My Pessary Won't Stay In — Troubleshooting Guide (2026)

A pessary that keeps slipping out is frustrating, uncomfortable, and can make you doubt whether pessary therapy is right for you. Good news: in 90% of cases, the pessary itself isn't the problem — the size or fit is. This guide walks through the 5 most common reasons a ring pessary won't stay in, how to diagnose which one applies to you, and what to do to fix it.

The 5 most common reasons a ring pessary won't stay in

Reason 1 (most common): The size is too small

Signs:

• Falls out during bearing down (bowel movement, cough, heavy lifting)
• Slips lower over the course of the day
• Falls out during exercise or physical activity
• You can insert one finger EASILY between the pessary rim and your vaginal wall (should be a snug fit, not loose)

Fix: Order the next size up. If you're currently on a size 3 (64 mm), try size 4 (70 mm). If size 4, try size 5 (76 mm). Sizes 3-5 fit about two-thirds of patients, so most size-up fixes fall within this range.

SciMed offers a 3-Size Right-Size Pack ($129.99) — 3 consecutive sizes to trial. Cheaper than 3 singles ($19.98 savings). Keep the fit as a spare, exchange the others via our 30-day free size exchange if you find the right size in a different pack.

Reason 2: The pessary is positioned wrong

Signs:

• Fits OK when you insert it but slips out within an hour
• You can feel it during normal walking (correct position should be undetectable)
• Discomfort concentrated at the vaginal opening rather than higher up

Fix: A correctly-positioned ring pessary sits with the FRONT RIM tucked behind the pubic bone, and the back rim in the posterior vaginal fornix (deepest part). If it's not tucked behind the pubic bone, it will slide out.

Reposition technique:

1. Wash hands, get into a comfortable position (squatting or one leg raised)
2. Insert one finger, feel for the front rim of the pessary
3. If the rim is at or below the pubic bone — push it UP and BACK until it tucks behind the pubic bone
4. Stand, walk, cough gently. If it still feels loose, the size is likely wrong.

Reason 3: You need the WITH Support version, not Without

Signs:

• Currently using Ring Without Support
• You also have stress urinary incontinence (leakage with cough/sneeze/laugh)
• You have cystocele (anterior vaginal wall bulge / bladder prolapse)
• Pessary sits fine but leakage isn't resolved AND the pessary sometimes shifts

Fix: Switch to Ring Pessary With Support ($49.99). The central membrane elevates the bladder neck, addresses cystocele, and often stays in place better because the membrane distributes pressure more evenly.

Reason 4: Recent anatomy change (weight loss, hormone therapy, surgery)

Signs:

• Pessary fit fine before, now suddenly slips
• You've lost 15+ pounds recently
• You started vaginal estrogen therapy (Estrace, Vagifem, Imvexxy) 3-6 months ago
• You had recent pelvic floor physiotherapy that strengthened muscles
• You had recent surgery (hysterectomy, colporrhaphy, etc.)

Fix: Your anatomy has genuinely changed — typically toward a smaller vaginal capacity. Order one size DOWN and retry. Vaginal estrogen restoration is a common cause of "my pessary suddenly slips" after 3-6 months of therapy — tissue thickens and the fit needs to be re-sized.

Reason 5: Wrong pessary type entirely

Signs:

• Multiple ring pessary sizes have failed to stay in
• Prolapse is severe (Stage III-IV) with significant tissue descent
• Ring pessary of any size falls out during minor exertion
• You've tried both With and Without Support versions

Fix: Return to your gynecologist or urogynecologist. You may need a different pessary type:

• Gellhorn pessary — mushroom-shaped, better retention for severe prolapse. Clinician-managed (removed and cleaned every 3 months in clinic).
• Donut pessary — solid donut shape, fills more of the vaginal space. Good for severe prolapse.
• Cube pessary — 6-sided cube with suction cups. Must be removed nightly. Good for post-surgical anatomy.

SciMed currently only stocks ring pessaries. If ring pessaries have failed, work with your provider to try a Gellhorn or cube through their clinical suppliers (Milex, Cooper Surgical, Bioteque).

Diagnostic flowchart — which reason applies to you?

What NOT to do when your pessary keeps falling out

• Don't force a size that's clearly too big. This causes vaginal ulceration and tissue damage.
• Don't use tampons alongside the pessary to "hold it in place." This creates infection risk.
• Don't wear a pessary you can't remove. If you can't remove it, contact your provider immediately.
• Don't give up on pessary therapy after one wrong size. 90% of "pessary failures" are size mismatches, not treatment failures.
• Don't try random household lubricants (petroleum jelly, coconut oil, olive oil) — these degrade medical-grade silicone. Only water-based lubricants.

When to see your healthcare provider (don't self-troubleshoot these)

• Vaginal bleeding or unusual discharge that doesn't resolve with cleaning
• Persistent pain (not just discomfort with wrong size)
• Inability to remove the pessary yourself
• Fever, chills, or systemic infection signs
• Visible tissue erosion or ulceration at the vaginal opening
• Multiple size and type failures despite following this guide

Frequently asked questions

Related reading

• Ring Pessary Size Guide — Sizes 0-9
• Complete Size Chart
• How to Insert a Ring Pessary
• Ring With Support Complete Guide
• Best Pessary for Menopause