What Is a Pessary?

A pessary is a soft, removable medical-grade silicone device placed inside the vagina to provide structural support. Pessaries have been used safely for decades and remain one of the best first-line options for women who want non-surgical treatment.

Pessaries can be used to treat:

  • Pelvic organ prolapse — cystocele, rectocele, uterine or vault prolapse (see POP guide)
  • Stress urinary incontinence — certain pessaries support the urethra, reducing leakage with cough, laugh, and exercise (see SUI guide)
  • Combined prolapse and incontinence
  • Temporary support — for example, during pregnancy, before planned surgery, or while weighing options

Who Benefits Most

Women who want to avoid or delay surgery, who are not ideal surgical candidates, who are not yet done having children, or who prefer a reversible option. A pessary fits into daily life and can be used for years.

Types of Pessaries

There are many shapes and sizes — your fitting will determine which works best for your anatomy and symptoms.

Support Pessaries

  • Ring (with or without support) — most common; easy for patients to remove and reinsert
  • Ring with knob — for stress urinary incontinence; the knob sits under the urethra
  • Dish — supports early-stage prolapse

Space-Occupying Pessaries

  • Gellhorn — for moderate-to-advanced prolapse; excellent support, but usually removed in the office
  • Cube or donut — fills the vaginal space for severe prolapse; requires office management

The Fitting Appointment

A pessary fitting is an office visit with no incisions, no anesthesia, and no downtime. Plan on 30–45 minutes.

  1. History and exam — we confirm the type and stage of prolapse and whether stress incontinence is also present
  2. Measurement — the provider estimates vaginal length and width during a pelvic exam
  3. Trial of sizes — a pessary is placed, and you are asked to stand, walk, cough, and bear down to make sure the fit is comfortable and the device stays in place
  4. Voiding check — you empty your bladder with the pessary in to confirm you can urinate normally
  5. Teaching — if you prefer self-care, we show you how to remove, wash, and reinsert the device
  6. Follow-up plan — a 2-week check to confirm comfort, then a routine schedule

A Good Fit Means

You do not feel the pessary. It stays in during normal activity, including coughing, exercise, and bowel movements. You can empty your bladder comfortably. If any of these are off, we simply adjust size or style.

Daily Care & Maintenance

Good pessary outcomes depend on a simple routine. There are two options:

Self-Managed Pessary

  • Remove the pessary at home 1–3 times per week (or whenever comfortable)
  • Wash it with mild soap and warm water; rinse and pat dry
  • Reinsert after a rest period — a daily break overnight is ideal when possible
  • Use a small amount of water-based lubricant for comfort with insertion
  • Come in for a check-up every 6 months

Office-Managed Pessary

  • Come in for a visit every 2–3 months
  • We remove, clean, and reinsert the pessary
  • We perform a pelvic exam at each visit to check for irritation
  • Topical vaginal estrogen is often prescribed to keep tissue healthy

Topical Estrogen

In postmenopausal women, a small amount of topical vaginal estrogen dramatically improves tissue health, reduces irritation, and lowers the risk of pessary-related erosion. Ask us about this at your fitting.

What You Can Do With a Pessary In

A well-fitted pessary should be comfortable and let you live normally. You can:

  • Exercise, walk, run, swim, and do yoga
  • Have bowel movements (the pessary is not in the way of stool)
  • Have sexual intercourse with many pessary styles — ask your provider about yours
  • Shower and bathe

When to Call Us

Contact us if you notice any of the following:

  • The pessary falls out or no longer stays in place
  • New or persistent vaginal bleeding
  • Unusual discharge or odor
  • Pain, burning, or pressure that was not there before
  • Difficulty urinating or having a bowel movement with the pessary in
  • You cannot remove a pessary that you normally remove yourself

Most issues are minor and easily corrected with a size change, a different style, or the addition of topical estrogen.

Risks & Potential Problems

Pessaries are very safe, especially when maintenance is kept up. Potential issues include:

  • Vaginal irritation — often solved with topical estrogen and good hygiene
  • Increased discharge — mild and not harmful
  • Rubbing or erosion — small sores on the vaginal wall; heal with a break from the pessary and topical estrogen
  • Difficulty removing — usually corrected in the office
  • Neglected pessary — a pessary left in for years without care can become embedded; this is why regular follow-up is essential

Frequently Asked Questions

Can I sleep with my pessary in?

Yes — most patients keep a pessary in continuously and take it out a few times per week. A nightly rest is ideal if convenient but not required.

Can I have intercourse with a pessary?

Ring-style pessaries can be left in during intercourse; space-occupying pessaries (like Gellhorn or cube) should be removed. Your provider will tell you which applies to your pessary.

Do pessaries fix prolapse?

Pessaries relieve symptoms of prolapse while in place — they do not permanently reverse the anatomy. Symptoms return when the pessary is out, which is expected.

Can I use a pessary instead of surgery forever?

Absolutely. Many women use a pessary for years or indefinitely with excellent results. You can always choose surgery later if preferences or anatomy change.

Are pessaries covered by insurance?

Yes. Pessary fittings and devices are covered by Medicare and most insurance plans. Our team will verify your benefits.

A Simple, Safe, Non-Surgical Option

If prolapse or leakage is bothering you but you are not ready for surgery, a pessary may be the answer. We will find the right style and size, teach you how to care for it, and stay with you through follow-up.

  • ✅ In-office fitting — no incisions, no anesthesia
  • ✅ Many styles and sizes — individualized fit
  • ✅ Self-managed or office-managed schedule
  • ✅ Co-management with topical estrogen when appropriate
Schedule Your Fitting

Call 678-344-8900 to speak with our team