States Food and Drug Administration (Figures 83.2 and 83.3) [2].

Importance

It is important to recognize vaginal pessaries so that they are not mistaken for unintentionally retained foreign bodies in the vagina. At MRI, the signal void created by a pessary may be misdiagnosed as a bowel loop or even suggest a sigmoidocele (Figure 83.4). Pessaries should be properly fitted and removed every few months for cleaning [1]. Occasionally a vaginal pessary may impact, fistulize or migrate, particularly if neglected, and imaging may contribute to the evaluation of such complications [3–6].

Typical clinical scenario

Pessaries are widely used by gynecologists as first-line therapy for pelvic organ prolapse, which typically affects older multiparous women. Pessaries may be divided into ring-shaped support pessaries and variously shaped space-filling pessaries, such as the distinctive T-shaped Gellhorn pessary (Figure 83.5).While pessaries of different shapes and sizes are designed and marketed for different forms of pelvic organ prolapse, there is no evidence or consensus on whether such tailored strategies are appropriate [7].