A Comprehensive Guide to Vaginal Pessaries

Finding yourself dealing with unexpected leaks when you cough or laugh? Maybe you have that uncomfortable feeling of pressure down below, like something is shifting or falling? If this sounds familiar, you're not alone. Pelvic health challenges like stress incontinence and pelvic organ prolapse (POP) are incredibly common for women, often affecting daily life and confidence.

The good news? There are effective ways to manage these symptoms, and not all of them involve surgery. One fantastic option that many women find relief with is a vaginal pessary.

What Conditions Do Pessaries Help With?

Pessaries are primarily used to manage symptoms related to two common pelvic health conditions:

• Pelvic Organ Prolapse (POP): This happens when the muscles and tissues supporting your pelvic organs (like the uterus, bladder, rectum, small intestine, or vagina) weaken. As a result, these organs can sag or bulge into the vagina. Causes can range from pregnancy and childbirth to heavy lifting and aging. The main symptom pessaries help alleviate is that feeling of fullness or a bulge in the vagina.
• Stress Incontinence: Urine leaks involuntarily when pressure is applied to the bladder, which frequently happens when you cough, sneeze, laugh, exercise, or lift a heavy object.

For many women, a pessary is chosen because they want symptom relief without undergoing surgery. It can also be a good option if you have health conditions that make surgery risky, or sometimes, after other treatments like pelvic floor exercises (Kegels) haven't been enough.

Exploring the Different Types of Pessaries 

Given the unique anatomy of each woman, pessaries vary in a wide variety of forms and sizes. The majority are composed of pleasant, long-lasting, soft, nonabsorbent silicone.

In general, they can be divided into two groups: space-filling pessaries and support pessaries.

• Ring Pessary: This is often the first type doctors recommend. The ring pessary is great for stress incontinence and mild to moderate POP. Many women find it easy to insert and remove on their own for cleaning, and some can even leave it in during sexual intercourse if it's comfortable.
• Gellhorn Pessary: This type is typically used for more advanced POP. It's a space-filling pessary, shaped like a disk with a knob in the center. Because it fills the vaginal space, it usually needs to be removed for sex, and often requires a healthcare provider to remove and clean it during office visits.

The Fitting Process: Finding Your Best Fit

Getting a pessary isn't a one-size-fits-all situation. It's super important that a medical professional fits your pessary to your specific anatomy and needs. If it's not fitted correctly, it might not help your symptoms or could even be uncomfortable.

Here's a peek at what happens during a fitting appointment:

• Your provider will do a pelvic exam to check your vaginal anatomy (like the size of your opening and length of the canal) and assess how severe your prolapse is.
• Based on the exam, they'll figure out the best type and size of pessary for you. The goal is one that's large enough to stay put (even when you cough or pee) but comfortable enough that you shouldn't even feel it once it's in place
• They'll gently insert the chosen pessary. They might use lubricant to make it easier, or even a numbing gel like lidocaine if you're worried about discomfort. Speak up about what feels comfortable or if something hurts.
• Once it's in, they'll "test" the fit. They might ask you to stand up, sit, squat, or cough to make sure the pessary stays where it should. They'll also have you try to urinate to confirm you can empty your bladder with it in.

Now, here's a really important insight: finding the right fit can often take more than one attempt. It's not uncommon to need two or three fitting appointments to get the size and shape just right. This "trial and error" phase can sometimes feel a little frustrating, but patience and open communication with your provider are key. They are working with you to find the perfect device

Caring for Your Pessary: Daily Living and Maintenance

How you care for your pessary depends on the type you have and whether you're comfortable managing it yourself. Some women remove and clean their pessary regularly (like the Ring), while others need their healthcare provider to do it during scheduled visits (like the Gellhorn).

• If you can take care of your pessary on your own, this is what care looks like:
• Whenever you touch your pessary, always wash your hands with soap and water beforehand.
• It is usually removed by hooking a finger to the rim just under your pubic bone, tilting it slightly, and then gently pulling down and out. Bearing down (like you're having a bowel movement) can sometimes help push the rim forward to make it easier to grasp.
• Cleaning is simple: use mild soap and warm water, then rinse and dry it completely. Since pessaries are silicone, they don't absorb odors or secretions.
• For insertion, you might fold the pessary (like a "taco"), use plenty of water-soluble lubricant, and try different positions that feel easiest for you, like squatting, standing with one foot up, or sitting. Gently push it back as far as feels comfortable.
• You can clean and reinsert your pessary weekly or even nightly if you prefer. Some women like to remove it at night and sleep without it.

You might notice an increase in vaginal discharge when using a pessary. Whitish discharge is typically normal.

Your provider might also recommend using low-dose vaginal estrogen cream. This is especially helpful as we age because vaginal tissues can thin. The estrogen helps keep the tissues healthy and can prevent irritation or damage from the pessary rubbing.

Potential Side Effects and What to Watch For

Pessaries are generally safe and carry minimal risks compared to surgery. However, like any medical device, they can sometimes cause side effects.

