Pessaries Explained: What they are, how they work and what to expect

Vaginal support pessaries are a conservative, non-surgical option that can be very effective for managing certain pelvic health symptoms.

This page explains what pessaries are, who they may help, how fitting works, and what ongoing management looks like, so you can decide whether a pessary might be right for you.

As with all pelvic health physiotherapy care, pessary use is optional, guided by your preferences, and tailored to your symptoms and lifestyle.

What is a pessary?

A pessary is a small, removable medical device that is inserted into the vagina to provide support to the pelvic organs.

Pessaries come in a range of:

  • Shapes

  • Sizes

  • Designs

This allows them to be tailored to different anatomies, symptoms, and activity levels.

They are made from medical-grade silicone and are designed to be safe, comfortable, and reusable.

What are pessaries used for?

Pessaries are most commonly used to help manage:

Pelvic organ prolapse

In pelvic organ prolapse, one or more of the pelvic organs (such as the bladder, uterus, or bowel) move downward and create a sensation of bulging, heaviness, or pressure.

A pessary works by:

  • Supporting the vaginal walls

  • Reducing downward movement of the pelvic organs

  • Improving symptoms such as heaviness, dragging, or bulging

Read more about physiotherapy for prolapse

Stress urinary incontinence

Pessaries can also be helpful for some people with stress urinary incontinence, where leakage occurs with activities such as coughing, sneezing, running, or jumping.

In these cases, a pessary may help by:

  • Providing support to the bladder neck

  • Offering gentle compression to the urethra

  • Improving continence during higher-load activities

Are pessaries the right option for everyone?

Pessaries can be an excellent option for many people, but they are not the right choice for everyone, and they are never the only option discussed.

We will always talk through all appropriate management options first, including:

  • Pelvic floor physiotherapy

  • Exercise-based management

  • Lifestyle strategies

  • Pessaries

  • Referral to medical or surgical specialists if indicated

The decision to use a pessary is always based on your preferences, your symptoms, and your goals.

When are pessaries fitted?

Pessaries are never fitted at an initial appointment (read more about what to expect at an initial appointment)

This is deliberate and important.

Before considering a pessary fitting, we will:

  • Thoroughly assess your symptoms

  • Discuss your diagnosis

  • Explore conservative management options

  • Talk through the pros and cons of pessary use

  • Ensure you feel informed and comfortable with the decision

Only if a pessary feels like a good option for you will we proceed to a fitting appointment.

Factors that can affect pessary fitting

Some factors can make pessary fitting more challenging — though not necessarily impossible — including:

  • Previous hysterectomy

  • Individual anatomical differences

  • Degree of pelvic floor support

These factors may influence:

  • Which pessary shapes are suitable

  • How easily a pessary stays in place

  • How many options need to be trialled

This is why adequate time and a careful fitting process are so important.

Important note about previous mesh surgery

If you have previously had pelvic mesh surgery, including mesh procedures for:

  • Pelvic organ prolapse, or

  • Urinary incontinence

We are unable to fit you with a pessary due to the increased risk of complications.

In these situations:

  • A urogynaecologist or gynaecologist may still be able to assist with pessary management

  • We can help guide you as to whether a pessary may still be appropriate under specialist care

  • We can support you with conservative pelvic health physiotherapy alongside specialist input

What happens at a pessary fitting appointment?

A pessary fitting appointment is one hour long.

This allows enough time to:

  • Assess vaginal tissues

  • Trial different pessaries if required

  • Ensure comfort and symptom reduction

  • Teach you how to manage the pessary safely

Sometimes the correct pessary is found quickly.
Other times, several options need to be trialled. Both are completely normal.

Step 1: Vaginal examination

We begin with a vaginal examination to:

  • Assess tissue health

  • Understand pelvic floor muscle function

  • Help guide which pessary size and shape is most likely to be appropriate

This examination is discussed in detail beforehand and only performed with your consent.

Step 2: Inserting the pessary

The pessary is inserted using lubricant.
Insertion should not be painful.

Once in place, we assess:

  • Comfort

  • Positioning

  • Whether it provides adequate support

You may be asked to:

  • Cough

  • Bear down

This helps check that the pessary stays in place and is doing its job while lying down.

Step 3: Functional testing

If the pessary feels comfortable and supportive while lying down, we then assess it during everyday activities.

This may include:

  • Walking

  • Squatting

  • Coughing

  • Running (if this is something you do regularly)

  • Emptying your bladder

The goal is to ensure that the pessary:

  • Remains comfortable

  • Reduces your symptoms

  • Does not interfere with bladder or bowel emptying

If symptoms persist or discomfort occurs, we may trial a different size or style.

Step 4: Learning to insert and remove the pessary

If the pessary is working well, we will then teach you how to:

  • Insert it yourself

  • Remove it yourself

We will never send you home with a pessary unless you feel:

  • Completely confident

  • Comfortable managing it independently

You’ll have plenty of opportunity to practise and ask questions.

Managing your pessary at home

You will be given clear, written instructions covering:

  • How often to remove your pessary

  • How and when to clean it

  • How long to leave it out

  • What symptoms or changes would be a concern

Depending on the pessary type, it is usually recommended to leave it out overnight every 1–3 weeks.

We will tailor this advice to your specific pessary and circumstances.

Vaginal oestrogen (post-menopause)

If you are post-menopausal, we may discuss (in conjunction with your GP) whether vaginal oestrogen could be beneficial.

Vaginal oestrogen can:

  • Improve tissue quality and elasticity

  • Reduce dryness or irritation

  • Improve comfort with pessary use

This is a local treatment and is different from systemic hormone therapy.

Follow-up and ongoing care

After your initial pessary fitting, we will:
- Review you after 2–3 weeks to ensure everything is going well
- Review again around 12 weeks after the initial fitting

Pessaries need to be replaced annually, as per manufacturer guidelines, so we will see you yearly for this.

In addition, you will need to see your GP annually for a speculum examination to check the health of your vaginal tissues

This combination ensures pessary use remains safe and effective long term.

How pessaries can change things over time

Interestingly, some people notice that after using a pessary for around six months, their symptoms may improve even when they are not wearing it.

This can happen because:

  • The pessary may lead to some shortening and improved support of connective tissues

  • Pelvic organ support improves over time

This doesn’t happen for everyone, but it does occur in a meaningful proportion of people.

For this reason:

  • We may be able to downsize your pessary after 3–6 months

  • Your pessary needs may change over time

  • How people use their pessaries day to day

There is no single “right” way to use a pessary.

Common approaches include:

  • Wearing it all day, every day, and removing it as instructed

  • Wearing it only during work or exercise

  • Starting with daily use and gradually reducing to use only for higher-load activities

  • Your use may change over time as symptoms improve.

Pessary fitting is a specialised skill.

Pessary fitting requires advanced training beyond standard physiotherapy qualifications, as well as experience with a wide range of pessary types and presentations. Our physiotherapist Melissa has completed advanced training in pessary fitting and has been fitting pessaries for over five years, allowing for careful assessment, appropriate selection, and safe ongoing management.

A final word

A pessary is a tool, not a commitment to one path of care.

When it’s the right option and fitted correctly, a pessary should:
- Reduce your symptoms
- Be comfortable
- Not interfere with bladder or bowel emptying
- Fit into your lifestyle

The decision to use one is always yours, and we’re here to guide and support you every step of the way.

If you’re unsure whether a pessary is right for you, that conversation can happen at your pace with no pressure and no expectation.

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