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HAVE PATIENT REPORT ANY OF THESE SYMPTOMS:
• Any changes in the color or consistency of vaginal discharge
• Any increase in amount of vaginal discharge
• Any foul odor associated with vaginal discharge
• Vaginal itching
Complete Prolapse. Pessaries recommended for third-degree
prolapse/procidentia are: Inflated Silicone Donut, 95% Rigid Silicone
Gellhorn, Flexible Silicone Gellhorn (Folding), Inflatoball, Silicone
Cube or Silicone Tandem-Cube.
Incontinence. Pessaries recommended for incontinence are: Ring
with knob, Incontinence Ring, Ring with Support and Knob, Hodge
with Support and knob, Hodge with knob, Hodge with Support,
Hodge, Incontinence Dish, Risser, Incontinence Dish with Support,
Smith and Gehrung with Knob.
For medical emergencies and for all other medically-related advice,
consult your health care professional.
Review separate instructions with patient to establish use regimen.
Donut Fitting Pessary
2-1/2", 2-3/4", 3", 3-1/4"
(Sizes 2, 3, 4, 5)
For third-degree uterine prolapse/procidentia
DESCRIPTION:
The DONUT fitting pessary is designed for third-degree
prolapse/prodentia. Using this pessary allows a non-surgical
approach to uterine prolapse.
To properly fit a patient with a DONUT pessary it is necessary to
have available a minimum of four sizes. The shaded area indicates
sizes recommended for office fit ting (most common sizes). With
these sizes you will be able to fit approximately 85% of patients.
Note: We recommend the DONUT pessary be inserted and
removed by a physician or other health care professional.
Available in the following sizes
Diameter in inches
2
2-1/4
2-1/2
2-3/4
3
3-1/4
3-1/2
3-3/4
CPT CODE Procedure: 57160
Other styles/models of pessaries (all single-patient use only)
are available. Consult the CooperSurgical website at
www.coopersurgical.com for details.
INDICATIONS:
For effective support of third-degree prolapse or procidentia.
CONTRAINDICATIONS:
• The presence of pelvic infections and/or lacerations
• Since the DONUT pessary may be difficult for the patient to
remove, it is also contraindicated in any sexually active patient
• A noncompliant patient
• Endometriosis has been suggested as a possible contraindication
to pessary use
• Health care professionals should use their own professional
judgment as to the advisability of using this pessary in a pregnant
patient
Diameter in mm
51
57
64
70
76
83
89
95
HCPCS: A4562
PRIOR TO FITTING:
Have the patient empty her bladder before fitting this pessary.
Ulcerations and erosions frequently occur in cases of complete
prolapse due to irritation of the exteriorized cervix.
Whenever possible, reducing the mass and treating the irritation are
primary steps before using a pessary.
The only method of determining the proper size DONUT pessary is
trial and error. The inside diameter allows for drainage without
reducing the effectiveness of the pessary. The unique flexible
silicone design facilitates insertion and removal. Silicone does not
absorb secretions or emit odors.
INSTRUCTIONS FOR USE
STEP-BY-STEP FITTING INSTRUCTIONS FOR THIS PESSARY
In general, the largest pessary that a patient can comfortably
accommodate should be fitted.
Perform a normal pelvic examination before inserting or fitting of any
pessary. A first approximation of size can be made by using your
fingers to determine the approximate width of the vaginal vault. This
will generally get you within a size or two of the proper pessary.
Note: If necessary, irrigate the vagina prior to insertion of the
pessary. This will cleanse the vagina of excess discharge and
secretions. HCPCS Supply Number A4320 (Irrigation Tray with
Syringe, any purpose).
1. Wear dry gloves. When necessary, the entering end of the
pessary can be coated with lubricant.
2. Use one finger to depress the perineum.
Hold the DONUT almost parallel to the
introitus. Guide the pessary into the
vagainal vault using a corkscrew motion
(see Figure 1).
3. The cervix should rest in the DONUT (see
Figure 2).
4. After fitting, the patient is told to sit, stand
and bear down slightly. Examine the patient
while she is in the standing position to
ensure the pessary has not shifted position.
The patient should not feel the pessary
once it is in position. The pessary should
Figure 2
not be too loose as it may turn or be
expelled, and it should not be too tight as it
may cause discomfort.
5. The health care professional should be able to sweep one finger
between the pessary and vaginal walls. If there is not enough
space to do this, the next smaller size should be tried. If
excessive space exists, the pessary will not be effective and may
rotate or even be expelled.
6. It is sometimes necessary to refit the patient with a different size
or type of pessary after a period of time. Do not assume that a
replacement will always be the same size as the previous one.
Check the fitting to ensure continued patient comfort and relief
of symptoms. The use life of a pessary is limited. Examine
frequently for signs of deterioration.
PATIENT FOLLOW-UP:
Have the patient:
• Report immediately any difficulty in urinating
• Report immediately any dis com fort
• Return within 24 hours for first examination
• Return for second examination within 3 days
• Return for examination every 4 to 6 weeks
Note: Above schedule of follow-up examinations may be altered to
fit the needs of the individual patient.
Figure 1
MXFITDON-DFU • Rev. A • 6/13