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. I have taken extra training to be able to fit pessaries, and even teach one of the few pessary fitting courses available so that other healthcare providers can fit pessaries across North America! 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 you to remove and clean at home, which is convenient for menstruation, sexual activity and maintaining vaginal tissue health. If you are unable to or do not wish to remove your pessary on your 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. You need to very comfortable with maneuvering this pessary in and out of the vagina yourself for it to be a good fit for you 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 you use a pessary in to help optimize your vaginal health and comfort. Your Family Doctor, Gynecologist, Nurse Practitioner or Physician’s Assistant can prescribe this to you if they feel it is suitable and you are interested when they give the prescription for the pessary. You can also do pelvic floor muscle exercises as outlined by a Pelvic Health Physiotherapist while using a pessary.

Pelvic Health Physiotherapy Pessary Fittings:

I want to ensure that we have ample time to get your full history and to try as many pessary sizes and types as we need to in order to find a good fit for you (typically 1-3 trials per appointment).

Because of this, we book a 30minute virtual appointment to chat about your health history, what symptoms are bothering you and to answer your pessary questions before we have you in clinic for a 1 hour pelvic floor assessment and pessary fitting appointment. We take the time together to ensure your pessary resolves your symptoms and feels comfortable in lying, sitting, with walking, lifting and using the bathroom.

We’ll also go through how to insert and remove your pessary together (if this is something you are interested in) so you know what to do yourself at home.

In order to purchase a pessary from a Pelvic Health Physiotherapist for ongoing use you have to get a prescription from your Family Doctor, Gynecologist, Nurse Practitioner or Physician’s Assistant. This is because these professionals have the training to assess your vaginal tissue health and they will be responsible for your ongoing pessary care (yearly check ins or dealing with any side effects). When you call to make a pessary appointment we get your healthcare provider’s information so we can fax them a form to complete.

We’ll follow up 1-2 weeks and 1 month after you have purchased and are wearing your pessary to make sure you are comfortable when wearing it and to ensure the vaginal tissues are staying healthy. After that, we follow up every 3-12 months, depending on the type of pessary you have, your vaginal health, and if you are managing the pessary yourself or not. Ultimately you are responsible for the maintenance of your pessary and following recommended appointments to promote vaginal tissue health.

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.

Pessaries are a conservative, often very effective and well tolerated option for management of pelvic organ prolapse and/or stress urinary incontinence. You can use a pessary in conjunction with Pelvic Physiotherapy exercises and treatment. If you have any questions about pessaries, feel free to contact me!