PROLAPSE & PESSARY CASE STUDY

Working in healthcare is fascinating. There are patterns but there are always surprises.

I love when people shatter a stereotype I have formed.

A pattern from my experience is that most Australians who are born in the 1970s or earlier are hesitant to communicate with their partner about anything to do with their private parts. Issues that are considered taboo such as prolapse and incontinence are even less likely to be discussed.

I often fit support pessaries for vaginal prolapse. When I’m describing different ways that people could choose to store their pessary, I include the very convenient option of a hook in the shower. Many women baulk at this suggestion or shy away from it because they don’t want their partner or anyone to see the pessary and ask questions. They are absolutely entitled to feel this way, but I wish culture hadn’t encouraged it.

In a world without taboo, leaving a clean pessary on a shower hook would be no different to leaving reading glasses on the bedside table.

It’s just a device that helps our bodies function more easily if required.

Recently, a woman born in the 1940s came into the clinic with her partner. As usual, he stayed in the waiting room while she came into her appointment. She told me about her prolapse and other health struggles that her and her husband had endured over the past few years.

They had each faced extremely challenging circumstances, but the other one had been a life jacket: staying close and keeping them afloat until they were out of the deep water again.

Her prolapse was no doubt worsened by caring for her husband when he needed her most. Her dark sense of humour made it clear that she was aware of this but held no resentment towards him. The subtext was that he would have done the same for her. She wished she could have come in for self-care earlier, but it just wasn’t possible for her at the time.

She was nervous about remembering how to insert the pessary independently after the appointment. She asked whether her husband could come in and listen to help her remember. Internally I was surprised because of my own stereotyping, but thought it was a great idea and gave a resounding “absolutely”.

He willingly joined us, (again to my surprise), and absorbed all the information I gave them like a sponge. He wasn’t begrudgingly helping. When it was time for the vaginal examination, he wasn’t awkward at all.

Her prolapse was more significant than most: a uterine procidentia. This means the entire uterus is outside of the vagina. Many seasoned health professionals who are used to vaginal examinations would find this confronting.

He showed no glimmer of feeling confronted or disgusted by the prolapse. All he showed was a calm determination. To learn, to understand, and to help her remember.

I demonstrated how to fit the pessary. It’s usually easy to teach women how to do so themselves.  This time, there were extra instructions because the starting position of the prolapse made it a little trickier to ‘charm the prolapse into cooperating’. She rightfully became nervous about trying to insert it herself because it’s more difficult to access your own vagina than someone else’s.

She asked whether her husband could help her fit it at home and he was obviously on board with the idea. Again, I was internally (pleasantly) surprised by both of them and commended the idea.

We checked that the pessary was working well enough to bother persisting with it before teaching him how to insert it. It stayed in place when she coughed and sat up, even when she stood out of bed. So it was his turn to learn.

As to be expected, he was a little nervous about fitting the pessary correctly and avoiding harm or pain. It was all very new to him and the prolapse was a little stubborn at times. His determination and his love for his wife never faltered though.

The mutual trust was a beautiful thing.

• She could trust him to figure out how to physically manipulate her internal organs because it was so evident that he was doing it FOR her, not TO her.
• He could be brave enough to try something so beyond his scope because he could trust her to tell him if there was a problem.

Rainy seasons can promote growth.

The skills they must have learnt from previously nursing each other were evident. The only layer over their communication was respect. There was no treading on egg-shells, no judgement and no secrets. Just conquering challenges as a team.

• Where one might feel too overwhelmed to remember the information overload, the other can help with retention.
• Where one might not feel confident about doing no harm, the other can give feedback to confirm safe sensations.
• Where one might not reach, the other can lend a helping hand

Healthier together.