Skip to main content

Advertisement

Log in

Mechanical Characterization of Ring Pessary Folding

  • Original Article
  • Published:
Journal of Medical and Biological Engineering Aims and scope Submit manuscript

Abstract

Purpose

Understanding the mechanical properties of current pessaries is important to improve on existing designs and innovate on novel solutions. Our objective was to mechanically characterize the force required to compress ring pessaries into a folded shape. We hypothesized that the force required to fold ring pessaries would scale inversely with the diameter squared.

Methods

We conducted a compression test on ring pessaries to analyze their folding behavior using a mechanical universal testing system. Ring pessaries size #1 through #7 (diameters 50.1–86.7 mm) were placed in the testing platform in a vertical orientation with the bending axis in the horizontal plane. An axial load was applied to induce deformation.

Results

With application of an axial force, all pessaries first showed in-plane deformation followed by out-of-plane buckling. Increasing force resulted in a transition between in-plane deformation and out-of-plane buckling, during which the pessary began to fold, analogous to classic Euler buckling of columns. This transition was reflected in the loading curve as a sharp change in slope between the initial strain-softening region and a subsequent nearly horizontal plateau region. The force at the transition point ranged from 4.4 N for a size #7 pessary to 23.5 N for a size #1 pessary. The relationship between force and diameter at the transition point appeared to approximate a 1/L2 dependence, where L is the pessary diameter.

Conclusions

Pessary mechanics show buckling and folding behavior with a dependence on pessary architecture. The force required to fold ring pessaries scales inversely with the pessary diameter squared.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Availability of Data and Material

All data will be made available per request.

References

  1. Cundiff, G. W., Amundsen, C. L., Bent, A. E., Coates, K. W., Schaffer, J. I., Strohbehn, K., & Handa, V. L. (2007). The PESSRI study: Symptom relief outcomes of a randomized crossover trial of the ring and Gellhorn pessaries. American Journal of Obstetrics and Gynecology. https://doi.org/10.1016/j.ajog.2007.02.018

    Article  PubMed  Google Scholar 

  2. Clemons, J. L., Aguilar, V. C., Tillinghast, T. A., Jackson, N. D., & Myers, D. L. (2004). Patient satisfaction and changes in prolapse and urinary symptoms in women who were fitted successfully with a pessary for pelvic organ prolapse. American Journal of Obstetrics and Gynecology, 190(4), 1025–1029. https://doi.org/10.1016/j.ajog.2003.10.711

    Article  PubMed  Google Scholar 

  3. Cundiff, G. W., Weidner, A. C., Visco, A. G., Bump, R. C., & Addison, W. A. (2000). A survey of pessary use by members of the American urogynecologic society. Obstetrics & Gynecology, 95(6 Pt 1), 931–935. https://doi.org/10.1016/S0029-7844(00)00788-2

    Article  CAS  Google Scholar 

  4. Trowbridge, E. R., & Fenner, D. E. (2007). Practicalities and pitfalls of pessaries in older women. Clinical Obstetrics and Gynecology. https://doi.org/10.1097/GRF.0b013e3180d0a4ce

    Article  PubMed  Google Scholar 

  5. Jones, K. A., & Harmanli, O. (2010). Pessary use in pelvic organ prolapse and urinary incontinence. Reviews in Obstetrics and Gynecology, 3(1), 3–9. https://doi.org/10.3909/riog0110

    Article  PubMed  PubMed Central  Google Scholar 

  6. Weber, A. M., & Richter, H. E. (2005). Pelvic organ prolapse. Obstetrics & Gynecology, 106(3), 615–634. https://doi.org/10.1097/01.AOG.0000175832.13266.bb

    Article  Google Scholar 

  7. Robert, M., Ab, C., Schulz, J. A., Ab, E., Harvey, M.-A., & On, K. (2013). Technical update on pessary use. Journal of Obstetrics and Gynaecology Canada, 35(2947), 664–674.

    Article  Google Scholar 

  8. Cheung, R. Y. K., Lee, L. L. L., Chung, T. K. H., & Chan, S. S. C. (2018). Predictors for dislodgment of vaginal pessary within one year in women with pelvic organ prolapse. Maturitas. https://doi.org/10.1016/j.maturitas.2017.11.008

    Article  PubMed  Google Scholar 

  9. Clemons, J. L., Aguilar, V. C., Tillinghast, T. A., Jackson, N. D., & Myers, D. L. (2004). Risk factors associated with an unsuccessful pessary fitting trial in women with pelvic organ prolapse. American Journal of Obstetrics and Gynecology. https://doi.org/10.1016/j.ajog.2003.08.034

    Article  PubMed  Google Scholar 

  10. Atnip, S. D. (2009). Pessary use and management for pelvic organ prolapse. Obstetrics and Gynecology Clinics of North America. https://doi.org/10.1016/j.ogc.2009.08.010

