A pessary is one of those medical devices that looks surprisingly simple but can make an enormous difference. Placed inside the vagina, it supports weakened pelvic tissues, reduces the sensation of pressure or bulging, and may help control stress urinary leakage. Think of it as a carefully fitted support system for pelvic organsnot glamorous, perhaps, but neither is a knee brace, and nobody complains when that keeps them moving.
Pessaries are available in multiple shapes and sizes because vaginas and pelvic floor conditions do not follow a one-size-fits-all instruction manual. The right device should feel comfortable, remain in place during ordinary activity, and improve symptoms without interfering with urination or bowel movements. This guide explains how pessaries work, how insertion and fitting are performed, common types, possible side effects, cleaning routines, and what everyday use may actually feel like.
What Is a Pessary?
A vaginal pessary is a removable medical device, usually made from flexible medical-grade silicone, that sits inside the vagina. It is most commonly used to manage pelvic organ prolapse or stress urinary incontinence.
Pelvic organ prolapse occurs when weakened muscles and connective tissues no longer adequately support structures such as the bladder, uterus, rectum, or upper vagina. As a result, one or more organs may descend and create pressure, heaviness, or a noticeable vaginal bulge. A pessary provides internal support and helps hold these tissues in a more comfortable position.
For stress urinary incontinence, certain pessaries support the bladder neck or urethra, reducing urine leakage during coughing, laughing, lifting, running, or sneezingthe body’s less-than-subtle ways of testing pelvic floor strength.
What a Pessary Can and Cannot Do
A pessary can relieve symptoms, improve bladder emptying in some patients, reduce urinary leakage, and make activities more comfortable. It may be used temporarily while waiting for surgery, during certain life stages, or as a long-term alternative to surgery.
However, a pessary does not permanently repair weakened pelvic tissues. Symptoms generally return when the device is removed. It also does not guarantee that prolapse will never progress, so follow-up examinations and pelvic floor care remain important.
Who May Benefit From a Pessary?
A clinician may recommend a pessary for someone who:
- Has a bothersome vaginal bulge, pelvic pressure, or heaviness.
- Experiences urine leakage during physical activity.
- Wants to avoid or postpone pelvic organ prolapse surgery.
- Cannot undergo surgery because of other health concerns.
- Wants symptom relief while completing childbearing or considering treatment options.
- Needs extra support during exercise or other specific activities.
Pessary use is a personal choice. Some people prefer the simplicity and reversibility of a nonsurgical device. Others try a pessary and later choose surgery. Neither decision earns a gold star; the best treatment is the one that safely matches the patient’s symptoms, health, and priorities.
How a Pessary Is Fitted
A pessary should initially be selected and fitted by an obstetrician-gynecologist, urogynecologist, nurse practitioner, or another clinician trained in pessary management. Buying a random size online and hoping for the best is not an ideal medical strategy.
The Pelvic Examination
The fitting appointment usually begins with a discussion of symptoms, medical history, sexual activity, bladder function, bowel function, and the patient’s ability or willingness to remove the device at home. A pelvic examination helps the clinician identify the location and severity of prolapse and assess the condition of the vaginal tissues.
Trying a Size and Shape
The clinician inserts a trial pessary and checks whether it supports the prolapse without causing pain or excessive pressure. The patient may be asked to stand, walk, cough, squat, bear down, or use the toilet. A good fit should remain in position while allowing comfortable urination and bowel movements.
The first pessary tested is not always the winner. Finding the correct device may require several sizes or styles. This is normal and does not mean the patient’s anatomy is being unusually difficult; it simply means anatomy declined to consult the product catalog.
Follow-Up After Fitting
Many clinicians arrange an early follow-up appointment to check symptom relief, vaginal tissue health, comfort, and the ability to remove and replace the pessary. Longer-term follow-up intervals depend on the device, the condition of the vaginal tissues, whether the patient performs self-care, and the clinician’s recommendations.
Common Types of Pessaries
Pessaries are generally divided into support devices and space-filling devices. Support pessaries are often easier to insert and remove. Space-filling models may provide stronger support for advanced prolapse but can require more assistance from a clinician.
Ring Pessary
The ring is one of the most frequently used styles. It resembles a flexible circular band and can be folded for insertion. A standard ring may work well for mild to moderate prolapse, while a ring with a supportive membrane can provide additional help for bladder or uterine prolapse.
Incontinence Ring or Dish
An incontinence pessary has a raised area that supports the urethra or bladder neck. It may be used for stress urinary incontinence alone or when leakage occurs along with prolapse.
