What Is a Pessary?

A pessary is a device made of medical grade silicone that can be fitted inside the vaginal canal to help with the symptoms of Pelvic Organ Prolapse. They come is various shapes and sizes depending on the position of your pelvic organ prolapse and your activity levels. Some pessaries can be removed daily and others can be left in for up to 6 months.

A pessary can help with urinary incontinence and feelings of an uncomfortable heaviness inside the vagina. They can also give support to the vaginal walls during exercise and allow the pelvic floor to function better.

A pessary may also be used to alleviate symptoms of your pelvic organ prolapse if you are awaiting surgery.

What happens at a pessary fitting appointment?

Prior to booking in a Pessary Fitting Appointment, you will need to have already had an appointment with a women’s health physiotherapist to check that you are suitable for a pessary. If you are already seeing a women’s health physiotherapist or women’s health medical professional from another clinic, we will require a report from them prior to you attending the Pessary Fitting Appointment.

At your initial Pessary Fitting Appointment, your physiotherapist will want to fully assess you to make sure using a pessary will be suitable for you and to find out the best type of pessary to fit you with.

The appointment will take up to 1.5hrs.

You will be asked a number of health & medical questions including information about your symptoms and lifestyle.

Your physiotherapist will then want to assess your general movements, breathing, muscle activity of both your abdominal muscles and your pelvic floor muscles.

To do this, a vaginal examination is required to assess the strength and endurance of the pelvic floor muscles, as well as the level of prolapse present. During this examination, a speculum may need to be used to check the health of the vaginal walls and any atrophy (thinning) of the tissues as this may require you to have a course of vaginal oestrogen prior to the fitting.

Once the type and size of pessary has been decided, this will be fitted and checked for sizing and may take a few attempts to get the correct fit which can be uncomfortable. This will also be assessed in a standing position.

After the pessary has been fitted, you will be asked to walk about and to try and pass urine. If you participate in higher levels of activity, you may be asked to run, jump or lift weights so it can be advisable to bring your workout trainers with you.

If you are fitted with a removable pessary, you will be shown how to self manage, including how to remove and insert it yourself as well as cleaning regimes.

After the initial pessary fitting, we will book you in for a follow up after 2 weeks to have it checked. You will then be rebooked in after a further 4-6 months to have the pessary changed.

It is important to know that the fitting appointment is more of a pessary trial as not all women will tolerate the use of a pessary.

Please note: You will be charged on top of your appointment fee for any pessary trialled within the session.

What are the Complications / Side Effects of having a Pessary?

Pain or discomfort from the fitting - this can be checked at the 2 week follow up appointment.

Irritation to the vaginal tissues may lead to soreness and occasionally if the tissues are tight around the vaginal entrance, these may tear slightly during the fitting leading to small spots of blood after. This should heal in a few days.

If the vaginal tissues have become irritated, you may need to not use your pessary for a couple of weeks and use vaginal oestrogen during this time. If you are unable to use vaginal oestrogen due to breast cancer treatment, we can discuss vaginal moisturiser options with you.

Difficulty passing urine or bowel movements - if this occurs, the pessary may be too big. If you are self managing you can take out your pessary and wait for it to be refitted at your follow up appointment. If you have a pessary that is to be kept in, please call the clinic to book in an earlier appointment.

Increased discharge is common with a pessary but if this becomes discoloured or odorous, this may be a sign of infection and you will need to book in to see your GP or visit the Sexual Health Clinic.

What happens at the follow up appointment?

This appointment will take up to 45 minutes.

If this is the first time you have had a pessary fitted, your physiotherapist will ask you questions about how you are getting on with it and ask any questions you may have since the fitting.

Another vaginal examination will be performed and the pessary will be removed. This is to be able to check the vaginal tissues and make sure that the correct pessary and size has been fitted.

Your physiotherapist may also check any pelvic floor or core exercises they have given you to make sure you are still able to perform these with the pessary in place.

Frequently Asked Questions

Can I have sex with a pessary?

You can have sexual intercourse with certain types of pessary and this will be discussed with you at your fitting appointment. If you have a pessary that you are able to self manage, you can remove this prior to having sex.

Can I use a pessary if I am pregnant?

Only ring pessaries are to be used in pregnancy and this will be discussed with you at your appointment. Often prolapse symptoms decrease during the course of pregnancy but if you are using a pessary and become pregnant, please book in with your physiotherapist to discuss your options.

How do I clean my pessary?

If you are removing your pessary, it will need to be cleaned with soap and water then air dried to avoid tissue or towel particles to attach to the pessary as these can introduce infection. It is a good idea to sterilise your pessary once a month by boiling it in water for 5 minutes and leaving to air dry. You do not need to clean your pessary if you do not remove it.

Can I have a coil (IUD) fitted if I have a pessary?

You will need to remove or have your pessary removed if you are going to have a coil fitted. If you already have a coil in situ then you can have a pessary fitted with the coil in place.

Do I have to take my pessary out if I have a menstrual bleed?

If you are still having menstrual bleeds, depending on the type of pessary fitted, you may want to remove it during this time. If you have a pessary that you do not remove, such as a ring pessary, you can still use menstrual products such as tampons with this in place, although it may feel a little uncomfortable. If you are still having periods and having a pessary fitted, this will be discussed with your physiotherapist.

What happens if my pessary falls out?

This can happen if the pessary is too small. This is why we will ask you to do lots of different activities whilst you are still in the clinic. This can also occur from straining to open your bowels, leaning forward or lifting something heavy after you have left the clinic. If you have been shown how to insert your own pessary, you can clean it and reinsert it or a larger size can be fitted at your follow up appointment.