[The gynecological pessary: Is it really a device of another age, a fig leaf?]

The use of pessary to put back up prolapsed organs to their normal position dates back prior to several millennia. This work aims to discuss its place in our clinical practice through an updated bibliographic review and emphasizes a hands-on approach to pessary fitting and management in terms of indication, pessary type selection, device' size, insertion, removal, follow-up visits and care.

A review of the literature, in the light of the latest publications and recommendations of French and international learned societies, as well as our own experience, were analyzed.

This device appears to be as effective as surgical management to relieve symptoms related to urogenital prolapse and restore body image. It can be used temporarily, awaiting a surgical solution or as a therapeutic test (mimicking the effect of a surgical procedure to predict its functional outcome or identifying a masked urinary incontinence). It can also represent an alternative to surgery (patient choice, women who wish to complete childbearing or who are unsuitable for surgery because of medical comorbidities) and thus can be used in first intention. However, despite its moderate cost and its harmlessness, this device remains somewhat little known as regards the practical modalities of its use, which, moreover, appear not consensual.

A guide intended for the attention of the patients as well as a film relating to the practical modalities of the device' use were elaborated to improve the knowledge of both professionals and users in order to optimize and secure the care pathway.

Gynecologie, obstetrique, fertilite & senologie. 2018 May 18 [Epub ahead of print]

E Nohuz, E Jouve, G Clement, B Jacquetin

Service de gynécologie-obstétrique, centre hospitalier de Thiers, route du Fau, 63300 Thiers, France; EA 4681, PEPRADE, université Auvergne Clermont, CHU Estaing, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France. Electronic address: ., Service de gériatrie, centre hospitalier Guy-Thomas, centre hospitalier de Riom, boulevard Étienne-Clémentel, 63200 Riom, France. Electronic address: ., Département de médecine générale, faculté de médecine, université d'Auvergne, place Henri-Dunant, 63001 Clermont-Ferrand, France. Electronic address: ., Service de gynécologie-obstétrique, pôle Femme et Enfant, CHU Estaing, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France. Electronic address: .