Gellhorn Pessary
The Gellhorn has a broad base and a central stem. It is often used for more advanced uterine or vaginal prolapse. Because it creates stronger internal support, removal and reinsertion may be more difficult than with a ring.
Cube Pessary
A cube pessary has concave sides that create gentle suction against the vaginal walls. It can support significant prolapse but normally requires frequent removal. The suction must be released before removal to avoid injuring vaginal tissue.
Donut Pessary
The donut is a thick, rounded, space-filling pessary used for advanced prolapse. It can be effective but is relatively bulky and may need to be managed during office visits.
Gehrung Pessary
The Gehrung is a flexible, curved device sometimes selected for prolapse involving more than one vaginal compartment. Its shape can be customized, but insertion may require more practice.
No type is universally “best.” Selection depends on the prolapse pattern, vaginal anatomy, comfort, dexterity, sexual preferences, and whether the patient plans to manage the pessary independently.
How to Insert a Pessary
Insertion instructions vary by pessary type. Patients should follow the technique demonstrated by their healthcare professional. The following steps describe a typical foldable ring pessary, not every device on the market.
- Wash your hands. Use soap and water, rinse well, and dry your hands.
- Check the pessary. Look for cracks, tears, rough edges, or other damage.
- Choose a comfortable position. You may stand with one foot on a stool, sit on the toilet, squat, or lie down with your knees bent.
- Apply lubricant. Place a small amount of water-based lubricant on the leading edge. Avoid using an unapproved oil-based product because it may damage some materials.
- Fold the ring. Compress it into a narrow oval or taco-like shape. Finally, a taco comparison with medical value.
- Insert it gently. Separate the vaginal opening with one hand and guide the folded pessary inward and slightly backward toward the tailbone, rather than pushing straight upward.
- Release and position it. Allow the ring to open and gently push it farther into place as instructed. It should sit comfortably behind the pubic bone.
- Check the fit. Walk, cough, sit, and urinate. A properly fitted pessary should not cause sharp pain or feel as though it is immediately falling out.
How to Remove a Ring Pessary
Wash your hands, choose a comfortable position, and bear down gently if needed. Hook a finger beneath the edge, rotate or fold the ring slightly, and guide it downward and out. Do not yank, twist aggressively, or continue if removal causes significant pain.
Cube and other suction-style pessaries require a different technique. The suction must first be broken by gently pressing a finger between the pessary and the vaginal wall. Patients should receive hands-on instruction before attempting this at home.
Possible Pessary Side Effects
Most side effects are manageable, especially when the device fits correctly and receives regular care. Common issues include:
- Increased vaginal discharge.
- A mild change in vaginal odor.
- Minor spotting, especially during removal.
- Vaginal irritation or dryness.
- Pressure, discomfort, or pain from an incorrect fit.
- The pessary slipping down or falling out during a bowel movement.
- New difficulty urinating or emptying the bladder.
- Constipation or rectal pressure.
Vaginal Irritation and Erosion
Continued pressure can occasionally cause inflamed areas, abrasions, or ulceration of the vaginal lining. The risk may be higher when tissues are thin and dry after menopause or when a pessary is left without appropriate follow-up. Treatment may include temporarily removing the pessary, changing its size, treating an infection, or using clinician-prescribed vaginal estrogen when appropriate.
Infection and Serious Complications
Foul-smelling discharge, fever, pelvic pain, or persistent bleeding may indicate infection or tissue injury. Severe complications such as a deeply embedded pessary, fistula, urinary obstruction, or significant tissue damage are uncommon and are most often associated with prolonged neglect or lack of clinical monitoring.
Pessary Cleaning and Care
The ideal cleaning schedule depends on the pessary style and the treatment plan. Some patients remove a ring nightly or several times per week. Others leave it in place and return to a clinic periodically for removal, examination, and cleaning. Follow the schedule provided by your clinician rather than borrowing a routine from a stranger in an online forum.
Basic Cleaning Steps
- Remove the pessary using the method taught by your healthcare professional.
- Wash it with warm water and a small amount of mild, unscented soap.
- Rinse thoroughly so no soap remains.
- Allow it to air-dry or pat it dry with a clean towel.
- Inspect it for cracks, tears, distortion, or rough areas.
- Store it in a clean, dry container when it is not being worn.
Avoid bleach, rubbing alcohol, strong disinfectants, scented products, harsh cleansers, and very hot water unless the manufacturer and clinician specifically approve them. There is generally no need to douche or clean inside the vagina.
Vaginal Estrogen
For some postmenopausal patients with dryness, irritation, or fragile vaginal tissue, a clinician may recommend low-dose vaginal estrogen. It is not automatically necessary for every pessary user, and individual risks, symptoms, and medical history should be reviewed before treatment.
