A pessary is a device that can help support the pelvic organs and hold them in place. A user inserts it through the vagina to manage symptoms of pelvic organ prolapse.
A pelvic organ prolapse occurs when the muscles and tissues that support the pelvic organs are no longer able to do so. This can happen because the muscles are damaged or weak.
A person can either use a pessary to treat pelvic organ prolapse or have surgery.
This article looks at the different types of pessary available, how to use them, and when to see a doctor.
There is a lack of evidence supporting the use of a specific type of pessary for certain types of prolapse.
Instead, doctors work with individuals to review options. From there, choosing a pessary is a process of trial and error, so it is important to tell a healthcare provider how the pessary feels and how well it works.
The type of pessary depends on the severity of a person’s prolapse, whether they have a uterus, their sexual activity, and urinary incontinence.
There are four stages of pelvic organ prolapse:
- Stage 1: This is a mild prolapse. The pelvic floor is still supporting the organs reasonably well.
- Stage 2: The organs remain inside the vagina but have begun to fall.
- Stage 3: The organs have fallen to or beyond the vaginal opening.
- Stage 4: The organs have completely fallen beyond the vaginal opening.
Most pessaries are silicone. This material stops the pessary from absorbing vaginal secretions, which prevents the vagina from drying out or developing odors.
Silicone may also make a pessary easier to clean.
Some specific types of pessaries include:
It is possible to wear support pessaries in most contexts, including during intercourse. According to a 2016 analysis, using a pessary does not adversely affect sexual function.
These work well for those who have stage 1 or 2 pelvic organ prolapse and include:
It is easy to insert but does not help with urinary incontinence.
A lever pessary works well for stages 1 and 2 prolapses, as well as for a retroverted uterus. It does not treat incontinence.
Gehrung pessaries can mold to the shape of the body. They work well for stages 1 and 2 prolapses but do not treat incontinence.
Designed for incontinence, this pessary works extremely well for stages 1 and 2 prolapses but less well for higher grades. It may migrate within the vagina.
A Marland pessary can treat incontinence.
Space-filling pessaries are ideal for treating higher grades of prolapse and incontinence.
These work well for those who have stage 3 or 4 pelvic organ prolapse and include:
These are ideal for those who are no longer sexually active. However, some people might find them difficult to remove. The pessary is concave and attached to a stem.
This pessary can relieve symptoms of cystocele and rectocele prolapses but is also difficult to remove. This pessary is the shape of a thick ring.
A person should take this pessary out during sex. Cube pessaries sometimes cause a bad smell. This pessary is cube-shaped.
A doctor or other healthcare provider can help with insertion instructions.
Insertion and removal
The correct way to insert a pessary varies from person to person.
Some may find it helpful to stand with one leg on a toilet or stool. It is also possible to insert a pessary while sitting or lying on the back with the legs spread.
Always wash hands before and after inserting the device. Fold the pessary in half and insert it back into the vagina as far back as is comfortable. The pessary will unfold into a supportive position.
To remove the pessary, wash hands and insert a finger into the vagina. Hook it under the pessary’s ring and gently tug. The pessary will fold slightly and come out.
If a person is concerned about removing a pessary, they can tie a long piece of dental floss to the pessary to help them pull it out.
A person can remove their pessary at their discretion. However, providers recommend that a person washes their pessary daily.
Use a mild soap and warm water, making sure to rinse away all the soap. Wait until the pessary is thoroughly dry before reinserting.
People should go to a doctor every 3–6 months to check for ulcers. If an ulcer has occurred, a person should not wear their pessary until it has healed.
When a pessary fits correctly, it should not hurt, and a person should not feel it.
The pessary does not fit if it:
- is painful or digs into the skin
- falls out
- twists or moves in the body
- interferes with urination or other normal functions
To check the fit, a doctor may suggest bearing down as if having a bowel movement. Pessaries that fit well should remain in place.
By keeping the pelvic organs in place, the pessary may ease symptoms of incontinence.
Some signs that a person might need a pessary include:
- incontinence, especially following childbirth or an injury to the pelvis
- unexplained pelvic pain
- changes in the internal shape of the vagina, such as being able to feel the cervix much lower than it used to be
- seeing the cervix or other parts outside of the vagina, especially when having a bowel movement
See a doctor for help with a pessary if:
- the pessary is painful, interferes with daily functioning, or falls out
- the pessary does not offer relief from prolapse symptoms
- the pessary smells bad
- there are signs of a vaginal infection such as pain, itching, or unusual discharge or odor
- a person cannot remove the pessary on their own
Pelvic organ prolapse is a serious medical problem that can cause pain. For those who want to avoid surgery or who are not eligible for surgery, a pessary can offer relief.
Using a pessary may require some practice. A person should keep trying if inserting the device is difficult at first.
It can take some trial and error to get the right fit and the right pessary, so communicate with a healthcare provider about the device, and be honest about any unpleasant symptoms or fit issues.