The ring pessary has a metal helix inside to keep it shaped and elastic.

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1 Prolapse / Stress-Incontinance Ring pessary Indication: Mild forms of prolapse with or without incontinance. The pelvic floor should be strong enough to hold the pessary. The ring pessary has a metal helix inside to keep it shaped and elastic. Through reposition of the prolapse and suburethral support it can prevent further stress incontinance. The patient may replace the pessary herself, e.g. when only needed for sport mm. The pessary with the smallest diameter to hold the prolapse should be used.

2 Thick round ring Vaginal Pessaries Prolapse / Stress-Incontinance Indication: Preferably older patients with mild forms of prolapse with ot without incontinance. The pelvic floor should be strong enough for holding. The thick ring has a bigger diameter than the conventional ring but no metal inside. The larger surface reduces the risk of necrosis in postmenopausal women. The pessary can be handled by patients themselves mm. The pessary with the smallest diameter to hold the prolapse should be used.

3 Prolapse / Stress-Incontinance Bowl and sieve bowl pessary Indication: Mild forms of prolapse. The pelvic floor should be strong enough to hold the pessary. Sieve bowl pessaries have the same shape than bowl pessaries and allow the discharge to pass more easily. : mm. The pessary with the smallest diameter to hold the prolapse should be used

4 Urethra pessary Vaginal Pessaries Stress-Incontinance / Prolapse Indication: Stress incontinance or mixed forms of stress and urge incontionance who ideally had no previous operations. The pelvic floor should be strong enough to hold a ring pessary. The urethra pessary contains a metal spiral inside to keep the shape. The thickening is supposed to support the urethra and to lift the bladder and urethra and thus to prevent urine loss in stress situations. The pessary can ce changed and re-inserted by patients themselves mm. The pessary with the smallest diameter to stay should be used.

5 Stress-Incontinance / Prolapse Urethra bowl pessary Indication: Stress incontinance or mixed forms of stress and urge incontinance ideally without previous operations. The pelvic floor should be strong enough to hold a ring pessary. The thickening is supposed to support the urethra and to lift the bladder and urethra and thus to prevent urine loss in stress situations. In comparison with the urethra pessary the urethra bowl might better treat a combined prolapse. The urethra bowl may also be changed and re-inserted by patients themselves mm. The pessary with the smallest diameter to stay should be used.

6 Prolapse / Stress-Incontinance Hodge Pessary Indication: Possibly in patients with previous operations having changed the anatomy in a way that common pessaries are not tolerated. The old therapy of a retroflexio has lost its significance. Our Hodge pessary contains a soft and flexible metal inside, that allows to form any shape according to the individual situation mm. The pessary with the smallest diameter to stay should be used.

7 Prolapse / Stress-Incontinance Cube pessary Indication: More severe prolapse with or without incontinance. The vacuum effect enables the pessary to stay in place even if the pelvic floor is not strong enough to hold any pessary. Daily handling by the patient is fascilitated by the flexibilty of the material and a special file and mandatory. Cube pessaries are indicated in combination with local estrogens. in patients with vaginal stenosis to resolve fibrous tissue from scars in patients with painful symptoms from cohabitation or miction in patients with planned vaginal operations to increase vascularisation. In isolated prolapse small pessaries are placed in the upper vagina (left), in patients with cysto-/rectocele lager (even trandem) pessaries are placed (right). Sizes and models: Standard/ perforated/ all with button, size 0 (25mm), 1 (29 mm), 2 (32 mm), 3 ( 37 mm) 4 ( 41 mm), 5 (45 mm)

8 Severe Prolapse / Stress-Incontinance Tandem pessary Indication: Extreme prolpase of uterus and vagina. The tandem pessary consists of 2 combined cube pessaries. Like in cube pessaries, the concave surface guarentees adhesion. The tandem pessary may also help to treat incontinance. In this case, the lower cube supports the urethra and the upper cube the treatment of descensus and adhesion. Sizes and models Tandem pessary with file and button non perforated or perforated 6 sizes of cubes can be combined: 0 (25mm), 1 (29 mm), 2 (32 mm), 3 ( 37 mm) 4 ( 41 mm), 5 (45 mm)

9 Severe Prolapse (e.g. with cysto-rectocele) Club pessary Indication: Extreme prolapse of uterus and/ or vagina and / or other organs when other pessaries do not resist the pressure. The stick prevents any rotation and assures the position of the higher basis. It is mandatory to care for a reposition of the prolapsed organs before placing the pessary mm. The pessary with the smallest diameter to stay should be used.

10 Vaginal aplasia/stenosis Vaginal dilators Indication: In patients in whom a vaginal dilatation is desired. Some indications are: Inborn malformations Restricting episiotomy and scars History of vaginal operations The model, frequency and length of treatment should be individualized. Small: Medium: Long: 26 mm diameter / 127 mm length 30 mm diameter / 112 mm length 37 mm diameter / 137 mm length