    Article  PubMed  Google Scholar 

  11. Thakar, R., & Stanton, S. (2002). Management of genital prolapse. BMJ, 324(7348), 1258–1262. https://doi.org/10.1136/bmj.324.7348.1258.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Holubyeva, A., Rimpel, K., Blakey-Cheung, S., Finamore, P. S., & O’Shaughnessy, D. L. (2021). Rates of pessary self-care and the characteristics of patients who perform it. Female pelvic medicine & reconstructive surgery, 27(3), 214–216. https://doi.org/10.1097/SPV.0000000000001013

    Article  Google Scholar 

  13. Sasso, K., Hanson, L., & Smith, D. A. (2003). Case study: Challenges of pessary management. Journal of Wound, Ostomy and Continence Nursing, 30(3), 152–158. https://doi.org/10.1067/mjw.2003.123

    Article  Google Scholar 

  14. Bugge, C., Dembinsky, M., Kearney, R., & Hagen, S. (2021). Does self-management of vaginal pessaries improve care for women with pelvic organ prolapse? The BMJ, 372, 1–4. https://doi.org/10.1136/bmj.n310

    Article  Google Scholar 

  15. Barsky, M., Kelley, R., Bhora, F. Y., & Hardart, A. (2018). Customized pessary fabrication using three-dimensional printing technology. Obstetrics and Gynecology, 131(3), 493–497. https://doi.org/10.1097/AOG.0000000000002461

    Article  PubMed  Google Scholar 

  16. Deng, B., Raney, J. R., Tournat, V., & Bertoldi, K. (2017). Elastic vector solitons in soft architected materials. Physical Review Letters, 118(20), 204102. https://doi.org/10.1103/PhysRevLett.118.204102

    Article  CAS  PubMed  Google Scholar 

  17. Chem, B., Jiang, Y., Liu, C., Raney, J. R., & Reina, C. (2021). Dynamic behavior of soft, resonant metamaterials: Experiments and simulations. Journal of Applied Physics, 129(13), 135104. https://doi.org/10.1063/5.0042456

    Article  CAS  Google Scholar 

  18. Timoshenko, S. P., Gere, J. M. (1961). Theory of elastic stability (2nd edn.). McGraw-Hill.

  19. Gibson, L. J., & Ashby, M. F. (1997). Cellular solids. Cambridge University Press. https://doi.org/10.1017/CBO9781139878326

    Article  Google Scholar 

  20. Cacciari, L. P., Pássaro, A. C., Amorim, A. C., Geuder, M., & Sacco, I. C. N. (2017). Novel instrumented probe for measuring 3D pressure distribution along the vaginal canal. Journal of Biomechanics. https://doi.org/10.1016/j.jbiomech.2017.04.035

    Article  PubMed  Google Scholar 

  21. Guttormson, R., Tschirhart, J., Boysen, D., & Martinson, K. (2008). The Midwest Surgical Association are postoperative activity restrictions evidence-based? The American Journal of Surgery. https://doi.org/10.1016/j.amjsurg.2007.12.014

    Article  PubMed  Google Scholar 

  22. Pereira-Correia, J. A., Rosa, L. P. L., da Silva Costa, V. R., Berle, F. V. D., Werneck, B. M., dos Santos, K. P. R., de Sousa Araujo, G. B., de Carvalho Bittencourt Sodre, M. J., de Fassio, R. L. R., & Muller, V. J. F. (2018). Comparison of vesical pressure values achieved by Valsalva maneuvers: A standardization proposal. Neurourology and Urodynamics, 37(7), 2191–2194. https://doi.org/10.1002/nau.23558.

    Article  PubMed  Google Scholar 

Download references

Funding

This project was partially funded by Penn Health-Tech at University of Pennsylvania.

Author information

Authors and Affiliations

Authors

Contributions

CXH: project development, data analysis, manuscript writing/editing. MC: data collection, data analysis, manuscript writing/editing. HY: data analysis, manuscript writing/editing. EM: manuscript writing/editing. LAA: project development, manuscript writing/editing. JRR: project development, data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Christopher X. Hong.

Ethics declarations

Conflict of interest

Christopher X. Hong is a consultant/advisor for Cosm Medical Corp., Toronto, ON, Canada. All other authors disclose no conflicts of interest.

Ethical Approval

This study did not meet the criteria for human subject research and was thus exempt from Institutional Review Board review.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hong, C.X., Cioban, M., Yasuda, H. et al. Mechanical Characterization of Ring Pessary Folding. J. Med. Biol. Eng. 41, 343–349 (2021). https://doi.org/10.1007/s40846-021-00618-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40846-021-00618-y

Keywords

Navigation