Do Pessaries Need Replacement?
A well-maintained silicone pessary may remain usable for years. Discoloration alone does not always mean it is damaged. Replacement is appropriate when the device develops cracks, tears, loss of shape, persistent odor that cleaning does not resolve, or no longer fits properly.
Sex, Exercise, Toileting, and Daily Activities
Whether intercourse is possible while wearing a pessary depends on the design. Some ring pessaries may remain in place comfortably, while Gellhorn, cube, donut, and other space-filling devices usually need to be removed. Patients should ask their clinician about their specific model.
A correctly fitted pessary should generally allow normal urination, bowel movements, walking, work, and exercise. If it repeatedly falls out during lifting, coughing, or defecation, the size or shape may need adjustment.
Managing constipation, avoiding repeated straining, maintaining a comfortable body weight, treating chronic cough, and performing recommended pelvic floor exercises can reduce pressure on weakened tissues. These measures complement pessary use, although they do not replace proper fitting and monitoring.
When to Contact a Healthcare Professional
Call your clinician if you develop:
- Persistent or increasing vaginal pain.
- Heavy bleeding or bleeding unrelated to menstruation.
- Fever or chills.
- Foul-smelling or unusual discharge.
- Difficulty urinating or inability to empty the bladder.
- Severe constipation or inability to pass stool.
- A pessary that is stuck, embedded, or impossible to remove.
- A device that repeatedly falls out.
- Cracks, tears, or sharp areas on the pessary.
Sudden severe pain, heavy bleeding, inability to urinate, or rapidly worsening symptoms require prompt medical assessment.
What Using a Pessary Often Feels Like: Practical Experiences
The first fitting is often less dramatic than patients expect. There may be pressure during insertion, but a properly sized pessary should not cause sharp pain. Many people notice an immediate reduction in the bulging or dragging sensation that had made standing, shopping, exercising, or finishing a workday uncomfortable.
The first device may not fit perfectly. A ring may slip when the patient coughs. A larger size may remain in place but create bladder pressure. Another style may support the prolapse beautifully but feel awkward during bowel movements. Pessary fitting is often a process of adjustment rather than a single magical appointment where trumpets play and the pelvic floor signs a peace treaty.
Learning self-insertion can also feel clumsy at first. Patients may struggle to keep a ring folded, use too much lubricant, or tense their pelvic muscles while trying to insert it. A different position often solves the problem. Some people find standing with one foot raised easiest, while others prefer lying down. With repetition, the process commonly becomes faster and less intimidating.
Removal may require even more patience. Bearing down gently can bring the device closer to the vaginal opening. Using a finger to hook the edge and folding the ring slightly usually helps. Keeping fingernails short can make the process more comfortable. When a device feels stuck, forcing it is rarely the winning move; a clinician can remove it safely and review the technique.
Increased discharge is another common experience. A small increase may be normal because the vagina recognizes that something is present. Panty liners may be useful, but strongly scented products can worsen irritation. A sudden foul odor, bleeding, pain, or a major change in discharge deserves medical attention rather than an experimental tour through the feminine-hygiene aisle.
Many users develop a simple routine. They keep mild soap, water-based lubricant, and a clean storage container together. They remove the pessary on scheduled days, inspect it, clean it, and note any spotting or discomfort. Travelers may pack these supplies in a small pouch along with their clinician’s contact information.
Intimacy requires honest communication. Some couples are comfortable with a ring left in place, while others prefer removing it. Space-filling pessaries are generally less compatible with intercourse. Discussing the device openly can prevent anxiety and help both partners understand that it is a medical support tool, not an unexpected houseguest.
Successful pessary use usually becomes pleasantly uneventful. The device should fade into the background while the patient returns to walking, exercising, caring for family, traveling, or working with less pressure and fewer leaks. That is the real goal: not to become fascinated by the pessary, but to think about it less because daily life feels easier.
Regular follow-up remains part of the experience even when everything seems fine. A clinician can detect irritation before it becomes painful, reassess the fit after weight or health changes, and determine whether the same device still meets the patient’s needs. Comfort today does not cancel maintenance tomorrow.
Conclusion
A pessary is a practical, reversible, and often effective option for managing pelvic organ prolapse and stress urinary incontinence. Success depends on selecting the correct type and size, learning safe insertion and removal, following an individualized cleaning schedule, and attending recommended follow-up visits.
Minor discharge or a brief learning curve may occur, but ongoing pain, bleeding, foul odor, urinary problems, or difficulty removing the device should never be ignored. With proper fitting and care, a pessary can provide long-term support without surgery and help patients return to ordinary activities with considerably less pelvic-floor drama.