Self management of vaginal ring pessary for pelvic organ prolapse

Self management of vaginal ring pessary allows you to remove and replace your ring pessary as and when it suits you. It will reduce the need for you to attend for pessary change at your doctor’s surgery or the hospital from twice a year to once every two years.

Self managing the pessary will give you the freedom to remove and replace the pessary when it suits you. You can then keep it in when you like and keep it out when you like. You may wish to do this for a number of reasons. You might like to have it out during the night or before sexual activity. This gives you more choice and many women find this empowering. They might feel more comfortable sleeping or more relaxed about sexual activity without the pessary in place.

No. You have the choice to remove and replace the pessary yourself and visit your doctor’s surgery or the hospital every two years: or have this done at your doctor’s surgery or the hospital every six months. For some women, this may not be convenient. If you find it difficult or fear that you may not remember to remove and replace the pessary every six months, feel free to ask for six monthly appointments for the pessary to be replaced at your doctor’s surgery or the hospital.

You need to wash your hands and find a comfortable position. You may prefer to lie down on bed, sit down or stand with one foot placed on a stool / chair or bed.

You need to relax your muscles, which might be easier lying down on your back in bed.

With one hand, you separate the labia, using the index and thumb. Introduce one finger of the other hand into the vagina.

Usually, it is easy to hook one finger in hole in the middle of the ring pessary. You may need to cough or push down.

Once you hook one finger in the ring pessary, you can pull it out. After the ring is removed, it should be washed in warm water and soap. It is then left to dry in room temperature.

Check that the pessary is clean and not damaged. Get lubrication, like K Y jelly or oestrogen cream, ready.

You need to wash your hands and find a comfortable position. You may prefer to lie down on bed, sit down or stand with one foot placed on a stool / chair or bed.

You will need to squeeze the pessary or twist into a figure of 8 in one hand.

Smaller size pessaries are harder to squeeze and may not be possible to twist into a figure of 8. Placing them in warm water for a while may make them softer. You can then cool them down into your hand before insertion.

Place lubrication on the side to be introduced first into the vagina.

Hold the squeezed / twisted pessary against the vagina and separate the labia with the thumb and index of the other hand.

Push the pessary into the vagina, using the hand that was holding the labia to advance it further.

Once the pessary is in the vagina, it tends to find its proper position, with one side behind the bone in the lower tummy.

You might be able to feel the lower end (bow). This is not unexpected. You then wipe any jelly or cream and wash your hands.

You need to do this at least every six months. However, most women do it more often, every weekend.

If you are using local oestrogen cream, you can use it to lubricate the pessary before insertion. If you are using non hormone cream, like Replens, you can use it as well. Alternatively, a water based lubricant, like K Y jelly.

Your doctor can prescribe the local oestrogen or non hormone cream. You can obtain water based lubricant, like K Y jelly, over the counter or ask your doctor for a prescription.