Pessaries are medical-grade silicone devices that help to support the pelvic organs. They can be used to relieve symptoms of pelvic organ prolapse or stress urinary incontinence.  Here are the most common types of pessaries:

Ring with Support Pessaries:

These pessaries are used for pelvic organ prolapse and/or stress urinary incontinence. These are support style pessaries, which mean they act as a hammock or sports bra in order to hold the organs up inside the vagina. They are easy for clients to remove and clean at home, which is convenient for menstruation, sexual activity and maintaining vaginal tissue health. If clients are unable to or do not wish to remove their pessary on their own, then the ring pessaries can also be left in for 3-6months at a time with medical check ins! The ring with support and knob may be suggested especially for stress urinary incontinence as it may give additional bladder neck support.

Dish with Knob Pessaries:

Just like the ring pessaries, this style is similar to the ring with support in that it creates a hammock for the tissues, however it takes up a little bit more space and also has the knob to help with bladder leaking.

Gellhorn Pessaries:

These pessaries are space-occupying pessaries. This means that they give support by taking up more space in the vagina. Gellhorn pessaries are typically used to support moderate to significant pelvic organ prolapse. These pessaries are often left in 3 months at a time, giving continual support and relieving significant prolapse symptoms, however some clients do manage gellhorn pessaries on their own. Because they can be more difficult to maneuver at home, these pessaries are typically not used by women who are sexually active via vaginal penetrative acts as they block anything else from entering the vagina.

​Cube Pessaries:

Cube pessaries are also space-occupying pessaries, acting kind of like a cork for the vagina. Cube pessaries are inserted and removed every day by the client. They are space-occupying pessaries so they have to be removed for penetrative sexual acts and menstruation. Clients need to very comfortable with maneuvering this pessary in and out of the vagina themselves for it to be a good fit for them to take home.

​Concurrent treatment:

It is often advised to use a vaginal moisturizer (such as Gynatrof) and perhaps a vaginal estrogen cream (such as Premarin) when clients use a pessary in to help optimize vaginal health and comfort. Their Family Doctor, Gynecologist, Nurse Practitioner or Physician’s Assistant can prescribe this to them if they feel it is suitable and the client is interested. Clients can also do pelvic floor muscle exercises as outlined by a Pelvic Health Physiotherapist, Occupational Therapist or other internal practitioner who assesses pelvic floor muscle function while using a pessary.

Potential side effects:

The most common side effects are usually minor and easy to treat and rectify. They include: expulsion/falling out (33%), bacterial vaginosis (32%), increased vaginal discharge (30%), vaginal bleeding or irritative symptoms (3-24%), UTI (13%), new stress urinary incontinence and difficulty with bowel movements. These are all reasons to remove your pessary and chat with me about your concerns.

Uncommon side effects include bleeding, incarceration or migration of the pessary (pessary moving into vaginal wall or other neighbouring tissues). One small study showed increased risk of squamous cell vaginal cancer. These events are typically associated with improper care and infrequent removal of the pessary. As a preventative measure, it is suggested you inform your loved ones that you may be wearing a pessary to allow adequate medical management if you are unable to share that information with your healthcare team due to injury or illness.

Common Questions from Practitioners:

Can I still do internal exams/pelvic floor muscle training if a client is using a pessary?

Yes, you can. The easiest bet is to have the client remove their pessary if they are able for your appointment then they can put it back in afterwards, but you can still assess levator ani function with pessaries in place. Pessaries in place may limit the ability to palpate deeper pelvic floor muscles/structures (ie douglas pouch, OI), and will limit the ability to do a medical evaluation of the tissues (ie PAP smear).

How long are pessary fitting appointments?

I schedule 1.5 hours total with clients – 30minute subjective/education around pessaries, than 60minutes for the fitting process (trial and error, movement tests etc).

Do I need an autoclave to fit pessaries?

You can use one of three models for fitting pessaries: single-patient (disposible, throw out ones that don’t work), high-level disinfectant soak for multipatient fitting kit pessaries, or autoclaving to sterilize fitting kit pessaries. This depends on how much you want to invest up-front in your pessary services, as well as if high level disinfecting is allowed by your local Public Health Unit or if sterilization via autoclave is required.

For more information about pessary use and implementation in clinic, please see our pessary course page. You can also check out this 30minute webinar I did for the Birth Healing Summit 2023.

For information to share with your clients, please see my patient resources page.