Are Silicone Pessaries Safe? Complete Side-Effects and Safety Guide (2026)

Are silicone pessaries safe? Complete side-effects and safety guide

Silicone ring pessaries have decades of real-world safety data and are recommended as first-line non-surgical treatment for pelvic organ prolapse by ACOG (Practice Bulletin 214) and AUGS. This guide covers what's common, what's rare, when to call your provider, and how to keep long-term use safe.

TL;DR: Silicone ring pessaries are broadly safe for long-term use. The most common side effects are mild vaginal discharge and occasional odor (both easily managed with routine cleaning). Serious complications — vaginal erosion, urinary retention, embedded pessary — are rare (~1–3% at 5+ years) and almost always preventable with regular follow-up. The single most important safety rule: keep your follow-up appointments.

Direct answer: yes, silicone ring pessaries are safe

A silicone ring pessary is an FDA-cleared Class II medical device (HCPCS A4562, FDA Product Code HHN) that has been used clinically since the 1950s. Modern medical-grade USP Class VI silicone is well-tolerated by the vaginal tissue, latex-free, BPA-free, and does not release systemic hormones or medications. Nothing in the device is absorbed into your bloodstream.

Peer-reviewed data supports safety at both short-term and long-term horizons. The 2024 TOPSY randomized controlled trial (NCBI Bookshelf NBK603994) evaluated patient self-management of silicone pessaries and found that patients who cleaned and re-inserted their own devices had comparable safety outcomes to those managed in clinic — supporting the modern self-management model.

Primary sources: ACOG Practice Bulletin No. 214: Pelvic Organ Prolapse (2019, revised 2024); AUGS-SUNA Consensus Statement on Vaginal Pessary Use (2023); TOPSY RCT (2024); Int Urogynecol J silicone vs PVC RCT (2024).

Common side effects (most patients experience one or more)

Vaginal discharge

Common · 40–60%

A small amount of clear or milky discharge is normal, especially in the first few weeks. The pessary slightly increases baseline vaginal secretions. This is not an infection.

Management: Wear a panty liner if bothersome. Discharge that develops a strong fishy odor, greenish/yellowish color, or is accompanied by itching may indicate bacterial vaginosis (BV) or yeast — see your provider.

Mild odor

Common · 20–35%

Some patients notice a mild musky odor that improves with regular removal + cleaning.

Management: Remove and wash the pessary with mild soap + warm water once per week. Strong or fishy odor warrants a BV check.

Mild pressure sensation or awareness

Common · 15–25% in first 2 weeks

You may feel the pessary during the first few days as your vaginal tissue accommodates. This usually resolves within 1–2 weeks.

Management: Wait 1–2 weeks. If pressure persists past 4 weeks or feels sharp, the fit may be wrong — return for a re-size.

Difficulty removing at first

Common · 10–20% in first month

Learning to remove the pessary at home takes practice.

Management: See our removal guide.

Uncommon but manageable side effects

Bacterial vaginosis or recurrent yeast

Uncommon · 5–10%

Some patients develop recurrent BV or yeast, particularly post-menopausal patients.

Management: Topical vaginal estrogen dramatically reduces recurrent BV/yeast in pessary users. See our yeast prevention guide.

Constipation or bowel-emptying difficulty

Uncommon · 4–8%

Occasionally the pessary shifts and creates mild pressure on the rectum.

Management: Removing the pessary temporarily to allow evacuation is workable. If consistent → return for a re-size.

Urinary changes — new incontinence or difficulty voiding

Uncommon · 3–7%

Some patients notice new stress incontinence AFTER inserting a pessary ("occult" incontinence). Others may struggle to empty their bladder.

Management: For occult incontinence, a with-support pessary often resolves. For voiding difficulty, size adjustment usually fixes it.

Rare but serious complications (seek care)

When to seek immediate medical attention: Severe pelvic pain, heavy vaginal bleeding, inability to urinate for more than 4-6 hours, fever with pessary in place, or a pessary that has become embedded. Remove the pessary if you can and contact your provider or urgent care.

Vaginal wall erosion or ulceration

Rare · 1–3% at 5+ years

Prolonged pressure from a poorly-fit or infrequently-cleaned pessary can erode the vaginal mucosa. Post-menopausal patients on no topical estrogen are at higher risk.

