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Table of Contents
Types and Uses
Sizing and Preparation
Possible Side Effects
A vaginal pessary is a soft, flexible device that supports pelvic structures and is usually used to treatpelvic organ prolapse, although it has a number of other benefits. The downside of a pessary is that it can cause pain and may interfere with sexual intercourse.
Different forms of pessaries have been used since ancient times. Today, most pessaries are made of medical-grade silicone and are durable, hypoallergenic, and relatively easy to insert and remove.
This article explains types of pessaries and their different uses, how to ensure it fits and is used properly, and possible side effects or complications of using a pessary.
Different types of silicone pessaries.Huckfinne / Wikimedia Commons
Most commonly, a pessary is a device that is used to support the pelvic floor and treat conditions likeurinary incontinence.
While pessaries are used mainly for these purposes, they can also deliver medications intravaginally. Even acervical cap, used to prevent pregnancy, can technically be considered a type of pessary.
Therapeutic Pessaries
Prolapseoccurs when a body part slips out of its normal position and protrudes into an adjacent structure. A pelvic organ prolapse is used to describe the protrusion of the pelvic organs—most commonly the bladder—through the vaginal opening.
For many women, a pessary is better than surgery to treat pelvic organ prolapse. Given that the surgical treatment of pelvic organ prolapse is associated with high rates of recurrence, pessaries offer a welcome alternative for most women.
Pelvic organ prolapse and urinary incontinence are closely linked, with around 40% of women with prolapse reporting stress incontinence (unintentional urination while coughing, sneezing, or heavy lifting).
To help relieve these and other conditions, pessaries are distinctly shaped to support the specific prolapsed structure. Among them:
A pessary cannot “cure” pelvic organ prolapse. It is a non-invasive technique used to avoid or delay vaginal surgery or when prolapse occurs during pregnancy.
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Pharmaceutical Pessaries
Pharmaceutical pessaries are solid, single-dose medications that are inserted into the vagina to treat local infections or other conditions.
Pharmaceutical pessaries are usually cone-shaped and made with a wax-like substance that dissolves at body temperatures, allowing for the gradual absorption of a drug into porous vaginal tissues. They are not unlike rectal suppositories that deliver drugs via the rectum.
One of the most common uses of a pharmaceutical pessary is to treat a severevaginal yeast infection. This type of pessary would contain a single dose of an antifungal drug (like clotrimazole) and be inserted before bedtime for easy overnight dosing.
There are also pessaries used to induce labor in women with prolonged pregnancy or thepremature rupture of membranes. The pessary contains the hormoneprostaglandin, which helps soften the cervix and induce contractions.
How Yeast Infections Are Treated
Occlusive Pessaries
A cervical cap, also known as FemCap, is a silicone device shaped like a sailor’s hat that is used in tandem with aspermicideto prevent pregnancy.
It is one of the least effective forms of contraception, and its use has dropped significantly given the superiority ofhormonal contraceptivesand intravaginal devices like thediaphragm.
Types of Barrier Contraceptives
Every vagina is different and requires a correctly fitted pessary to work well. The pessary should not only be comfortable but should not interfere with your ability to urinate. It should not fall out if you bear down or strain.
Therapeutic pessaries are fitted in a healthcare provider’s office. To get the correct size, the healthcare provider will first perform apelvic examand try several different sizes until the right one is found. The largest size you can wear comfortably is usually the best choice.
If a pessary is fitted correctly, the healthcare provider’s finger should pass easily between the pessary and the vaginal wall.
If a pessary is used to treat stress urinary incontinence, you may be asked to cough when the pessary is inserted and removed. The correctly fitted pessary will not fall out.
There are factors that can interfere with the proper fit, including:
A pessary usually requires an appropriate lubricant to help ease in the device. Postmenopausal women may be advised to use estrogen cream which helps relieve dryness and increase the thickness of the vaginal wall.
Your healthcare provider will show you how to insert the pessary correctly, but the procedure generally follows similar guidelines:
If you have trouble inserting a pessary when standing up or sitting down, try lying on your back with your knees bent.
Removing a pessary typically involves a simple reversal of steps. With most pessaries, you can latch your index finger under the rim to gently pry the device up. Inflatable pessaries require a deflation key or release valve.
Care and Safety
Before insertion, always wash your hands and the pessary with soap and warm water. You should also wash your hands before removing the device and give it a good wash, rinsing well and allowing it to air-dry.
Some pessaries can be left in for weeks at a time but never longer than three months.Others must be removed and cleaned nightly.
Pessaries can sometimes fall out during a bowel movement, especially if you are straining. If it does, remove it from the toilet and soak it in rubbing alcohol for 20 minutes and clean water for another 20 minutes before washing it with soap and warm water.
