What is a pessary?

A pessary is a prosthetic device that can be inserted into the vagina to support its internal structure. It’s often used in the case of urinary incontinence and a vaginal or pelvic organ prolapse. A prolapse occurs when the vagina or another organ in the pelvis slips out of its usual place. The support a pessary provides can help a woman avoid pelvic surgery.

This device can also be used as a vessel for administering medication slowly.

A pessary needs to be fitted by a medical professional as they can cause vaginal damage and fail to improve symptoms if fitted incorrectly. A collapsed pessary is inserted into the vagina and put in place just under the cervix. Depending on the type of pessary used, it may be inflated using a bulb.

There are two main types of pessary: support and space-filling. They come in many different shapes and sizes to fit a woman’s individual anatomy. They are all usually made from medical-grade silicone, which makes them durable and resistant to absorption.

The most commonly used support pessary is the ring pessary with support. This is because it fits a large majority of women and can be used at all stages of pelvic organ prolapse.

The most commonly used space-filling pessary is the Gellhorn pessary. This has a broad base with a stem that comes in different lengths so that it will also be able to fit most women.

A pessary will be inserted by a medical professional, usually a gynecologist, in an initial fitting. They may need to try different styles and sizes to find the one that’s right for you.

Once you both feel the fitting is correct, they will give you training as to how to insert and clean the pessary by yourself.

You’ll return to the clinic a week later to check the device’s fit. The gynaecologist will remove the pessary so that they can examine the vagina for signs of irritation. They will then clean and replace it so long as all is well.

Usually, you’ll have further follow-up appointments two weeks and six months later, but some women may need to return more frequently. You’ll also be offered an annual examination of your vaginal wall.

Most women find they are able to successfully use a pessary for two years or more without requiring surgery for their condition.

There are sometimes mild side effects from pessary use, such as vaginal irritation, foul-smelling discharge, and urinary tract infections. However, because the pessary is removable, any side effects experienced can usually be corrected quickly.

It’s possible to have intercourse with a ring pessary in place, though most women prefer removing it for sexual activity.

If you are comfortable removing and reinserting your own pessary, you may remove the pessary once or twice a week. Once removed, clean it with mild soap and warm water and then rinse before replacing it. You doctor may prescribe a vaginal estrogen cream to apply inside your vagina while the pessary is out to prevent irritation.

Pessaries can fall out if you strain. If you can, try not to bear down during bowel movements. If the pessary does fall out, you can reinsert it after you clean it.

Many women find insertion easier when they are standing up with one foot resting on a stool. It’s important to use plenty of water-based lubricant for insertion.

If you aren’t comfortable removing and reinserting your own pessary, your doctor will set up follow-up visits for you to come and it done in the office. Frequency of visits can range from monthly to every three months, depending on your needs.

A pessary can occasionally cause some complications:

  • Foul-smelling discharge. This could be a sign of a condition called bacterial vaginosis, which is an imbalance in the natural bacteria found in your vagina.
  • Irritation and even damage inside the vagina.
  • Bleeding.
  • Passing a small amount of urine during exercise or when you sneeze and cough. This is called stress incontinence.
  • Difficulty having sexual intercourse.
  • Urinary tract infections. Initial signs of this may be difficulty urinating, feeling unwell, or a high temperature.

It’s important that you see your doctor if you develop any signs of these complications, as they are usually very treatable.

A pessary could be a good option for women with a pelvic organ prolapse, be it mild or severe. Many women like the idea of avoiding surgery, and most get used to a pessary very quickly. A few minor complications may occur, but when immediate help is sought from a doctor, these can usually be resolved quickly and easily.