Common mild side effects include:

• Vaginal irritation
• Increased vaginal discharge (remember, some increase is normal!)
• Foul-smelling vaginal discharge
• Urinary tract infections (UTIs)

It's really important to pay attention to your body and know when to reach out to your healthcare provider. Make a quick call to them if you see any of these possible problems:

• Pain or discomfort: This is often the main sign that the pessary doesn't fit correctly and you likely need a different size.
• Pink or bloody discharge or spotting: This could indicate that the pessary is bruising or scraping on the wall of your vagina. You'll likely need a refitting or temporary removal to let the tissue heal.
• Unusual or foul-smelling discharge: While some discharge is normal, a bad odor can signal an infection, like bacterial vaginosis. This needs treatment, often with antibiotics.
• Symptoms of a UTI: Like difficulty urinating, feeling unwell, or a high temperature.
• The pessary is still falling out or you're having persistent stress incontinence: This means the pessary might not be effectively doing its job, or the fit isn't right.
• Difficulty with sexual intercourse: This might indicate the need for a different type of pessary or suggest a fit issue.

The good news is that when these issues are caught early, they are usually very treatable and can be corrected quickly. Don't hesitate to call your doctor!

Pessary vs. Surgery: Weighing Your Options

Pessaries and surgery are intended to alleviate the symptoms of POP and stress incontinence. Deciding which is best for you is a conversation to have with your doctor, as both have pros and cons.

• Pessary Advantages: It's non-invasive, relatively inexpensive, and safe with very minimal risks. It's a great way to see if symptom relief is possible without committing to surgery.
• Surgery Advantages: For severe prolapse where a pessary isn't working well, or if you prefer a potentially more long-term fix, surgery might be a better option. If you can't manage the required follow-up appointments for pessary care (either self-managed or provider-managed), surgery might also be more practical. Some studies suggest surgery might offer more long-term satisfaction for advanced POP.

Ultimately, the best choice depends entirely on your individual health, lifestyle, the severity of your condition, and your personal preferences. Your healthcare provider can help you carefully weigh the benefits and risks of each approach.

Where to Get a Pessary

If you and your healthcare provider have decided that a pessary is the right option for you, the next step is to find a reliable source to obtain one. Pessaries are considered advanced medical equipment and should be sourced from reputable providers to ensure quality and safety.

You can get a pessary through the following:

1. Your Gynecologist or Urologist

Most women receive their first pessary directly from their healthcare provider after a professional fitting. Clinics and hospitals often have access to trusted medical equipment suppliers and can order the correct type and size based on your individual needs.

2. Authorized Medical Equipment Suppliers

There are numerous medical equipment suppliers—both local and online—that specialize in pelvic health products. Look for suppliers that are certified and experienced in providing advanced medical equipment, particularly those who carry a range of pessary options like ring pessaries, Gellhorn, or cube pessaries. This ensures better chances of finding the right fit.

3. Medical Accessories Suppliers Online

If you're looking for convenience or need a replacement pessary, several medical accessories suppliers offer discreet shipping and clear instructions for use. However, always ensure that you’ve been properly fitted by a healthcare professional before ordering a pessary online.

Tips for Buying:

• Always verify that the supplier is reputable and offers FDA-approved or CE-marked products.
• Choose suppliers that specialize in women’s health or urological products.
• Avoid purchasing pessaries second-hand or from unverified marketplaces.

Taking control of your pelvic health begins with choosing the right support, and sourcing it from trusted medical accessories suppliers ensures safety, hygiene, and peace of mind.

Conclusion: Taking Control of Your Pelvic Health

Living with symptoms of pelvic organ prolapse or stress incontinence doesn't have to be your normal. Vaginal pessaries offer a safe, non-surgical, and effective way to find relief for many women.

They are a safe and viable treatment option that can truly improve your quality of life.

If you're experiencing symptoms that are impacting your daily life, please know that help is available. Talking to your healthcare provider is the best first step. They can help determine if a pessary could be the right solution, tailored just for you.

FAQs

1. What is a vaginal pessary?

A vaginal pessary is a soft, removable device inserted into the vagina to support pelvic organs and relieve symptoms of prolapse or stress incontinence without surgery.

2. What is the downside of a pessary?

While effective, pessaries can cause vaginal irritation, increased discharge, or infections if not cleaned regularly or fitted properly. Some women may also find insertion and removal challenging.

3. What are the disadvantages of a pessary?

Disadvantages include the need for ongoing maintenance, potential for discomfort or improper fit, sexual interference with some types, and occasional side effects like odor or urinary infections.

4. Can a pessary help heal a prolapse?

A pessary won’t “heal” a prolapse, but it can manage symptoms and prevent worsening. It provides structural support, easing pressure and allowing women to avoid or delay surgery.

5. What not to do when wearing a pessary?

Avoid skipping follow-up visits, neglecting cleaning routines, using harsh soaps, or ignoring signs of irritation or pain. Also, don’t use oil-based lubricants—they can damage silicone pessaries.