Of all the options for managing pelvic organ prolapse, the pessary is the one patients have usually heard the least about, and the one that most often earns a "why didn't anyone tell me about this sooner". A pessary is a small, removable device worn inside the vagina to support the walls of the vagina or the uterus. Fitted well, it can take the dragging, bulging sensation of a prolapse from constant to barely-there, without surgery. Here's what they are, who they suit, and what actually happens at a fitting.
What is a pessary and how does it work?
Think of a pessary as scaffolding. Prolapse happens when the pelvic floor muscles and ligaments can no longer fully hold the pelvic organs in place; a pessary sits inside the vagina and physically supports those walls so the organs stop descending into the space. Modern pessaries are made from silicone, vinyl or latex, and come in many shapes. The Australian Commission on Safety and Quality in Health Care lists pessaries among the recommended non-surgical options for prolapse and notes they're safe for both short and long-term use.
A successful fit can improve prolapse symptoms and help bladder, bowel and sexual function. It doesn't cure the prolapse; take the pessary out and the support goes with it. For many women that trade is well worth it, whether as a long-term solution, a bridge while completing pelvic floor training, a way to stay active while deciding about surgery, or comfort through a pregnancy.
What types of pessary are there?
- Ring pessary: the most common starting point. A flexible ring (sometimes with a supportive membrane) that sits around the cervix or under the bladder neck. Easy to insert and remove, and can usually stay in during sex.
- Cube and Gellhorn pessaries: space-occupying designs used for more significant prolapse when a ring won't hold. These provide stronger support and usually need more hands-on management.
- Bladder-support pessaries: designed for stress urinary incontinence rather than prolapse, supporting the urethra during coughing, running and lifting. The Contiform we stock at Blossom Pelvic Health is in this category: it's a bladder-support pessary for stress incontinence symptoms, which often travel with prolapse, but it is not a prolapse device and isn't a substitute for a fitted prolapse pessary.
If you've been told to use a "pessary" and aren't sure which kind is meant, the word covers three unrelated things. Our guide to the three types of pessary: prolapse, continence and medication separates them.
Who fits a pessary, and what happens at the appointment?
In Australia, prolapse pessaries are fitted by a doctor, gynaecologist, or a pelvic health physiotherapist with pessary training. Fitting is not guesswork you do at home with an online size chart. The clinician examines you, assesses the type and grade of your prolapse, then trials a size and shape. You'll usually stand, walk, cough and bear down to check it holds without discomfort, and confirm you can pass urine with it in. It's normal to try a couple of sizes before landing on the right one, and a review visit is booked to check the fit and the tissue.
A well-fitted pessary shouldn't hurt. Most women can't feel it at all once it's in. If you can feel it, it moves, or it's uncomfortable, that's a fit issue to solve with your clinician rather than something to push through.
Do I need a pessary for my prolapse?
Not necessarily. Whether a pessary makes sense depends on your symptoms, prolapse type and grade, your goals, and what else is in your plan. Plenty of women manage well with exercise modifications and supervised pelvic floor training alone; others find the pessary is what lets them run, lift and chase toddlers while that strength work takes effect. It's a conversation for your pelvic health physio or gynaecologist, and the honest answer from an assessment beats any general rule we could print here.
Living with a pessary: care, sex and review
Management depends on the type. Many ring pessary users learn to remove, wash and reinsert their own device, anywhere from nightly to every few months per their clinician's advice. Space-occupying pessaries are usually managed at clinic reviews. Regular reviews matter because the vaginal tissue under a pessary needs periodic checking, particularly after menopause; your clinician may suggest topical oestrogen to keep tissue comfortable. Watch-and-report signs are new discharge, odour, bleeding or discomfort. Material sensitivities (for example latex allergy) are worth flagging before fitting.
If a pessary becomes part of your plan, keep the rest of the picture in view too: bowel habits that avoid straining (our guide to how to poo properly is the place to start), pelvic floor training if prescribed, and everyday comfort. You'll find the prolapse support products we stock useful alongside a plan, though none of them replace the fitting chair.
New to the topic and want the full picture first? Start with our cornerstone guide: Pelvic organ prolapse: what it is, what it feels like, and what actually helps. And for free phone advice, the National Continence Helpline is 1800 33 00 66.