If you intend to insert and remove the pessary on your own, you will need to see your healthcare provider two weeks after your initial visit and every three months thereafter to ensure there are no ulcers or signs of vaginal erosion.
If there are signs of injury, you will need to stop using the device until fully healed. In some cases, you may be fitted with a smaller pessary.
Though effective, a pessary is not without its downside. If used appropriately, the risks are relatively low but may include:
Pessaries can also interfere with sexual intercourse and may even cause stress urinary incontinence, particularly if the device is ill-fitted.
Complications
The most common complications associated with a pessary include:
These problems are usually treated with antibiotics or estrogen cream. Your healthcare provider may recommend you stop using the pessary temporarily.
More concerning complications may include compromised vaginal tissues which can become vulnerable to infection, includingbacterial vaginosis (BV)andurinary tract infections (UTIs). Symptoms may involve:
Most infections occur when a pessary is left in for too long, is kept for longer than five years, or is not cleaned properly between uses. The risk also increases if you ignore signs of vaginal irritation or fail to see your healthcare provider for routine monitoring.
When to Call a Healthcare ProviderIf you experience any signs of a vaginal infection, call your healthcare provider immediately. The same applies if the pessary falls out and you are unable to replace it.
When to Call a Healthcare Provider
If you experience any signs of a vaginal infection, call your healthcare provider immediately. The same applies if the pessary falls out and you are unable to replace it.
Summary
A pessary is inserted into the vagina to support pelvic structures such as the bladder, uterus, and rectum and to prevent their protrusion into the vagina. They are made in a variety of shapes and sizes and can be an effective, non-invasive way to treat pelvic organ prolapse.
A pessary also refers to a device that delivers medication into your body via vaginal tissue.
In most instances, you will be able to insert and remove a pessary on your own at home. You do need to follow the instructions for cleaning and caring for the device.
Side effects are usually mild and include irritation. However, you may encounter more serious downsides such as interference with sexual intercourse and infection. See your doctor if you experience pain, unusual discharge, or odor.
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10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Chung SH, Kim WB.Various approaches and treatments for pelvic organ prolapse in women.J Menopausal Med. 2018;24(3):155-62. doi:10.6118/jmm.2018.24.3.155Costa J, Towobola B, McDowell C, Ashe R.Recurrent pelvic organ prolapse (POP) following traditional vaginal hysterectomy with or without colporrhaphy in an Irish population.Ulster Med J. 2014;83(1):16-21.Iglesia CB, Smithling KR.Pelvic organ prolapse.Am Fam Physician.2017 Aug;96(3):179-85.Atnip S, O’Dell K.Vaginal support pessaries: indications for use and fitting strategies.Urologic Nursing,2012;32(3):114-25.Zhou X, Li T, Fan S, et al.The efficacy and safety of clotrimazole vaginal tablet vs. oral fluconazole in treating severe vulvovaginal candidiasis.Mycoses.2016;59(7):419-28. doi:10.1111/myc.12485Thomas J, Fairclough A, Kavanaugh J, Kelly AJ.Vaginal prostaglandin (PGE2 and PGF2a) for induction of labour at term.Cochrane Database Syst Rev.2014 Jun;6:CD003101. doi:10.1002/14651858.CD003101.pub3Planned Parenthood.What is the difference between a cervical cap and a diaphragm?Tam T, Davies M.Pessaries for vaginal prolapse: Critical factors to successful fit and continued use.OBG Manag. 2013;25(12):42-59.Hsieh MF, Tsai HW, Liou WS, et al.Long-term compliance of vaginal pessaries: Does stress urinary incontinence matter?Medicine (Baltimore). 2019;98(14):e15063. doi:10.1097/MD.0000000000015063O’Dell K, Atnip S.Pessary care: follow up and management of complications.Urologic Nursing.2012;32(3):126-37,
