Operative gynecology : . he foot, and to do this satis-factorily it is necessary to keep an assortment of different sizes on hand. Ifind that, as a rule, there is a tendency to use pessaries that are too long andtoo large. If it can notbe inserted without pain,it is best to use a packfor a short time. Thediscomforts caused by theintroduction of a pessarymay be lessened by plac-ing a pledget of cottonsaturated with a 10 percent solution of cocainjust within the vaginalopening for about eightminutes beforehand. Theintroduction is accom-plished by drawing backthe posterior vaginal walland then sl
Operative gynecology : . he foot, and to do this satis-factorily it is necessary to keep an assortment of different sizes on hand. Ifind that, as a rule, there is a tendency to use pessaries that are too long andtoo large. If it can notbe inserted without pain,it is best to use a packfor a short time. Thediscomforts caused by theintroduction of a pessarymay be lessened by plac-ing a pledget of cottonsaturated with a 10 percent solution of cocainjust within the vaginalopening for about eightminutes beforehand. Theintroduction is accom-plished by drawing backthe posterior vaginal walland then slipping in thepessary, coated with vase-line, with its long axis corresponding to the antero-posterior direction of theretracted vulvar orifice. Care must be taken to avoid rubbing the urethralorifice and the delicate anterior vulvar tissues. As soon as the pessary is withinthe vagina it is turned and pushed back with the finger until the cervix is feltto lie within the ring or in front of the posterior bar (see Fig. 99).. Fig. 99.—Hard Rubber Ring Pessary Lying at the VaginalVault Encircling the Cervix, and Serving to Limit theTendency to Descensus. PACKS. 183 Every woman who wears a pessary should use a douche at intervals of twoor three days, and it is often most conducive to cleanliness to remove it forthree or four days each month during the menstrual period. A pessary shouldnever be looked upon as a permanent fixture. Sooner or later it ought to beremoved, when it may be found that the patient does as well without it. Ifan operation is done to correct the displacement, the patient must be told thatthere is no further occasion for it, and she must dispense with it. Somewomen get coddled into the pessary habit, when their narrow lives circle aroundthe state of their pelvic organs and the mysterious action of the pessary, untiltheir condition becomes a sad one, for which, I am sorry to say, some physicianis usually responsible. I am very apt to break up such a state of thin
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