The Use of The Pessary

New York, NY

Madam chairman, and friends. In Holland the particular method that is recommended there is the occlusive pessary. More than thirty five years ago at the medical congress of Amsterdam, the physicians decided that this subject of birth control was one that must be taught to their people if they would remain within their borders. At once the medical profession began to test out the use of a pessary. They have from that time on used and recommended what is called the Mensinga pessary, which has, I believe, seven sizes. It is a little different from the one used in England and also the one used in the United States. This is made of different material and different sizes. Altogether I have seen as many as fourteen different pessaries devised and effected in Holland. Now, the physicians soon came to recognize that it was quite necessary to take their time, to find a way to teach the woman who was normal the use of a pessary, and so Dr. Rutgers, who was most interested in this subject at that time, has instructed the nurses how to fit the pessary upon a normal woman who is not suffering from disease. It is most interesting to see these women come to these clinics and to be there and to witness the instruction. They are first taught to douche. A small syringe is used, and they are taught the use of this syringe. Next this pessary is inserted with soapsuds and is fitted. The nurse does this until she gets the correct size. When this round one does not fit, there is another kind which does fit almost always. You see what that does? It covers the whole wall. It is not like the small American pessary which I will show you later. That is the kind of pessary that is used in Germany, and in Austria, and in Holland.

This small pessary is the one that is used in France and now has been taken on in England.

My personal experience from women whose records I have is that this is the kind of pessary that accidents happen from. This can be pushed aside. It does not seem to have the same skin, and it does not seem to fit so well over the cervix as that other kind which is called here the "mizpah". The top comes off and seems to be a more practical kind.

This kind, the little one, the French pessary, has been used in France for many years, and of course there have been no records kept so you cannot tell how many times this has failed.

In England today this is the method being used there in the so-called mother clinics. In America we have the records of the 1250 families who have used methods successfully for at least one year; the pessary, 335 families have used the pessary followed by a douche, of which 265 have used the douche following the use of the pessary; the condom--355 people have used the condom successfully, and 171 of these people have followed the use of it by a douche; next on record is the suppository, 181 families have used suppositories, and 108 have followed it by a douche. The other methods that are here, an antiseptic douche, only 264 people. Most of us know that an antiseptic douche is not a preventative, but is a hygienic measure. Coitus interruptus , 175 families have used that method, 61 have followed by a douche.

This is recent information we have had of people in the United States who have used those methods and have been willing to give us the information.

As far as pessaries are concerned, I think that the kind used in Holland is the best. The records there for five years show that there were only 1% failure, and five years previously 3% were failure. But they claim that if a woman is normal, if her organs are normal, and if she is taught and knows how to insert a pessary, that this practice cannot fail.

Now, they do not advise the woman to leave this in the body only over night. The next day when the husband is gone and the children are out at school, the woman is advised to take a cleansing douche and to wash the pessary and put it away. The reason they like it best is because it is not expensive; the only cost is its first outlay. And before the war they had the right kind of rubber and it was supposed to last from three to five years, and the charges were something like a gilder or a gilder and a half, which meant about sixty cents. Altogether the pessary is considered in Holland and in France the most successful method of birth control. (applause)

THE CHAIRMAN: "I have asked Mrs. Sanger if this type of pessary was available in America. And she told me not this kind. In as much as this is the kind we are able to get in America, I would like to ask her if they use an ointment or something like it in connection with this."

MRS. SANGER: The idea is this. A little powder, any antiseptic dry powder in the cup before it is put on doubly secures against pregnancy, particularly if it is well fitted. That is always one reason why I have stood so definitely for the principle of birth control being disseminated by the medical profession. As a nurse myself, I know that all women are not alike, that they are different. That it means individual examination or individual instruction. And with powder placed in the cup before it is inserted, and with the woman taught how to insert it, we have had a great deal of success, and very few failures with the right kind of pessary.

QUESTION. "Will you kindly state what kind of powder?"

MRS. SANGER: Boric powder, and even bicarbonate of soda.