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Chung SH, Kim WB.Various approaches and treatments for pelvic organ prolapse in women.J Menopausal Med. 2018;24(3):155-62. doi:10.6118/jmm.2018.24.3.155Costa J, Towobola B, McDowell C, Ashe R.Recurrent pelvic organ prolapse (POP) following traditional vaginal hysterectomy with or without colporrhaphy in an Irish population.Ulster Med J. 2014;83(1):16-21.Iglesia CB, Smithling KR.Pelvic organ prolapse.Am Fam Physician.2017 Aug;96(3):179-85.Atnip S, O’Dell K.Vaginal support pessaries: indications for use and fitting strategies.Urologic Nursing,2012;32(3):114-25.Zhou X, Li T, Fan S, et al.The efficacy and safety of clotrimazole vaginal tablet vs. oral fluconazole in treating severe vulvovaginal candidiasis.Mycoses.2016;59(7):419-28. doi:10.1111/myc.12485Thomas J, Fairclough A, Kavanaugh J, Kelly AJ.Vaginal prostaglandin (PGE2 and PGF2a) for induction of labour at term.Cochrane Database Syst Rev.2014 Jun;6:CD003101. doi:10.1002/14651858.CD003101.pub3Planned Parenthood.What is the difference between a cervical cap and a diaphragm?Tam T, Davies M.Pessaries for vaginal prolapse: Critical factors to successful fit and continued use.OBG Manag. 2013;25(12):42-59.Hsieh MF, Tsai HW, Liou WS, et al.Long-term compliance of vaginal pessaries: Does stress urinary incontinence matter?Medicine (Baltimore). 2019;98(14):e15063. doi:10.1097/MD.0000000000015063O’Dell K, Atnip S.Pessary care: follow up and management of complications.Urologic Nursing.2012;32(3):126-37,
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Chung SH, Kim WB.Various approaches and treatments for pelvic organ prolapse in women.J Menopausal Med. 2018;24(3):155-62. doi:10.6118/jmm.2018.24.3.155Costa J, Towobola B, McDowell C, Ashe R.Recurrent pelvic organ prolapse (POP) following traditional vaginal hysterectomy with or without colporrhaphy in an Irish population.Ulster Med J. 2014;83(1):16-21.Iglesia CB, Smithling KR.Pelvic organ prolapse.Am Fam Physician.2017 Aug;96(3):179-85.Atnip S, O’Dell K.Vaginal support pessaries: indications for use and fitting strategies.Urologic Nursing,2012;32(3):114-25.Zhou X, Li T, Fan S, et al.The efficacy and safety of clotrimazole vaginal tablet vs. oral fluconazole in treating severe vulvovaginal candidiasis.Mycoses.2016;59(7):419-28. doi:10.1111/myc.12485Thomas J, Fairclough A, Kavanaugh J, Kelly AJ.Vaginal prostaglandin (PGE2 and PGF2a) for induction of labour at term.Cochrane Database Syst Rev.2014 Jun;6:CD003101. doi:10.1002/14651858.CD003101.pub3Planned Parenthood.What is the difference between a cervical cap and a diaphragm?Tam T, Davies M.Pessaries for vaginal prolapse: Critical factors to successful fit and continued use.OBG Manag. 2013;25(12):42-59.Hsieh MF, Tsai HW, Liou WS, et al.Long-term compliance of vaginal pessaries: Does stress urinary incontinence matter?Medicine (Baltimore). 2019;98(14):e15063. doi:10.1097/MD.0000000000015063O’Dell K, Atnip S.Pessary care: follow up and management of complications.Urologic Nursing.2012;32(3):126-37,
Chung SH, Kim WB.Various approaches and treatments for pelvic organ prolapse in women.J Menopausal Med. 2018;24(3):155-62. doi:10.6118/jmm.2018.24.3.155
Costa J, Towobola B, McDowell C, Ashe R.Recurrent pelvic organ prolapse (POP) following traditional vaginal hysterectomy with or without colporrhaphy in an Irish population.Ulster Med J. 2014;83(1):16-21.
Iglesia CB, Smithling KR.Pelvic organ prolapse.Am Fam Physician.2017 Aug;96(3):179-85.
Atnip S, O’Dell K.Vaginal support pessaries: indications for use and fitting strategies.Urologic Nursing,2012;32(3):114-25.
Zhou X, Li T, Fan S, et al.The efficacy and safety of clotrimazole vaginal tablet vs. oral fluconazole in treating severe vulvovaginal candidiasis.Mycoses.2016;59(7):419-28. doi:10.1111/myc.12485
Thomas J, Fairclough A, Kavanaugh J, Kelly AJ.Vaginal prostaglandin (PGE2 and PGF2a) for induction of labour at term.Cochrane Database Syst Rev.2014 Jun;6:CD003101. doi:10.1002/14651858.CD003101.pub3
Planned Parenthood.What is the difference between a cervical cap and a diaphragm?
Tam T, Davies M.Pessaries for vaginal prolapse: Critical factors to successful fit and continued use.OBG Manag. 2013;25(12):42-59.
Hsieh MF, Tsai HW, Liou WS, et al.Long-term compliance of vaginal pessaries: Does stress urinary incontinence matter?Medicine (Baltimore). 2019;98(14):e15063. doi:10.1097/MD.0000000000015063
O’Dell K, Atnip S.Pessary care: follow up and management of complications.Urologic Nursing.2012;32(3):126-37,
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