‘Private Parts’ Exhibition Co-Production Session with Lynne Rogerson (Mon 14th November 2022) ‘I think we’ve done an awful lot of work in encouraging people to present with incontinence and prolapse. The generation of my mum, who’s in her 80s, would accept that having prolapse and/or incontinence was part of having children and/or getting older, and it’s kind of ‘put up and shut up’…’
‘Private Parts’ Exhibition Co-Production Session with Lynne Rogerson (Mon 14th November 2022) 938.002 – Aitken ring pessary. ‘I assume you don’t use earthenware any more? No; that’s amazing. The ones we use now are quite like the black one, only white – the ones that we use now are literally plastic, and again, come in different sizes. My sort of standard patter with them is that it’s to stop the uterus dropping through… and stop prolapse of the bladder. You can still have sex with these in, whereas things like this shelf pessary would have to be inserted in ladies who weren’t sexually active. You’d get a bit of a shock if you had a go with that in!’
‘Private Parts’ Exhibition Co-Production Session with Lynne Rogerson (Mon 14th November 2022) 191115 – Simpson shelf pessary, vulcanite. ‘These are more for ladies who’ve had a hysterectomy. Once you have had a hysterectomy, so you no longer have a cervix of a uterus, you have what’s called the vault. These are for vault prolapse, so these again would be changed every four to six months, and if people get on with them and are not sexually active, they’ll have them in until they die, but if they don’t get on with them, that’s when we look at surgery.’
‘Private Parts’ Exhibition Co-Production Session with Lynne Rogerson (Mon 14th November 2022) 389.109 – Fritsch ring pessary introducing forceps. ‘We don’t use these any more. We would literally grab [the pessary], squishing it, and put it in with our fingers. These look more like something bone-crunching for removals [(abortions)].’
‘Private Parts’ Exhibition Co-Production Session with Lynne Rogerson (Mon 14th November 2022) Vaginal mesh: ‘There was the whole thing with mesh in the media, and I think it scared a lot of people from presenting [coming in with their problems] again. Would it still be used in some circumstances? Yes. The original use of vagina mesh was to close up hernias. If you just stitch a hernia up (where the bowel pops out through the uterine/bladder wall??), there’s a relapse [not the right word] rate, so you use a piece of mesh. The thinking was ‘why not apply the same thing to the vagina?’, but the vagina is dirty – it has to be dirty to work properly, and we have periods and – God forbid – occasional sex. It can also shrink in the vagina, and there were reports of all kinds of problems, like pain during intercourse. This is something that happened in July 2018. That procedure, the TVT (a re-thought version of the product/procedure), is still ongoing. We think it will be allowed back because it was a very good operation, but only in tertiary centres like Leeds. There’s a big campaign called Sling the Mesh, who are a quite small but very noisy group who have been involved politically in moving all this forward. They’re all about getting rid of it altogether, the TVT too. Most urogynaecologists feel that TVT is a good procedure with minimal risk. We have had to go back to much more traditional, older procedures, which are much more invasive. But there is an awful lot of work, because predominantly, the issue between prolapse and incontinence is a weakness in the pelvic floor, which is usually due to pregnancy and childbirth but can be due to other things, such as chronic cough, chronic constipation, carrying a lot of weight, having a job with lots of heavy lifting. It’s all about the collagen, so there’s work with stem cells trying to grow the collagen we need, but I think that’s a long way off. We’ve used pig collagen as a softer, hopefully improved support – it smells like wee. If you can imagine, inside here is quite a big piece of mesh with arms attached, and this gadget here (the black thing), when you depress the plunger, a needle pops out, and this is used to go very deep into the pelvis and push these arms into the pelvis – into the ligaments of the pelvis – to secure it. Because it comes like this as a kit, the fact is that people who are not generally pelvic floor surgeons had a go with it, and that’s predominantly where the issues have arisen. That is something that historically has been a problem in medicine – the sort-of ‘have a go’ mentality rather than being properly trained in a procedure. Another big driver in this kind of procedure is that it could be done in private practice, and if people weren’t offering it, they were missing out, which is quite shocking actually. It’s a mixture [of the product itself and the above problem]. I think the TVT – the tape for incontinence – as a procedure, that is really good, we have really good data for it when it was produced from a really big randomised trial. But the problem with that is that again, that was put in my people who were not trained. Whereas with this, the idea of big pieces of mesh secured in the vagina, as a dirty environment with bacteria being able to hide, if you like, in the mesh, was not great, and I think it was introduced without robust clinical trials.’
https://www.jstor.org/stable/20212272?searchText=duckbill+speculum&searchUri=%2Faction%2FdoBasicSearch%3FQuery%3Dduckbill%2Bspeculum&ab_segments=0%2Fbasic_search_gsv2%2Fcontrol&refreqid=fastly-default%3A374b014052afb132642028c4a20ae9a2 ON THE VALUE OF HODGE'S PESSARY. By ALEXANDER DUKE, F.K.Q.C.P.L, Ex-Assistant Master Rotunda Hospital ; Gynaecologist Steevens' Hospital, Dublin, in The British Medical Journal, Vol. 2, No. 1384 (Jul. 9, 1887), pp. 63-64 ‘Without at all agreeing with those who think that the primary cause of all female complaints can be traced to uterine misplacement, I still consider that there is a large percentage of such cases to be met with due to that cause ; and it is a most fortunate matter that by the judicious use of a Hodge's pessary we are enabled to give more relief in cases of retroflexion and retroversion (the most common forms of uterine misplacement), than by any other means with which I am acquainted. This pessary is the original from which all the numerous so-called improved uterine supports are taken ; and it will seldom chance that those who fail to give relief with a properly fitted " Hodge " will be fortunate enough to succeed with any of the numerous uterine supports sold by the instrument makers. [...] By substituting a slightly longer instrument at each change of the pessary (till the normal position is retained without the necessity for wearing one any longer), I find, if the last instrument applied has been worn for a sufficient time, there is no return of the misplacement whatever. I am a firm believer in the Hodge's lever action, when properly placed in situ, and this can be put to ocular demonstration by raising the posterior wall of the vagina with the duckbill speculum ; when, if the patient be in proper position, and the pessary mainly held in place by the lateral pressure of vaginal walls, it will be observed to move backwards and forwards by each inspiration and expiration of the patient. It is this valuable property of the pessary which slowly but surely raises the body of the uterus, and by taking the weight and strain off the ligaments, allows them gradually to regain their natural tone and elasticity, a point almost as important as the reposition of the organ itself.’