Prevention: Regular follow-up (every 6 months), topical vaginal estrogen if post-menopausal, and pessary removal at prescribed interval. Erosion is almost always preventable.

Embedded pessary

Rare · <1% at 5+ years

A pessary left in place for many years without removal can become embedded in vaginal tissue. Almost always caused by patients who stop follow-up care.

Prevention: Follow the removal + cleaning schedule your provider prescribes. If you've had a pessary in place for more than 2 years without removal, contact your provider.

Urinary retention

Rare · 1–3% at initial fitting

A too-large pessary can compress the urethra and prevent bladder emptying.

Management: If you cannot pass urine for 4–6 hours after insertion, remove the pessary and return to your provider. You likely need a smaller size.

Fistula (extremely rare)

Very rare · <0.1%

A vaginal fistula from a neglected embedded pessary. Nearly always the consequence of years of neglect.

Prevention: Regular follow-up. This is essentially preventable.

Signs everything is going right

You should experience: No dragging heaviness, no bulge sensation, comfortable movement, normal urination and bowel movements, and — after the first 2 weeks — no awareness of the device during daily activity. Mild discharge is fine.

Signs to remove and call your provider

Call your provider within 24 hours if you experience:
  • Persistent pelvic or vaginal pain
  • Heavy or unusual vaginal bleeding
  • Foul-smelling discharge
  • Fever >100.4°F
  • Inability to empty your bladder
  • Persistent constipation
  • Skin irritation or new sores
  • New pelvic pressure
Immediate ER visit if: Severe pain, heavy bleeding, unable to urinate 6+ hours, or high fever with severe abdominal pain.

Contraindications — when NOT to use a pessary

  • Active vaginal or pelvic infection
  • Unexplained vaginal bleeding
  • Vaginal ulceration or open sores
  • Unwilling or unable to attend follow-up appointments — single biggest predictor of complications
  • Severe vaginal atrophy without topical estrogen
Ready to try a silicone ring pessary? $49.99 direct. FDA-cleared. HSA/FSA eligible.
Shop pessaries →

Long-term safety data

Silicone ring pessaries have been in clinical use since roughly the 1950s. Modern USP Class VI medical-grade silicone has been standard since the 1980s. Main long-term safety concerns — erosion, embedded devices, fistula — are almost always the consequence of stopping follow-up care, not device failure.

The 2024 TOPSY RCT specifically evaluated patient-managed silicone pessaries and found the safety profile comparable to clinic-managed care.

Follow-up cadence: Provider check-in at 2 weeks after initial fitting, 3 months, then every 6–12 months long-term.

Frequently asked questions

Is a silicone pessary safe to wear during sex?

A ring pessary without support can typically be worn during intercourse without removal. A ring with support membrane usually needs to be removed before sex.

Can I sleep with a pessary in?

Yes. Continuous wear including sleeping is normal.

Can I exercise, run, or swim with a pessary in?

Yes to all three. Chlorine and ocean water do not affect the silicone.

What if the pessary shifts or falls out?

Occasional shifting is normal. Consistent falling out → size is too small, return for a re-size. See our troubleshooting guide.

How often should I remove and clean the pessary?

Follow your provider's guidance. Common intervals: weekly, monthly, or every 3 months. The 2024 TOPSY RCT supports weekly patient self-management.

Is a pessary safe during pregnancy?

A pessary is sometimes used during pregnancy — only under provider direction. Do not self-fit during pregnancy.

Can a pessary affect my Pap smear?

The pessary is removed before Pap smear and re-inserted afterward. Does not affect results.

Is a pessary safe with an IUD?

Yes. Different anatomical planes, no interaction.

Any medications that interact with a pessary?

No. Silicone is inert. All medications are safe with a pessary in place.

Persistent odor or discharge — what should I do?

Persistent strong odor or unusual discharge warrants a same-week provider visit for BV or yeast culture.

How long can I safely use the same silicone pessary?

Typically 12–24 months. Replacement cost: $49.99 direct.

Is there any cancer risk from pessary use?

No. No established link between pessary use and cancer. Silicone is chemically inert.

📖 Related reading

Medical disclaimer: This page is for informational purposes only. Individual safety profiles vary. Consult your provider before starting or continuing pessary use. Frequency estimates are pooled from AUGS-SUNA 2023 Consensus, ACOG Practice Bulletin 214, and the 2024 TOPSY and Springer RCTs; your individual risk may differ.