Pessary Care and Use

A pessary is a small, soft, removable device that is put inside your vagina. It's a nonsurgical way to treat pelvic organ prolapse (POP). POP occurs when one or more of the pelvic organs (the bladder, uterus, cervix, vagina, and rectum) slip out of their normal position. This happens due to weakened pelvic muscles. It can happen after pregnancy and childbirth. It can also be caused by getting older or being overweight. POP also runs in some families (inherited).

A pessary helps to support the weakened (prolapsed) pelvic organs. It eases the symptoms of POP. This device may be an option if you don’t want to have pelvic surgery for POP or if you can’t have surgery. It can also be a short-term treatment until you do have surgery.

Choosing a pessary

Pessaries come in many shapes and sizes. They are most often made of medical-grade silicone. The 2 main types of pessaries for pelvic organ prolapse are:

  • Support pessaries. These devices are an option for mild prolapse. A ring pessary is most often used. It's a ring shape with an open center.
  • Space-filling pessaries. These are an option if you have a more severe prolapse. A Gellhorn pessary is the type most often used. It's a closed circle with a stem sticking up in the center.

Your healthcare provider will help you find a pessary that is best for you. This will be based on the specific problem you are having. Your provider will do the first fitting of your pessary. They will do a vaginal exam to check the type of prolapse you have. They will also measure your vagina. You may need to try a few pessaries to find one that works well for you.

Some pessaries, like the ring, can be left in during sex, while others can’t. Let your provider know if you are sexually active. This will affect the type of pessary that is selected.

Caring for your pessary

Your healthcare provider will advise you how to care for, insert, remove, and clean your specific pessary. Some types of pessaries may need to be removed and cleaned every few months by your provider. Other types, such as the ring, are easy for you to remove and clean on your own. Follow any directions from your provider.

Inserting a ring pessary

Follow your healthcare provider’s specific directions for inserting, removing, and cleaning your pessary. In general, here is what you need to know for a ring pessary:

  1. Wash your hands and your pessary with soap and clean, running water.
  2. Find a position that is comfortable for you when inserting the pessary. You may want to stand and put 1 foot up on a chair. Or you can lie on your back on your bed, with your knees bent. Or sit on the edge of a chair.
  3. Fold the pessary in half. The curved part should be facing up. If you are using a lubricant, put a small amount on the edge of the pessary that will be going into your vagina first.
  4. Hold the folded pessary in one hand. Hold it vertically, so that the lubricated end is pointing up.
  5. With your other hand, use your index finger and thumb to gently spread open the lips of your vagina.
  6. Then place the folded pessary into your vagina. The part that is lubricated should go in first. Gently push the pessary in as far as you can. Then let go and remove your finger. The pessary will unfold and open up into its correct position.

Removing a ring pessary

  1. Wash your hands with soap and clean, running water.
  2. Find a position that is comfortable for you. You may want to stand and put one foot up on a chair. Or you can lie on your back on your bed, with your knees bent. Or sit on the edge of a chair.
  3. Place your index finger into your vagina. Put your finger through the center hole of the pessary and hook it around the rim of the device. Then pull the pessary out of your vagina.
  4. Wash your hands and your pessary with soap and clean, running water. Let the pessary air dry.

When to call your healthcare provider

Call your healthcare provider if you have any of these:

  • Bad-smelling vaginal discharge
  • Change in color of your vaginal discharge
  • Vaginal pain or irritation
  • Bleeding from your vagina
  • Trouble peeing
  • Trouble having a bowel movement
  • Trouble having sex
  • Your pessary falls out