Am Fam Physician. 2000;61(9):2729
See related article on the pessary.
What is a pessary?
A pessary is a plastic device that fits into your vagina to help support your uterus (womb), vagina, bladder or rectum.
The pessary is most often used for “prolapse” of the uterus. Prolapse means that your uterus droops or tends to “fall out” because it loses support after you give birth or have pelvic surgery. This problem is usually fixed with surgery, but you can also use a pessary to help keep the uterus in place.
A pessary can help if you have a “cystocele” (when your bladder droops down into your vagina) or if you have a “rectocele” (when your rectum sticks up into the bottom of your vagina).
A pessary can also help many women with stress urinary incontinence (the leaking of urine when you cough, strain or exercise). Pregnant women with incontinence can also use a pessary.
What kind of pessary will I use?
Your doctor will decide which type of pessary you should use depending on the problem you have. The pessary has to be fit just right. There are no tools that can tell what the right size is. The pessary is fit by trial and error. It usually takes a few tries to get the right one.
After the first fitting, you'll need to go back to the doctor's office to have the pessary rechecked. Your doctor will probably check the pessary in a few days. After that you will probably be checked every few months. Sometimes the size or shape of the pessary will have to be changed.
How do I care for my pessary?
It's important that you follow your doctor's instructions about caring for your pessary. Most pessaries can be worn for many days to weeks at a time before they have to be taken out and cleaned with ordinary soap and water. You should be sure to keep your check-up appointments and clean the pessary as your doctor tells you.
Does the pessary cause any side effects?
You may notice more vaginal discharge than normal. Your vaginal discharge may also develop an odor. Certain vaginal gels can help with these side effects. Your doctor may or may not have you douche as well.
Vaginal irritation is another possible side effect. Women who are past menopause may need to use estrogen cream for the irritation.
Can the pessary get lost or fall out?
The vagina is a closed tube. The pessary can't go anywhere else inside the body. The pessary can fall out of the vagina if you strain or lift something. This usually means that your pessary is too small. Check with your doctor if your pessary keeps falling out.
What else should I know?
Many pessaries can be worn during intercourse—your doctor will tell you if you can't. Be sure to tell your doctor promptly if you have any discomfort with the pessary or if you have trouble urinating or having a bowel movement.