25.     Ring Pessaries:

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MCQ Paper 1

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a. are outmoded False
b. should be changed in hospital False
c. may indicate the possible benefit of prolapse surgery True
d. are programmed to fall out in Sainsburys False
e. should be discarded when a ring change occurs False
f. may cause vaginal bleeding True

Ring pessaries still have an important role.

Many an elderly lady’s life has been transformed by the insertion of a ring.

Changing them is simple and well within the scope of a good practice nurse.

If a patient with prolapse derives great benefit from a ring, it is reasonable to infer that surgery will be beneficial.

However, if the ring is working, why expose her to the risks of surgery?

There is an element of ritual about ring changing and rings can be washed and re-inserted.

When the ring is changed the vaginal skin should be checked by speculum to make sure there is no ulceration.

The interval between ring changes varies from clinic to clinic.

I try to train patients to accept ring changes at six month intervals with the GP, but it is an uphill struggle.

It is usually a good idea to have the patient use an oestrogen cream once every week or two.

The aim is to keep the vaginal skin healthy and reduce the risk of ulceration and bleeding.

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