title: Double pessary use in grade 4 uterine and vaginal prolapse.
abstract: BACKGROUND
  Certain situations dictate conservative management of grade 4 uterine or vaginal vault prolapse in women. The reduction of a prolapse may not be possible if the vagina cannot retain a single pessary. We have used double pessaries in the management of this condition.
  
  
  METHODS
  With the patient in the dorsal lithotomy position, either a Donut or Inflatoball (Milex Products Inc., Chicago, IL) pessary is inserted and pushed into the vagina as far as is comfortable. A second pessary, either a flexible Gellhorn or Shaatz (Milex Products Inc.), then is placed caudad to the first.
  
  
  RESULTS
  We have used this approach in five women who have been followed for 7-15 months. There have been no erosions or vaginitis and all the women experienced symptomatic relief.
  
  
  CONCLUSIONS
  In women who want or require conservative management of grade 4 prolapse and are unable to retain a single pessary, the placement of two pessaries often will be successful.
authors.affiliation: Department of Obstetrics and Gynecology, Women and Infants' Hospital of Rhode Island, Brown University School of Medicine, Providence 02905, USA.
authors.forename: D L
authors.initials: DL
authors.lastname: Myers
authors.forename: C A
authors.initials: CA
authors.lastname: LaSala
authors.forename: J A
authors.initials: JA
authors.lastname: Murphy
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010570:Pessaries; D013997:Time Factors; D014596:Uterine Prolapse / Q000517:prevention & control*