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Pessary

A pessary is a vaginal device, most commonly made of a soft material called silicone, that fits into your vagina and supports the bladder, vagina, and uterus or rectum. Pessaries come in many shapes and sizes. Your doctor or nurse practitioner will fit the appropriate pessary for you.

Pessaries may be used for the treatment of pelvic organ prolapse (POP). Some pessaries can be useful for the treatment of incontinence. Sometimes, pessaries are used for short-term relief until surgery is scheduled or to see how the bladder behaves with additional pelvic support.

Using a pessary

  • When you first get your pessary, you will be asked to come back for a checkup within a few weeks, and then every few months thereafter.
  • You can wear your pessary for days or months at a time before it needs to be removed and cleaned. Some women take care of the pessary themselves, while other women prefer to have the pessary managed by a health care provider.
  • If your pessary falls out, it may mean it was too small. Ask your doctor for a refitting if this continues to happen.

If you care for your pessary yourself

  • You will be taught to remove it.
  • You should remove and clean the pessary every two weeks.
  • You should keep it out overnight.
  • Contact your provider if you have any trouble inserting or removing your pessary, or if you notice any vaginal bleeding, or abnormal discharge.

Seeing your health care provider for your pessary

  • If you are not managing your pessary on your own, you should see your provider regularly.
  • The pessary will be checked to make sure it is giving you good support and is not causing any injury to the vaginal tissue.
  • At each visit, your pessary will be removed and cleaned, your vaginal tissue will be inspected, and the pessary will be reinserted.
  • It is very important to follow the instructions about when to return to have your pessary checked.
  • At first you may need to return to the clinic more often, although we will gradually increase the time between your visits; however, you should never go longer than four to six months between visits.

How do I know the pessary is working?

  • You should not be aware of the pessary once it is in place.
  • You should be able to attend to your normal activities without discomfort.
  • The pessary should provide support of your weak tissue without causing you any pressure or pain.
  • If the pessary is took big, you will feel some pressure or have some discomfort.
  • If the pessary is too small, it may not provide enough support or may move out of position or fall out with a hard strain or activity.

Do I need estrogen?

  • We may suggest that you use vaginal estrogen. This comes in a cream, tablet, or in a vaginal ring.
  • Vaginal estrogen can help prevent irritation or breakdown of the vaginal tissue.
  • Vaginal estrogen can help increase vaginal lubrication and elasticity, which may also make the removal and insertion of the pessary more comfortable.

Sexual activity and the pessary

  • Some women are able to have intercourse with the pessary in place, while other women find it uncomfortable.
  • We encourage women who want to have intercourse to learn how to manage their pessary on their own so that they can remove it if necessary.

Major risks

The only major health risk of the pessary is if the pessary is not checked at regular intervals. There are rare reports of pessaries disturbing the vaginal skin and pressing into the surrounding structures, such as the rectum or bladder. With regular checks, this should not be a risk.

Minor risks

  • Difficulty voiding, not emptying your bladder
  • Increase in urine leakage
  • Minor breakdown of the vaginal tissue, inflammation
  • Vaginal bleeding

Please call immediately if you:

  • Are unable to urinate
  • Are unable to have a bowel movement
  • Have vaginal or rectal pain or pressure
  • Have vaginal bleeding or spotting
  • Have severe odor or discharge

If the pessary falls out, you can call to get it replaced or refitted.

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