What Are Vaginal Pessaries?
A vaginal pessary is a soft, removable device that goes in your vagina. It supports areas that are affected by pelvic organ prolapse (POP). This happens when your pelvic floor is weakened and organs like your bladder, rectum, vagina , or uterus slip out of place .
A pessary can also help if you have stress incontinence, which causes you to leak pee when you cough, strain, or exercise. Women who have incontinence during pregnancy might find a pessary helpful, too.
What is prolapse? Pelvic organ prolapse happens when weakened tissues and muscles that usually support your pelvis cause organs to sag and drop or bulge. These organs can include your rectum, uterus, urethra, small intestine, vagina, or bladder. In milder cases, your organs drop. In more severe cases, your affected organs may bulge outside of your vagina.
There are different types of prolapses, including:
- Uterine prolapse (dropped uterus). Your uterus can drop down into your vagina when your pelvic floor becomes weaker.
- Cystocele or anterior vaginal wall prolapse (dropped bladder). Your bladder can bulge onto your vagina when pelvic floor muscles above your vagina are weakened. This is the most common type of pelvic organ prolapse.
- Rectocele or posterior vaginal wall prolapse (dropped rectum). Your rectum can bulge onto your vagina's back wall because of weakened pelvic floor muscles in between your vagina and rectum.
- Enterocele. Your small intestine can bulge onto the top or back wall of your vagina because of weak pelvic muscles.
Types of Pessaries
Most pessaries are made out of silicone – a harmless, soft, and nonabsorbent material. Types of pessaries include:
- Ringpessary. This circle-shaped device is often the first type of pessary doctors recommend. You can easily insert and remove it without a doctor’s help.
- Gehrungpessary. A U-shaped pessary that’s used for more advanced uterine prolapse, it is molded to fit its user.
- Gellhorn pessary. This disk-shaped device with a small knob in the middle is used for more severe prolapse.
- Cube pessary. This pessary is used for advanced-stage prolapse. It’s compacted down and inserted into the vagina, where it uses suction to support the areas affected by prolapse.
- Shaatz pessary. Shaatz pessaries are shaped like a disk (like the Gellhorn) but without the knob in the center.
- Lever pessary. Lever pessaries include Smith, Hodge, and Risser versions and are typically used for a retroverted uterus, often during pregnancy.
- Inflatable pessary. These pessaries are ideal for uterine prolapse and also in cases when you also have prolapse of another organ.
How to Insert a Pessary
Most pessaries require a fitting in your doctor's office to ensure proper placement. They’ll take measurements and fit you for one in their office. It’s important to get the right fit. If a pessary is too small, it can fall out. If it’s too big, you might feel too much pressure or discomfort. You may need more than one in-office visit to find the best pessary for you. Steps for the fitting usually include:
Pelvic exam. The length of the vaginal canal, the size of the vaginal opening, and your pelvic organs will all be checked by your doctor to help with choosing the correct pessary for you. Your doctor will also make the choice based on how severe your prolapse is.
Choice of type and size. The pessary that's best for you has to be the right size so that it doesn't fall out while you're peeing or cause discomfort. The right one will stay in and you won't be able to feel it when it's placed.
Placement. Your provider will insert the pessary and may use lubricant or lidocaine around your vaginal opening to be sure the process doesn't cause pain.
Test for function. To be sure your pessary is working the right way, your doctor may ask you to do certain activities like cough, sit, or squat. They'll also ask you to go pee, as your pessary needs to stay in place when you pee.
There are also pessaries that are available over the counter. These usually treat stress incontinence and can help support your urethra.
Downsides of Pessaries
There are some risks or complications of pessaries. They can lead to:
- Pain. This is usually caused by a pessary that's the wrong fit.
- Bleeding or discharge. Fluid or bleeding after placement of a pessary happens if the pessary rubs against your vaginal wall, which also means it's not the right size. Your doctor may recommend removing it and may prescribe vaginal estrogen to heal the affected skin.
- Vaginal infections. If you notice white discharge or fluid with an unpleasant smell coming from your vagina, this could be a sign of an infection, which will need to be treated with antibiotics.
Can a pessary affect bowel movements? If a pessary isn't the right fit, you may have constipation. And if you already have constipation, a pessary could make it worse.
Can a pessary cause lower back pain? Lower back pain or pressure can be a side effect of pessaries. Talk to your doctor if you have this symptom.
How to Care for Your Pessary
Be sure to follow your doctor’s instructions for how to remove and clean your pessary. If you have a type that you can remove on your own (such as the ring), remove it and clean it every night or every week. Use a mild soap with water. Rinse and dry the pessary completely before you reinsert it into your vagina.
If you have a type of pessary that you need your doctor to remove, like the Gellhorn, you’ll visit your doctor about every 1 to 3 months to have it taken out and cleaned.
How many years can you use a pessary?
If your pessary is the right fit, you can use it for many years. One small study showed some women were able to use their pessaries for more than 5 years.
Call your doctor if you have pain, discomfort, or pink or bloody discharge.
These could be signs that your pessary doesn’t fit right. You may need a different size. Blood may mean that the pessary is rubbing against the walls of your vagina. The area will heal when the pessary is removed.
When you have a pessary, you may notice a whitish discharge. This is normal. But call your doctor if the discharge changes color or smells bad. You may have an infection or vaginal irritation. Your doctor may prescribe an antibiotic or estrogen cream to help protect the skin in your vagina, which becomes thinner as you age.
What About Sex?
Other pessaries, like the Gellhorn and cube, fill the vagina. If you use one of these, you can’t have sex. Talk to your doctor if you plan to have sex. They’ll consider this when choosing the type of pessary that’ll work best for you.
When to See the Doctor
Call your doctor if you have symptoms like blood or bloody discharge, signs of an infection, or discomfort or pain from a pessary. They may recommend you come in for another fitting or prescribe an antibiotic.
If you have trouble with stress incontinence or prolapse, a pessary may be a good option to relieve your symptoms. Pessaries help support your pelvic organs that may slip into your vagina or can help keep you from peeing a little during certain actions like laughing, coughing, or exercising. If you have these conditions, pessaries can be a minimally invasive option, compared to surgery. Talk to your doctor about whether a pessary is right for you.
Vaginal Pessaries FAQs
- How long can a pessary be left in? The length of time you leave a pessary in depends on the type. Those that are harder to remove can be left in for months until time for cleaning at your doctor's office. If it's easier to remove, you might choose to remove and clean it every night or weekly.
- Can you pee with a pessary in? Yes, your pessary should stay in when you're peeing.
- Is it better to have a pessary or surgery? Talk to your doctor about which option is best for you. If your prolapse is more severe, a pessary may not work for you. Surgery is more invasive than a pessary but may provide a long-term fix.
- What does a pessary ring do? A pessary ring supports your pelvic organs if you have stress incontinence (peeing a little when you do certain things like laugh or exercise) or prolapse (your organ slips into your vagina and causes discomfort).
- Is it painful to have a pessary ring fitted? During your fitting, your doctor can use lidocaine or a lubricant to ease any discomfort.