Vaginal pessaries for pelvic organ prolapse

A vaginal pessary is a device which can be inserted in the vagina to control prolapse. It is made of latex, silicone or vinyl.

Vaginal pessaries usually control the problems associated with prolapse of the vagina and / or uterus. This option avoids surgery and is especially suitable for patients who wish to have more children, or those who have social circumstances or medical conditions that prevent them from having surgery.

Pelvic organ prolapse can cause sense of bulge, discomfort, urinary and bowel problems as well as sexual difficulties. The device is used as a temporary measure before surgery or as an alternative to surgery.

A vaginal pessary is placed inside the vagina. It will stretch its walls and hold the soft tissues up, so as to prevent the uterus or the vaginal walls from bulging out of the vagina. Occasionally for patients with very weak pelvic floor muscles, the pessaries may not stay in place. Your doctor will discuss this with you.

Several types of vaginal pessaries are available, but the commonly used ones are ring, shelf and Gellhorn pessaries.

Ring pessaries are rounded and soft. They do not prevent you from having sexual intercourse.

Ring vaginal pessaries

Ring pessary in position

Shelf pessaries are like a saucer with a knob underneath. They are hard and do stop you from having sexual intercourse.

Shelf pessary

Shelf pessary in position

Gellhorn pessaries are similar to the shelf style but are soft. They prevent you from having sexual intercourse.

Gellhorn pessary

Gellhorn pessary in position

All come in different sizes and the right size is judged on examination. This is like trying a pair of shoes and a number might be tried before the right size is identified.

Usually, ring pessaries are tried first. If your pelvic floor muscles are not strong enough to hold the ring in place, you will be able to try other styles. You can discuss the best option for you with your doctor.

You will be asked to test the pessary by taking a short walk to make sure that the pessary does not cause you any discomfort or slip.

You will be advised to go to the toilet, to make sure it doesn’t prevent you from passing urine. If the pessary falls out or feels tight or uncomfortable, it will be replaced with a larger or smaller one accordingly.

The pessary needs to be replaced and the doctor will check it is working properly for you no later than every six months. You will have the opportunity to discuss any concerns you may have.

You can change the vaginal ring pessary yourself. This option gives you the freedom to change vaginal ring pessaries when you like, for example by night or before sex. As long as you change the vaginal ring pessary at least once every six months, then you only need to see a nurse or a doctor every two years. This will reduce the need to attend in General Practice or at the Hospital. There is a special information leaflet on self management of vaginal ring pessaries.