How Vaginal Pessaries Can Help Women Who Suffer from Incontinence and Prolapse

By: Shannon Wallace, MD • Posted on June 15, 2021

What is a Vaginal Pessary?

Urinary leakage and discomfort from vaginal prolapse are common problems among women. You may have heard that surgery is the only option for treatment. But this is not true!

Pessaries are an excellent, low-risk treatment strategy for pelvic organ prolapse or urinary incontinence.

A vaginal pessary is a soft, removable device, similar to a vaginal contraceptive diaphragm, that sits in the vagina.

A vaginal pessary works by supporting the areas that are affected by pelvic organ prolapse which happens when the bladder, rectum and uterus drops in the vagina.

A vaginal pessary can also help if you have urinary incontinence when laughing, coughing, straining or exercising. The pessary applies compression to the urethra during activities that can cause urinary leakage.

About 85 percent of women can be successfully fitted with a pessary. Using a pessary can allow you to be comfortable and active without surgery.

Types of Pessaries

There are many shapes and sizes of pessaries. Most pessaries are made out of silicone – a harmless, soft and nonabsorbent material. Common types of pessaries include:

Ring
Donut
Gellhorn
Cube Pessary

Your doctor will choose the right one for you during a pessary fitting.

Ring Pessary

A ring pessary is a circle-shaped device and is often the first one that doctors recommend. Many women are able to insert and remove a ring pessary without a doctor’s help.

Donut Pessary

Donut pessaries are larger than ring pessaries and can be used for large prolapse. Donut pessaries can be challenging to insert and remove.

Gellhorn Pessary

A Gellhorn pessary is a disk-shaped device with a small knob and is used for advanced-stage prolapse in women who are not sexually active. It is difficult to remove and you will need to return to the office for cleaning.

Cube Pessary

A cube pessary may also be recommended for advanced-stage prolapse. A cube pessary forms suction inside the vagina to support the areas affected by prolapse. You will need to come to the office for cleaning because cube pessaries are very hard to remove on their own.

Wearing a Pessary

Your doctor will perform a vaginal examination and take measurements of your vagina to fit you properly for a pessary.
The fitting is done during an office visit, allowing you to leave that same day with improved symptoms.
Sometimes it can take a few tries to find the right fit. If a pessary is too small, it can fall out. If it is too big, you might feel too much pressure or discomfort.

Caring for Your Pessary

Your pessary should be comfortable and you should not feel it when it is in place. Sometimes the pessary will shift near the opening of the vagina and you can use your fingers to push it back inside.
If you have a pessary that you can remove on your own, you should remove it and clean it at least once per week.
If you have a pessary that you need your doctor to remove, you will visit your doctor every 1 to 3 months to have it removed, cleaned and reinserted.
Most patients with pessaries will see their doctors every 3 to 12 months.

What Else Should I know About My Pessary?

Pessaries may cause increased white or yellow discharge from the vagina which is normal. However, you should call your doctor if you develop discharge with an odor or if you have any pain, discomfort or pink or bloody discharge.
Your doctor may prescribe a vaginal moisturizer or vaginal estrogen in a cream, tablet or ring form. This will help to protect and to strengthen the vaginal skin which can reduce the risk of ulcerations or sores that may be caused by rubbing of the pessary on the vaginal wall.
You should let your doctor know if you are sexually active so they can find the pessary that works best for you. You can have sex while wearing certain types of pessaries or you can be fitted with a pessary that is easy to remove and reinsert after sex.

Be Strong, Be Healthy, Be in Charge!
-Shannon Wallace, MD

Dr. Shannon Wallace is an Associate Staff Physician at the Cleveland Clinic Women’s Institute in the Division of Urogynecology and Pelvic Floor Disorders. She specializes in the minimally-invasive treatment of stress urinary incontinence, overactive bladder and pelvic organ prolapse, as well as complex pelvic health disorders like recurrent urinary tract infections, interstitial cystitis/painful bladder syndrome, genitourinary syndrome of menopause and rectovaginal and vesicovaginal fistulas.

Dr. Wallace obtained a Bachelor of Science degree in Chemistry and Neuroscience at Princeton University. She then returned to her hometown of Denver, Colorado where she earned her medical degree at the University of Colorado School of Medicine. She completed her residency training in Obstetrics and Gynecology at the Icahn School of Medicine at Mount Sinai in New York City, New York followed by her fellowship in Female Pelvic Medicine and Reconstructive Surgery at Stanford University Hospital in Palo Alto, California in the Department of Urology.

Dr. Wallace sees patients and operates at Cleveland Clinic Main Campus as well as the Medina Campus. She has special skills in vaginal surgery, laparoscopic surgery and robotic-assisted laparoscopic surgery. She is passionate about improving the quality of life of her patients as well as providing compassionate and evidence-based medical and surgical care.

women's health, incontinence, urinary incontinence, bladder leakage, organ prolapse, prolapse, Dr. Shannon Wallace, Dr. Wallace, urology, urogynecology, stress urinary incontinence, overactive bladder, pelvic organ prolapse, Vaginal Pessaries

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