Vaginal Pessaries for Pelvic Organ Prolapse

For many women living with pelvic organ prolapse, surgery can feel like a daunting prospect, or simply not the right option at this point in their lives. A vaginal pessary offers a safe, effective, and non-surgical alternative that can provide immediate relief from symptoms and allow women to get back to doing the things they enjoy. In this blog, Consultant Obstetrician and Gynaecologist Ms Charlotte Chaliha, explains how a vaginal pessary can help with prolapse, the different types of pessaries and on-going care.

>Article Summary: This guide explains what vaginal pessaries are, the different types available, what the fitting process involves, and how to manage one day to day.

What Is a Vaginal Pessary?

A vaginal pessary is a device, typically made from soft medical-grade silicone, latex, or vinyl, that is inserted into the vagina to provide internal support to the pelvic organs. Think of it as a brace for the pelvic floor: it holds the bladder, uterus, or rectum in their correct positions when the muscles and connective tissues that normally do that job have become weakened.

Pessaries have been used to manage prolapse for centuries and remain one of the most commonly recommended first-line treatments. They are suitable for women of all ages, can be used during and after pregnancy, and are particularly valuable for those who are not ready for surgery, wish to preserve fertility, or have medical conditions that make surgery higher risk.

Understanding Pelvic Organ Prolapse

Pelvic organ prolapse occurs when the muscles, ligaments, and connective tissues of the pelvic floor become too weak to hold the pelvic organs, the bladder, uterus, or rectum, in their normal positions. One or more of these organs can then descend into or through the vaginal canal.

Common causes include childbirth (particularly vaginal deliveries, prolonged pushing, or instrumental delivery), the menopause (when falling oestrogen levels lead to a loss of tissue strength and elasticity), ageing, chronic heavy lifting, obesity, and chronic constipation or straining.

Symptoms of pelvic organ prolapse typically include a sensation of heaviness, dragging, or pressure in the vagina or pelvis, a visible or palpable bulge at the vaginal opening, difficulty emptying the bladder or bowels fully, stress urinary incontinence, discomfort or pain during sexual intercourse, and lower back ache that worsens throughout the day.

The Benefits of Using a Pessary

For many women, a pessary offers a life-changing improvement in symptoms with minimal risk and no recovery time. The key benefits include:

• Immediate symptom relief: Many women notice a significant reduction in pelvic heaviness, urinary leakage, and discomfort as soon as the pessary is correctly fitted.
• A genuine non-surgical alternative: A pessary is ideal for women who want to avoid surgery, have not yet completed their family, or have health conditions that make surgery a higher-risk option.
• Support for pelvic floor rehabilitation: A pessary can work alongside pelvic floor physiotherapy, reducing the constant strain on weakened muscles and giving them the opportunity to strengthen.
• Active lifestyle: With the right pessary in place, many women are able to return to physical activities, including jogging and high-intensity exercise, that prolapse had previously made uncomfortable or impossible.
• Reversibility: Unlike surgery, a pessary can be removed at any time. It is a flexible solution that adapts to your circumstances and life stage.

Types of Vaginal Pessaries

Pessaries come in a range of shapes and sizes, designed to suit different degrees of prolapse and different anatomies. They broadly fall into two categories: support pessaries and space-filling pessaries.

The Fitting Process

Pessaries are not one-size-fits-all; finding the right type and size requires a professional assessment, and sometimes a little patience. The process typically works as follows:

• Pelvic examination: Your specialist will carry out a thorough pelvic exam to assess the degree and type of prolapse, the size and shape of your vaginal vault, and any other relevant factors that will guide the choice of pessary.
• Initial fitting: A pessary is selected and inserted. It should feel comfortable and remain securely in place without causing any pressure or pain.
• The walk test: After insertion, you will be asked to walk around, squat, and use the bathroom to confirm that the pessary stays in place, does not interfere with bladder emptying, and feels comfortable in motion.
• Trial and adjustment: It is entirely normal for it to take two or three attempts to find the right size and style. Each fit is assessed carefully before a final recommendation is made.

Day-to-Day Maintenance and Long-Term Care for vaginal Pessaries

The level of maintenance required varies depending on the type of pessary used. A ring pessary (with or without support) can remain in place for several months and typically it is advised to change these every 6 months. For women who are sexually active a removable pessary can be trialled.

There are removable pessaries that can be cleaned with mild soap and warm water, and reinserted weekly, or left in place for

Follow-Up Appointments 
Regular follow-up is important. Most women are seen every three to six months initially, with appointments extending to annually once a stable, well-tolerated fit has been established. At each visit, your specialist will inspect the vaginal walls for any signs of irritation, rubbing, or injury, and check that the pessary remains the right size, as the vaginal anatomy can change over time.

Vaginal Health
Many specialists prescribe a topical oestrogen cream to use alongside a pessary, particularly for post-menopausal women. Oestrogen supports the health and resilience of the vaginal tissue, reducing the risk of irritation or ulceration from the device and making the pessary more comfortable to wear long-term.

Potential Risks and What to Watch For

When fitted and maintained correctly, pessaries are very safe. Some side effects are normal and expected; others are signs that something needs to be reviewed.

Normal and expected: A mild increase in vaginal discharge, typically white or clear,  is common and not a cause for concern.

Contact your specialist if you notice:

• Foul-smelling discharge – this may indicate infection and requires prompt assessment
• Pink or bloody discharge – which can be a sign of ulceration or rubbing against the vaginal wall
• Difficulty passing urine – which may suggest the pessary has shifted or is the wrong size
• Pain or discomfort – a well-fitted pessary should not be painful; discomfort usually indicates an incorrect fit

Pessary vs Surgery: How Do They Compare?

For many women, the choice between a pessary and surgery is not a straightforward one, and it does not have to be made urgently. Here is how the two approaches compare:

Special Considerations for Vaginal Pessaries

Sexual Activity: Sexual intercourse is often possible with a ring or Shaatz pessary left in place. Space-filling types, such as the Gellhorn or cube pessary, will need to be removed before sex and reinserted afterwards. Your specialist will discuss what is most appropriate for your individual circumstances and lifestyle.

Self-Management: Many women learn to insert and remove their own pessary at home, particularly with a ring pessary, and this can significantly improve quality of life by reducing the need for clinic visits. Your specialist or a specialist nurse can teach you the technique, and most women find that it becomes quick and straightforward with a little practice.

Lifestyle Measures That Help: A pessary works best as part of a broader approach to pelvic health. Maintaining a healthy weight, treating constipation, avoiding heavy lifting where possible, and committing to a programme of pelvic floor exercises will all support the effectiveness of a pessary and help prevent prolapse from worsening over time.

A Practical Solution That Puts You in Control

A vaginal pessary is not a compromise; it is a well-established, clinically proven treatment that gives many women their lives back without the need for surgery. Whether you use one short-term while building pelvic floor strength, or as a long-term management strategy, it is a flexible and effective option that deserves far more attention than it typically receives. If prolapse symptoms are affecting your daily life, asking about a pessary at your next appointment is a very good place to start.